Definition & Overview
In normal development, the testicles begin to develop inside the womb and descend a few weeks before the baby is born. In some instances, however, one or both of the testicles fail to descend into the scrotum, resulting in a condition called cryptorchidism. This can be caused by hormonal imbalance, defective nerve development, or structural abnormalities in the genitals.
To correct this condition, male babies undergo orchiopexy or undescended testicle reconstruction. This surgical procedure is done when the baby is between five and 15 months old to help minimise serious complications that are associated with the procedure when it is delayed. If the condition is untreated, the patient faces the risk of becoming infertile or developing serious medical conditions like testicular cancer or testicular torsion during adolescence or adulthood. Cryptorchidism can also lead to the development of inguinal hernia, in which a part of the intestine descends and gets trapped into the scrotum.
Who Should Undergo & Expected Results
Orchiopexy was initially developed during the 19th century to treat paediatric cryptorchidism. During the last century, this condition has become quite common affecting about five percent of infants born every year. It is important to perform the surgery as early as possible to avoid further complications. In some cases, the testes would descend into the scrotum on its own before the child reaches his first birthday but rarely after.
Undescended testicle reconstruction can still be performed on adolescent and young male patients whose condition was not corrected during childhood. However, this procedure is rarely advised for older men with undescended testicles as the risks typically outweigh the benefits.
Orchiopexy is also recommended for those diagnosed with testicular torsion, a condition characterised by the twisting of the spermatic cord, cutting off blood supply to the testicles. This typically affects infants and adolescents and requires immediate medical attention.
Orchiopexy is considered a simple and safe surgical procedure that does not require overnight stay in the hospital. In treating paediatric cryptorchidism, it has high success rate with little to no complications. The same results can be expected if it is performed for the treatment of testicular torsion, as long as the condition is diagnosed and the surgery is performed as early as possible.
How Does the Procedure Work?
The procedure starts with the administration of anaesthesia to put the patient to sleep. The surgeon will then make a small incision in the groin to locate the testicle. The spermatic artery, the structure anchoring the testicle, is identified and carefully freed from surrounding tissues. In most cases, the spermatic artery is stretched to allow the testicle to descend into the scrotum. Another incision is then made in the scrotum to create a pouch. Once the testicle is drawn into the scrotum, it is stitched in place to prevent it from re-ascending. The incisions are then closed with sutures. Some patients have testicles located high up in the abdomen area or the inguinal canal. In such cases, a laparoscopic procedure will be performed to draw the affected part down into the scrotum.
In treating testicular torsion, an incision is made in the scrotum and the surgeon carefully untwists the spermatic cord. The affected testicle is also evaluated to check if cell death or necrosis has occurred. In some rare cases, there may be a need to remove the affected testicle entirely to avoid complications. The healthy testicle is then stitched in place to avoid the reoccurrence of the condition.
Possible Complications and Risks
As in any surgical procedure, the patient faces the risk of developing an adverse reaction to the anaesthesia used. There is also a risk of bleeding, though most instances are manageable and do not require blood transfusion.
There is also the possibility of damaging the nearby blood vessels during undescended testicle reconstruction. The spermatic cord can also sustain an injury, leading to the eventual removal of the testicle. There are some instances in which the testicle would ascend back into its original position after surgery, warranting the need for another operation.
Other complications that patients have reported are difficulty in urinating and severe pain in the surgical site.
Barthold JS. Abnormalities of the testes and scrotum and their surgical management.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 132.
Elder JS. Disorders and anomalies of the scrotal contents.In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 539.