What is Orchidopexy Surgery?
Orchidopexy (also known as orchiopexy) is a surgical procedure used to correct undescended testes (cryptorchidism) in children. The procedure involves repositioning one or both testicles into the scrotum.
This surgery may be recommended when a testis has not descended by 6 months of age and is usually performed between 6 months and 12-18 months of age to improve the chances of optimal testicular function and reduce the risk of complications.
Why is Orchidopexy Necessary?
The testicles need to be in the scrotum to function correctly. The main reasons for orchidopexy surgery are:
- Fertility Protection: Undescended testes are exposed to higher body temperatures, which can affect sperm production. This could lead to reduced fertility if not treated.
- Reduced Risk of Testicular Cancer: Boys with undescended testes have a slightly higher risk of developing testicular cancer later in life. Orchidopexy allows for easier monitoring of the testicles as the child grows.
- Preventing Testicular Torsion: An undescended testis is more prone to twisting (torsion), which can cut off its blood supply and cause permanent damage.
- Improved Appearance and Function: Repositioning the testis into the scrotum can prevent future psychological concerns related to appearance and function.
How is Orchidopexy Surgery Performed?
The surgery is usually performed under general anaesthetic as a day procedure. A small incision is made in the groin, and the surgeon moves the undescended testis into the scrotum, securing it in place with dissolvable sutures.
If the testis cannot be felt in the groin, laparoscopy (keyhole surgery) is performed to locate the testis within the abdomen. In cases where the testis is too high to be brought down in a single operation, then a second procedure may be required a 3-6 months later to give a better chance for a successful outcome.
How Long Does Orchidopexy Take?
The operation itself usually takes about 20 minutes.
Including the time for anaesthesia and recovery, your child will be away for about an hour.
Once your child is awake in the recovery room, you will be notified and able to join them.
When Should Orchidopexy Be Performed?
Orchidopexy is typically recommended between 6 and 18 months of age. Performing the surgery early ensures that the testicles are positioned in the scrotum while the child is still in nappies, which can improve healing and reduce discomfort.
What Are the Risks of Orchidopexy Surgery?
As with any surgical procedure, there are some risks involved in orchidopexy, including:
- Anaesthetic Risks: Complications related to general anaesthesia are rare, particularly for a short procedure like this.
- Recurrence of High Testis: In about 1% of cases, particularly in premature infants, the testicle may move back to a high position and require another operation.
- Injury to Nearby Structures: Rarely, the blood vessels, vas deferens or the testicle itself may be injured during the procedure.
- Infection: Occurs in approximately 1% of cases but is easily treated with antibiotics.
- Bleeding and Bruising: Minor bruising and swelling are common and usually resolve within a week.
- Hernia Development (from laparoscopy): In rare cases, hernias can develop at the abdominal incision site after laparoscopy.
Recovery and Aftercare After Orchidopexy
After surgery, your child will be closely monitored in the recovery room. You will be able to feed your child in the recovery room. Most children are able to go home within 1-2 hours of waking up, once the nursing team have ensured your child is safe and comfortable.
Caring for the Wound and Dressings
The surgical area will become swollen and a little firm under the wound, which is part of the normal healing process and the scar developing over time. Your child will have a waterproof dressing over the groin and scrotum, which can be removed after one week during a bath or shower. Glue is often applied on the scrotal wound during the surgery, it will help keep the area waterproof and protected inside the nappy.
The swelling and bruising are usually minor and will resolve within 1-2 weeks.
The scar will fade over time and usually becomes less noticeable as it heals.
Pain Relief After Orchidopexy
Your child will receive pain relief and local anaesthetic during the operation, which will last for several hours.
Afterward, they may need paracetamol (e.g. Panadol) or ibuprofen (e.g. Nurofen) for a few days. Please inform your surgeon and anaesthetist if your child has any allergies or intolerances to medications.
You can also help manage discomfort by distracting your child with quiet activities such as reading, drawing, playing board games or other engaging activities which can reduce the need for medications.
When Can My Child Return to Normal Activities?
Your child should avoid certain activities during the recovery period:
- Bathing/Showering: You can bathe or shower your child the day after surgery
- Swimming: Wait at least 1 week after surgery before swimming.
- Daycare/School: Your child can return to daycare or school within 5-7 days.
- Sports/Physical Activity: Avoid sports and other physical activities for 2-3 weeks to allow the wound to heal properly.
Troubleshooting and When to Seek Medical Attention
You know your child best. If you have any concerns, please see your family doctor or call your surgeon. Seek medical attention if your child experiences any of the below issues after surgery:
- Persistent or increasing pain despite pain relief.
- Fever over 38.2°C.
- Vomiting or feed intolerance.
- Discharge or bleeding from the wound.
- No bowel movements after three days.
Is There a Wound Infection?
Infections can develop 2-4 days after surgery, though they are uncommon. Signs of infection include:
- Redness or tenderness around the wound.
- Discharge from the wound site.
- Fever over 38.2°C.
If you suspect an infection, see your family doctor or contact your surgeon for advice.
The areas is very swollen
The area normally does become swollen after the operation, usually for a few days. If your child has increasing pain, tenderness and redness there may be a wound infection, or bruising.
Please see your GP and call your surgeon so your child can be assessed.
Is It Normal for the Testis to Still Feel Too High After Surgery?
It is common for the testis to feel high in the first few months after surgery due to swelling and thickening of the tissues.
In rare cases, scar tissue may hold the testis up high. This may require another operation in a few years to correct the testes position again.