Orchiopexy Procedures: What to Expect

Everything You Need to Know

An orchiopexy is a surgical procedure that repairs an undescended testicle, or that prevents a testicle from retracting. The procedure involves moving the testicle from either the abdomen or groin area —depending on where it is currently located—and into the scrotum (skin sac below the penis). Then, the doctor will surgically attach the testicle into the scrotum with a "tacking stitch."

Learn more about the procedure, why someone would need it performed, as well as the potential risks involved.

Care instructions after orchiopexy
Illustration by Brianna Gilmartin, Verywell.

What Is Cryptorchidism?

Cryptorchidism is a term that describes one hidden testis (or both testes) that did not descend or is absent altogether by the age of four months. In premature infants, cryptorchidism describes one or both testicles that do not descend at the appropriate age. When both testicles are affected, it’s called bilateral cryptorchidism, and the procedure to repair the condition is called a bilateral orchiopexy. 

Incidence of Cryptorchidism

The absence of one or both testicles in the scrotum occurs at birth in approximately 1.8 percent to 8.4 percent of full-term infants. In premature newborns, that number can be as high as 30 percent according to a study published in the German Medical Journal.

By the time infants reach one year of age, the incidence of cryptorchidism decreases to around 1 percent to 2 percent. It stands to reason that health care providers do not immediately opt for performing an orchiopexy, but rather, wait for a period of time to observe the condition and find out if it spontaneously corrects itself without surgery.

Diagnosis

The diagnosis of cryptorchidism is evident by a missing testicle in the scrotum. 

The question is whether the testicle remains in the abdomen, is in the groin, or is absent altogether. 

According to one urological study, imaging (such as X-rays or CT scans) is not a useful diagnostic tool for diagnosing cryptorchidism. 

The study author explains that if the undescended testicle cannot be palpated (felt), the next course of action for diagnosing the condition is an evaluation by a specialist, usually a urologist, and then possibly an orchiopexy surgery. This is if the testicle has not descended after the infant is six months of age.

Timing

Many experts say that an orchiopexy should be performed between six and 12 months of age. What does the research say?

In one study, urologist Dr. David Kurtz suggests that “Patients with UDTs [undescended testicles] diagnosed after six months of age, should be referred to a specialist for correction, so that surgery may be performed within one year thereafter. This allows the testes to descend spontaneously if they are to do so, while facilitating early intervention.”

Kurtz goes on to explain that early intervention is aimed at decreasing the risks involved in untreated undescended testicles.

The risks of untreated undescended testicles could potentially include testicular cancer and infertility.

Other research studies discovered that early surgery resulted in positive effects. However, one evaluation found that people had a significantly lower probability of fathering a child in those who were treated for bilateral (both sides) undescended testicles.

This was not the case in people in the study who had a single undescended testicle.

Orchiopexy was deemed beneficial for fertility in the long-term for those who had a unilateral undescended testicle and received the procedure before their second birthday.

Risks

The incidence of having an undescended testicle increases for infants with certain conditions.

High-Risk Conditions for Cryptorchidism

  • Low birth weight
  • Certain genetic disorders

An example of one such genetic disorder that puts a person at high risk is Prader-Willis (a syndrome that causes obesity, intellectual disability, and shortness in height).

Although the incidence of cryptorchidism increases with certain syndromes, it is typically a condition that appears without other genetic disorders.

Delaying Treatment

Orchiopexy is considered a voluntary procedure, but there is a risk of serious consequences when leaving cryptorchidism untreated too long. These include:

  • Decreased fertility (particularly if both testicles are affected)
  • Testicular atrophy (shrinkage)
  • Testicular torsion
  • An inguinal hernia
  • Injury to the area where the undescended testicle is located
  • Testicular cancer

Research has found that boys who had the procedure done by age 10 decreased their risk of testicular cancer to that of the general population. 

Older Boys and Adults

Although an orchiopexy is most commonly performed on young children, the procedure is also needed sometimes in older boys and men. In these instances, the testicle descends as normal but intermittently retracts back up into the groin area.

