Orchiopexy, also known as orchidopexy, is a procedure used to treat babies with undescended testicles. When testicles don’t descend naturally, surgery is required to lower and fix them in their usual position in the scrotum. Renowned consultant paediatric and neonatal surgeon Mr Munther Haddad gives expert insight in to the procedure in this informative article. He also outlines what parents can expect from the recovery process.
Is orchiopexy surgery the only solution for undescended testicles?
The answer is yes. After birth, some babies do have undescended testes but they will often descend themselves before their first birthday. If this hasn’t happened after one year, they will need surgery to bring them down.
What is the best age for a child to undergo orchiopexy?
The preferable age is just before the child’s first birthday. Some people even advise having it done around the age of six months. This is because it is important to avoid any damage to the testes which can occur when they are not found in their proper place. The temperature of the testes in the scrotum is usually about 1.5 degrees centigrade lower than in the abominable core. The increased temperature might affect the cells which will produce semen or seminal fluid in the future.
Some boys are not examined and remain undiagnosed until around school age. In these cases, it’s better for the procedure to be carried out as soon as the diagnosis is made to limit any potential damage to the testes.
Is anaesthetic used during orchiopexy?
Yes, general anaesthesia is used. This is because there is some dissection involved in the procedure and so the baby needs to be still.
What happens during the orchiopexy?
Orchiopexy is a day-case surgery, meaning the child can return home on the same day. The child comes in the morning and is seen by the medical team. This typically includes the surgeon, a scrub nurse, an anaesthetist and their assistant as well as another nurse who acts as a runner. After consent is given for the procedure, the site is marked and the surgery can begin.
As part of the procedure, we carry out an examination, also done under anaesthesia, to determine the exact location of the testes. Some cases of cryptorchidism, also known as undescended testes, are impalpable, meaning that they cannot be felt by physical examination. When this is the case, we need to locate the position of the testes and so a key-hole procedure (laparoscopy) is carried out to locate exactly where the testes are in the abdomen. Once their location is known, we proceed accordingly.
If the testes are found near the exit of the opening in the abdomen, this means the testes can be moved down to the scrotum relatively easily. However, if they are found further away, a two-step technique may be required to ensure that blood supply can effectively reach the testes in their new location. In this method, some dissections are made to lengthen the arterial supply to the testes. After six months, another procedure to finally move the testes to the scrotum will be required.
In other cases, the testes are palpable, meaning they are found along the pathway of the usual descent. For these patients, an open technique is used where a small incision is made in the groin. The testes are dissected and checked to ensure that blood supply can reach as far as the scrotum. Additionally, a small incision is made in the scrotum itself to fix the testes down in a small pouch underneath the scrotal skin.
We also check the size of the testes and their viability during the procedure. Usually, the scrotal and groin wounds are closed by absorbable material so there’s no need to remove stitches afterwards. The surgery itself usually takes between forty five and sixty minutes and once the procedure is complete, we monitor the child for three to four hours before discharge. In this time, the baby can eat and drink.
What is recovery like after an orchiopexy?
The family is provided with some medication to take home to control the pain. Usually, we ask parents to give the pain killers regularly in the first two days to abolish the feedback of pain and then afterwards as necessary, whenever they are in pain or discomfort.
Some cling-film like dressing may also be applied which should be kept on for around five days, when it can be removed and the baby can have a full bath. Meanwhile, they can have a sponge bath or a shower, as long as the area is thoroughly dried afterwards.
Children recover very well from surgeries, in fact much better than adults so the recovery process after an orchiopexy is usually smooth. The child can play as normal but they shouldn’t ride any kind of small bike because it may cause some pressure or pain. They should also wait to go swimming until at least two weeks after surgery. A follow up appointment between four and six weeks later allows us to check on their progress.
What is the success rate of orchiopexy in children?
The success rate is very high, around ninety to ninety five per cent. In very rare cases, infections can occur or a retraction of the testes as they ascend. However, the vast majority of surgeries are successful.
If you are seeking treatment for your baby’s undescended testicles or would like more information, you can book a consultation with Mr Haddad by visiting his Top Doctors profile