Orchidopexy for Undescended Testis
There are two types of orchidopexy or orchiopexy, or fixing of a testis in place: one that is done for boys with undescended testis, and one that is done for testicular torsion. If you are interested in reading about surgery for testicular torsion, please visit this page.
Before you go on, you may want to visit our educational resource page about undescended testis.
What is orchidopexy for?
In simple terms, orchidopexy is a surgery to fix the testis in a permanent location in the scrotum.
Boys usually have two testes. One or both of them may be “undescended”, which means that the testis may not have made it all the way down to the scrotum during development.
Some testes stay inside the abdomen. Some are in the groin, and some are just above the scrotum.
To bring the testis to the best location for growth and for future monitoring, pediatric urologists or pediatric surgeons “fix” or “pexy” the testis in the scrotum.
What’s the difference between a single-stage or two-stage orchidopexy?
In some boys, the testis is easily felt on the groin or above the scrotum. The distance that the testis has to “travel” is shorter. This makes it easier to do a “single stage orchidopexy”. At the end of the surgery, the testis is felt in the scrotum.
In other boys, the testis stays within the abdomen or can’t be felt outside the body. In that case, the surgeon may need to do an examination under anesthesia, and a “diagnostic laparoscopy.”
The examination under anesthesia makes sure a physical examination is repeated while the child’s muscles are all relaxed, making it easier to feel the real location of the testis.
If the testis still can’t be felt outside the body, a “diagnostic laparoscopy” is done, where a small telescope is inserted into the abdomen to look for the testis inside. This is often the first part of a two-stage surgery, where the testis is gradually brought down to the scrotum in two stages.
There can be as many as six to twelve months between the first and second stages of surgery. It’s only after the second stage that the testis is in the scrotum.
Does the child need to be admitted? What type of anesthetic is needed?
In many parts of the world, an orchidopexy is either done as a “day procedure” or an “overnight” procedure.
A day procedure means that the child, who is usually very healthy, goes home on the same day. An overnight procedure means the child is admitted overnight and goes home the next day, usually because they need some observation for different reasons.
Your anesthesiologist will talk to you and your child about the best options for anesthetic. This depends on their age, their overall health, and what the surgeon needs to do.
Most children need sedation so they can be asleep and immobile during the surgery.
If your surgeon and anesthesiologist feel like a “diagnostic laparoscopy” should be done, your child will have a temporary breathing tube in their airway for the procedure.
In general, this anesthetic is very safe. Please don’t be afraid to ask your anesthesiologist about specific concerns you may have for your child.
What if we don’t do the surgery?
Orchidopexy is advised for boys with undescended testis because of the following benefits:
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In some studies, has been shown to decrease the risk of cancer of the testis
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Allows the testis to be in the “best environment” for growth and function
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Allows the testis to be in a location where it can be easily “palpated” or felt for monitoring for abnormalities
Not performing an orchidopexy may increases the chances of “Atrophy” or the testis losing function or growth. For boys with the testis in the abdomen, this also means that the patient and his parents will have no way of learning if the testis has become cancerous since they can’t feel it regularly.
What are the risks?
Orchidopexy is a safe procedure—that is to say, the rate of complications is low, but not zero.
Complications include:
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Bleeding
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Pain, specially for the first two days
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Swelling, which can happen for up to several weeks after the surgery
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Recurrence, or the testis going back to its old location
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Atrophy, or the testis becoming smaller. We like to remind parents that a boy with undescended testis often has the testis smaller to begin with.
How do I take care of my child after an orchidopexy?
Every surgeon chooses a different dressing and different types of aftercare after orchidopexy. The dressing can range from waterproof dressings, surgical glue that dries down like a plastic covering, and gauze with medical tape. What is important is that you discuss the aftercare with your surgeon.
In general, we avoid getting the wound directly wet with running water for the first week of surgery, and it helps to have some covering on the wound.
Make sure to check the wound daily for discharge or signs of infection.
Swelling is normal. In the first two days, a cold compress to the scrotum may help reduce the swelling.
In general, there is no restriction on what to eat.
If a child is able to avoid heavy exercise, or activities that put pressure on the groin, then all the better. This means we generally ask our patients to avoid biking, swimming, jogging, or other heavy exercise. They are allowed to go about usual activities like going to school, sitting up straight, or walking short distances.
In general, children should be allowed to shower. Cleanliness reduces the risk of infection.
The information in this infographic is for general information purposes only.
We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.
Please feel free to send us a message for questions on pediatric urologic health!
