Type of Surgery
Information
Last updated: 02/17/2009
Cryptorchidism
Some orchiopexies in children are relatively simple procedures; however, others are complicated by the location of the undescended testicle. In general, an orchiopexy for an undescended testicle that lies in front of the...
scrotum or just above it is a less complicated operation than one done to treat a non-palpable testicle. The procedure is usually done under general anesthesia.
If the undescended testis is in the groin area, the surgeon will make a small incision in the groin and a second small incision in the scrotum. The testis is moved downward from the groin without complete separation from the gubernaculum. It is then placed inside a small pouch created by the surgeon between the skin of the scrotum and a layer of muscle in the scrotum called the dartos muscle. The testicle is held in place with sutures that are eventually absorbed by the body.
The Fowler-Stephens technique is often used when the undescended testicle is located high above the scrotum or in the abdomen. It may be done in two stages scheduled several months apart. In the first stage, the surgeon moves the testicle downward and attaches it temporarily to the inside of the thigh. In the second stage, the testicle is transferred into the scrotum itself and sutured into place.
A third type of orchiopexy is called testicular auto-transplantation. The surgeon removes the undescended testicle completely from its present location and re-implants it in the scrotum by reattaching its surrounding tissues and blood vessels to nearby blood vessels. This technique minimizes the risk of an inadequate blood supply to the re-implanted testicle.
Testicular torsion
An orchiopexy done to treat testicular torsion is usually done under general or epidural anesthesia. The surgeon makes an incision in the patient's scrotum and untwists the spermatic cord. The affected testicle is inspected for signs of necrosis, or tissue death. If too much tissue has died due to loss of blood supply, the surgeon will remove the entire testicle. If the tissue appears to be healthy, the surgeon sutures the testicle to the wall of the scrotum and then closes the incision. In most cases, the surgeon will also attach the unaffected testicle to the scrotal wall as a preventive measure.
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Other Information
Orchiopexy (or orchidopexy) is a surgery to move an undescended testicle into the scrotum and permanently fix it there. It is performed by a pediatric urologist or surgeon on boys with cryptorchidism, typically before they reach the age of two. Some patients remain undiagnosed until their teenage years and undergo the surgery at that time.
The undescended testicle may be located within the normal line of descent (for example, in the inguinal canal) or high in the scrotum or ectopically (i.e. the abdomen). The surgeon may use an endoscope through the umbilicus to locate the testicle, and through other small opening(s) performs the procedure. The higher the testicle, the less successful the procedure. However, the procedure has a high success rate overall.
Orchiopexy can also be performed to resolve a testicular torsion. If caught early enough and the blood supply can be restored to the testicle, this operation can be performed to prevent further occurrence of torsion. If the blood supply has been interrupted for too long, then an orchiectomy must be performed.
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