The retraction of the testicle may result in pain and discomfort—in some cases when this occurs, the testicle can get twisted, blocking off the blood supply from the spermatic cord. This is an emergency scenario called testicular torsion. An orchiopexy would then be performed to prevent testicular torsion from recurring, or from occurring in the first place.

In many instances the unaffected testicle may also be fixed with an orchiopexy procedure, to ensure the prevention of testicular torsion in both testicles.

During Surgery

Duration

The procedure takes approximately 45 minutes for most patients. It normally involves outpatient surgery, which means that most patients go home the same day. Adults who have received general anesthesia will need to ensure that they have arranged for a ride home since they will not be able to drive for at least 24 hours after the surgery.

Anesthesia

The surgical procedure is done using general anesthesia, which causes the entire body to go to sleep and helps to relax the muscles and reflexes completely. In addition to general anesthesia, caudal anesthesia may be given to block the pain in the abdomen, low back, and lower trunk area after surgery. A local anesthetic shot may be given in place of caudal anesthesia if the surgeon deems it preferable. 

Incision

A very small cut is made in the groin area to find the testicle. The testicle is examined to ensure it is healthy. Many times, there is an accompanying hernia sac (a pouch that is pushed out from the abdomen) that the doctor must address before the orchiopexy is finished. 

Next, a pocket is created under the scrotal skin and the testicle is placed into the scrotum. Finally, the surgeon will close the incisions with stitches that naturally dissolve and do not need to be removed.

Before Surgery

Pre-operation instructions must be followed before the surgery. These often include no eating or drinking for a time span before surgery (the surgeon will give written, specific instructions).

In addition, food and water instructions will differ depending on the age of the child or adult receiving the surgery.

After Surgery

It is normal for the patient to be confused, fussy, or nauseated after surgery. The patient may wake up crying. These effects, however, will wear off once the anesthesia is out of the child’s system.

For parents whose child has had the procedure, the most important job is to stay calm and keep the baby or child calm and relaxed, both before and after the surgery.

Postoperative instructions usually include no heavy lifting and no straining or strenuous workouts for approximately two weeks after surgery.

Discharge (At-Home Instructions)

The feeling of grogginess may still be there once the patient arrives home as well. This is normal and should eventually go away.

Diet

Only clear liquids should be given for a couple of hours after the surgery (these include water or Popsicles, Kool-Aid, and Gatorade without dyes). If clear liquids are tolerated well, in two hours or more a soft diet of foods such as bananas, rice, toast, soup, or applesauce can be given. Greasy foods should be avoided.

A normal diet can be started the second day after discharge.

Pain Management

Pain medication will be prescribed by the health care provider for the first two days after surgery (usually Tylenol or Motrin for kids under five). Children over the age of five may be given a prescription for Tylenol with codeine for pain.

Follow-Up Visit

A follow-up visit with the surgeon or the primary health care provider will be scheduled for around four to six weeks after the procedure.

Incision Care

Discharge instructions will include how to change the sterile dressing around the site. An antibiotic ointment is usually applied several times per day to the incision area. Sponge baths (with a washcloth) should be done for four to five days after surgery. There should be no complete submersion in water at all.

Activity After Surgery

The health care provider will advise on activity level, but there will be limitations. Bike riding and swimming are usually prohibited for one week. Children are usually allowed to return to school within two to three days after surgery. Participation in contact sports and gym class, however, is not permitted until the follow-up appointment with the surgeon (usually in four to six weeks).

When to Call the Doctor

Contact the physician immediately if symptoms occur, including:

  • fever over 101 degrees
  • foul-smelling draining from the incision area
  • tenderness or pain near the incision that worsens in severity
  • increased swelling or redness near the incision
  • nausea, vomiting, diarrhea or constipation that doesn’t improve

A Word From Verywell

It’s important to note that these guidelines on what an orchiopexy involves are general. The surgeon will discuss the specific directions and a written list of discharge instructions will usually be reviewed during an office visit before the surgery date. They should be given to the parents whose child is having the procedure or the adult who is having the procedure done. It’s vital that the instructions by the health care professional are followed, even when they differ from information from other sources.

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