Orchiopexy

What is an orchiopexy?

An orchiopexy (OR-kee-oh-peck-see) is surgery to move undescended testicles or to treat testicular torsion. To treat undescended testicles, a surgeon moves them from inside your child’s belly (abdomen) or groin area and attaches them inside the scrotum (the pouch of skin below your penis). To fix testicular torsion, your provider will untwist your testicle and secure it to the inside of your scrotum.

The surgeon may also need to repair hernias or put in an artificial testicle (testicular prosthesis) during surgery.

Other names for an orchiopexy are orchidopexy (OR-keh-doh-peck-see) and undescended testicle repair surgery.

What conditions does an orchiopexy treat?

An orchiopexy corrects two conditions:

• Undescended testicles. This is when a fetus or baby’s testicles don’t drop (descend) from inside their belly into their scrotum before birth or in the first few months of life.
• Testicular torsion. This is when your testicle’s blood supply (the spermatic cord) twists and cuts off blood flow to your testicle.

At what age should an orchiopexy be done?

If your child’s testicles don’t descend on their own by the time they’re about 6 months old, healthcare providers recommend orchiopexy between 6 and 24 months of age.

Providers treat testicular torsion immediately. If blood flow doesn’t return to your testicle within six hours, they may have to surgically remove it.

How do I prepare for an orchiopexy?

Your child’s provider will give you instructions on how to prepare for an orchiopexy. Following their directions closely can reduce the risk of complications. You may need to:

• Not feed your child anything solid (fast) for eight hours before the procedure
• Not give your child formula or cows’ milk for six hours before the procedure, breast milk for four hours before the procedure or clear liquid (like juice or water) for two hours before the procedure
• Thoroughly wash your child’s belly and groin the day before and the morning of the procedure

It’s OK for your child to take daily medications the day of the procedure unless their provider says otherwise.

Tell your healthcare provider about any prescription or over-the-counter medications your child is taking, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase the risk of bleeding.

If you have testicular torsion, you’ll have surgery right away and may not have time to prepare. Remember to tell your provider about all medications you’re taking.

What happens during an orchiopexy?

If your child is having an orchiopexy, a team of healthcare providers who specialize in taking care of kids will perform it. This includes:

• A pediatric surgeon or pediatric urologist
• A pediatric anesthesiologist
• A pediatric nurse

During an orchiopexy for undescended testicles, your child’s providers will:

1. Sedate your child with general anesthesia, so they aren’t awake, won’t move and won’t feel pain
2. Make a small cut (incision) in your child’s groin or scrotum
3. Locate the undescended testicle and the spermatic cord
4. Examine the testicle — if it looks unhealthy, they may need to remove it and replace it with a prosthesis
5. Repair hernias
6. Make a small cut in the scrotum to make a pocket (Dartos pouch) that’ll hold the testicle
7. Gently pull the undescended testicle down into the pocket
8. Secure the testicle with dissolving stitches
9. Close all incisions and cover the stitches with glue, gauze or bandages

What happens during an orchiopexy for testicular torsion?

If you have testicular torsion, your surgeon will:

1. Make a cut in your scrotum
2. Untwist your spermatic cord and examine your testicle
3. If your testicle looks healthy, they’ll stitch it to your scrotum so that it doesn’t twist again
4. If your testicle looks unhealthy, they’ll likely remove it and may replace it with a prosthesis (artificial testicle)
5. Stitch the cut closed with dissolvable stitches and cover the stitches with glue, gauze or bandages

How long does an orchiopexy take?

An orchiopexy takes about an hour in most cases.

What happens after orchiopexy?

After orchiopexy, providers will move you or your child to a recovery room. Healthcare providers will monitor you or your child until it’s safe to go home (usually about two hours after the procedure is complete). Orchiopexy is an outpatient procedure. So most of the time, you don’t have to stay at the hospital overnight.

What are the advantages of orchiopexy?

Advantages of orchiopexy include:

• Health benefits. An orchiopexy may help prevent infertility. It also helps you check yourself for testicular cancer when you’re older.
• Lower risk of injury. You’re more likely to injure a testicle if it’s in your groin instead of your scrotum. Sports, seat belts and tight clothing can cause injuries.
• Safety. An orchiopexy is a relatively safe procedure with a low risk of complications or side effects. Most people return home the same day.

What are the risks or complications of an orchiopexy?

All surgical procedures carry some risk. Risks of an orchiopexy include:

• Reactions to anesthesia
• Infection
• Mass of clotted blood (hematoma)
• Swelling
• Bruising
• Scarring

Rarely, your testicle may move back up and out of your scrotum (reascending testicle). You’ll need additional surgery for a reascending testicle if that happens.

What can I expect during recovery from an orchiopexy?

If you’ve had an orchiopexy, you’ll probably have pain or discomfort for a few days to a week. The stitches should dissolve in about two weeks.

People also often feel tired after an orchiopexy. Your child may sleep more for a few days afterward. They may feel nauseous or vomit for about a day from the anesthesia.

Most adults and kids older than a year can resume normal activities about two or three days after an orchiopexy. But someone who’s had an orchiopexy shouldn’t participate in sports or rough physical activity for at least two weeks. These activities may include tumbling, jumping, sprinting and straddling toys (rocking horse, seesaw, swing and bicycle or tricycle). Always ask your child’s provider whether it’s OK for them to return to these types of activities and any sports or exercise.

It’s important to remember that your child’s body is unique, so recovery times may vary. Follow your healthcare provider’s instructions on managing your child’s pain and discomfort.

How do I take care of my child after they have an orchiopexy?

Your child’s healthcare provider will give you instructions on what to expect, how to manage pain and how to care for the incision site after an orchiopexy. They may recommend:

• Acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) for pain (always check with your child’s provider before giving them pain medication)
• Applying an ice pack wrapped in a light towel for 10 to 30 minutes, four times a day, which helps decrease bruising, swelling and pain
• Limiting what your child eats to clear liquids (water, broth and sports drinks) and bland, soft foods (applesauce, bananas, rice and toast) for the first 24 hours after surgery
• Keeping the affected areas as clean as possible to prevent infection (wash your hands with soap and water before handling your child’s bandages and incision areas)
• Showering or sponge bathing

Ask your provider when you can wash your child in a bathtub or shower. Sometimes, you can bathe the next day, or they might recommend waiting a week.

These are good guidelines to follow if you’ve had orchiopexy for testicular torsion, too. You also shouldn’t drive for a week or two after orchiopexy. Ask your provider when it’s OK to have sex.

When can my child go back to school?

Most children can go back to school or daycare three to five days after an orchiopexy.

When should I see my healthcare provider?

Schedule a follow-up appointment with your pediatrician or surgeon two weeks after an orchiopexy. You may need to schedule another follow-up two to three months later.

Call your healthcare provider right away for any of these symptoms:

• Heavy bleeding, pus or a foul smell at the incision sites
• Fever
• Increased pain or pain you can’t manage with over-the-counter medications
• Swelling