Orchiopexy (also known as orchidopexy or orchidorraphy) is surgery to move an undescended testicle into the scrotum. It is usually done when babies are about 12 months old by a pediatric urologist. In some cases, the child may be older than that, but it is rarely done in teenagers or adults because the condition is often diagnosed and resolved within a few months after birth. An undescended testicle is a testicle that does not move into its proper position in the scrotum, the bag of skin hanging below the penis, before birth. The testicle may be in the abdomen, groin, or somewhere near the pubic area. An undescended testicle may occur on one or both sides, but more commonly affects the right testicle. A doctor can usually palpate to find where the testicle is, but sometimes an ultrasound, magnetic resonance imaging (MRI), or even laparoscopy may be needed to locate it.
There are two situations that require orchiopexy to correct; these incllude; an undescended testicle and testicular torsion. Typically, undescended testicles are corrected early in childhood to prevent future complications such as infertility and increased risk of testicular cancer.
Pros: To maintain the testicle’s ability to produce sperm and hormones. The temperature in the scrotum is 1.5-2.5 degrees Celsius lower than that in the abdomen. The higher temperature affects sperm production. Adults with an undescended testicle that is not treated will only have a 30% chance of conceiving. Adults with two undescended testicles are infertile. Reduce the risk of prostate cancer by 40-50 times since the inappropriate temperature can stimulate the chance of normal cells into malignant cells. Allow easier examination of the testicles. Increase confidence in masculinity. Reduce the risk of injury from sports or wearing a belt. Reduce the risk of inguinal hernia or torsion of the undescended testicle, which can be very painful.
Depending on the location of the undescended testicle, the incision may be made in the crease of the groin or in the lower abdomen to pull the testicle down into the scrotum. In some cases, the doctor may use a laparoscope. Both types of surgery require general anesthesia so you will be asleep during the procedure. One surgery is often enough to resolve the issue, but sometimes another surgery may be required after a few months if the testicle is too high or in the abdomen.
As with any procedure in which anesthesia is administered, you will be asked not to feed your child anything (including any liquids) after midnight on the evening prior to the surgery. If your child is on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if your child is on, or has recently been taking any medication that may interfere with his ability to clot his blood. The most common of these medications are aspirin-like compounds and all related pain relievers, fever reducers, or anti-inflammatory compounds(whether prescription or over-the-counter).
Since this is a simple procedure, you will likely only spend one night at the hospital. If the testicle was located higher in the abdomen, a longer hospital stay may be required. Avoid contact sports and strenuous activities for a couple of weeks after the procedure. A follow-up appointment will be made for two to three months after the surgery.
Excessive bleeding or hematoma. Injury to blood vessels or spermatic cord, leading to atrophy. Recurrence, requiring additional surgery.
What are the recommendations for travel for this procedure?
If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure. Travelers to Thailand should plan to stay in the country for at least two to five days after the procedure, depending on their condition after surgery, or for the entire duration of treatment. If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel. During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your ""Fit to Fly"" certificate (if needed).
Can orchiopexy reduce my son’s chances of being infertile or developing undiagnosed testicular cancer?
Warmer temperatures inside the body can impair the development of the testes and may affect the production of healthy sperm. Orchiopexy moves the testicles into the scrotum, where they’re about three to five degrees cooler than they would be if they remained inside the abdominal cavity. This improves the chances of fertility later in life. Orchiopexy also makes it possible for young men to easily and routinely examine their testes to detect any abnormalities such as testicular cancer.
In what situations will testicles not be found in the scrotum?
A retractile testicle is a testicle that may move back and forth between the scrotum and the groin. It is most commonly found in children between six and seven years of age and almost never once a child becomes a teenager. It often occurs to both testicles. It is common for the testicles to descend back into the scrotum when the child is asleep. Testicles are usually of normal size and can be moved into the scrotum manually. The problem only lasts a brief time and does not require treatment. An ectopic testicle is one that moved from the retroperitoneum through the external ring and away from the scrotum. In 80% of cases, only one testicle is affected, and in 75% of cases, the testicle is found in the superficial inguinal pouch. The testicle is usually of normal size and spermatogenesis and androgen function are normal. The treatment is surgery. Hormone replacement therapy is ineffective. Monorchia or anorchia (absence of testes) is rare and only found in 3.3 to 5.2% of cases of undescended testes. It usually affects one side (monorchia) and may be caused by the testicle not developing due to vas deferens hypoplasia or agenesis of the kidneys and/or ureters or due to testicular torsion, causing loss of blood flow and ultimately atrophy, leading to “vanishing testes.”
What are the chances my son may develop testicular cancer when he gets older?
Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, and at a rate of less than 1 percent. However, recent studies suggest that surgical repositioning may help in early detection of a testicular mass prior to the spread of disease, which may reduce the rate of malignancies. It is important to note that testicular cancer is most often curable, given the available treatments. At Boston Children’s, we are at the forefront of research and committed to improving the long-term outlook for boys born with undescended testicles.