Orchiopexy (Orchidopexy) Surgery in Delhi, India

Orchiopexy, also known as orchidopexy, is a surgical procedure designed to correct undescended testicles—a condition called cryptorchidism. This condition occurs when one or both testicles fail to descend into the scrotum before birth. During the procedure, a paediatric urologist or surgeon carefully moves the testicle into the scrotum and secures it in place to prevent it from retracting back into the groyne.

Orchiopexy is typically performed on boys between 6 months and 2 years of age to minimise the risk of future complications, including infertility, testicular torsion, or an increased likelihood of developing testicular cancer. Early intervention through this surgery helps ensure proper testicular development and reduces long-term health risks.

Before the Procedure

• Preoperative Instructions: Parents will receive specific instructions on how to prepare their child for surgery. This usually includes guidelines on fasting (no food or drink) for several hours before the procedure, typically starting from midnight before the surgery day.
• Anaesthesia Evaluation: An anaesthesiologist will determine the most appropriate type of anaesthesia for the child. Orchiopexy is usually performed under general anaesthesia, meaning the child will be asleep and feel no pain during the surgery.
• Discussion of Risks and Benefits: The surgeon will explain the risks and benefits of the procedure, so that parents fully understand what the surgery involves and what outcomes to expect. Any questions or concerns can be addressed during this discussion.
• Signing of Consent Form: Parents will be asked to sign a consent form, to give permission for the surgery to proceed. This form confirms that they understand the procedure and agree to it.

During the Procedure

Here’s what to expect during orchiopexy surgery:

• Anaesthesia Administration: The procedure begins with the administration of general anaesthesia. This ensures that the child is asleep and does not feel any pain during the surgery. An anaesthesiologist will monitor the child’s vital signs throughout the procedure.
• Surgical Incision:Once the anaesthesia takes effect, the surgeon makes a small incision in the groyne area to locate the undescended testicle. If the testicle is higher up in the abdomen, a laparoscope (a small, camera-equipped instrument) may be used to assist in locating it.
• Mobilising the Testicle: The surgeon carefully frees the testicle from surrounding tissues and structures, creating enough slack in the spermatic cord to allow the testicle to be moved into the scrotum without tension.
• Securing the Testicle:During the procedure, the surgeon carefully frees the testicle from surrounding tissues and structures, creating enough length in the spermatic cord to allow the testicle to be moved into the scrotum without any tension. This ensures that the testicle can be positioned correctly in the scrotum without pulling or strain, which is important for its proper function and long-term health.
• Closing the Incision:  Once the testicle is secured in the scrotum, the surgeon closes the incisions with dissolvable stitches. These stitches will gradually dissolve as the wound heals, eliminating the need for their removal manually.

After the Procedure

• Monitoring After Surgery: After the surgery, the child will be taken to a recovery room, where medical staff will monitor their vital signs as they wake up from anaesthesia. It is normal for the child to feel groggy and disoriented initially. The healthcare team will ensure they are comfortable and stable before transferring them to a regular room or allowing them to go home.
• Pain Relief Medications: Mild discomfort or pain is common following the procedure. The healthcare team will provide appropriate pain relief medications to help manage any discomfort. Parents should monitor the child’s pain levels and communicate with the medical staff if the pain appears excessive or difficult to tolerate.
• Post-Surgery Instructions: After the procedure, newborns will need to be handled gently and kept calm to promote healing. Parents should avoid any rough play or sudden movements when holding or carrying their baby. It’s important to provide a calm environment and allow the child to rest as they recover.
• Healing of Surgical Site: Proper care of the surgical site is crucial for healing. Parents should keep the incision clean and dry, following any specific instructions given by the surgeon. It’s essential to monitor the incision for signs of infection, such as increased redness, swelling, or discharge, and to report any concerns to the healthcare team.

Improved Testicular Position

One of the primary benefits of orchiopexy is the successful placement of an undescended testicle into the scrotum. This procedure ensures that the testicle is in the correct anatomical position, allowing for normal temperature regulation and function, which are essential for sperm production and hormonal balance.

Reduced Risk of Infertility

Orchiopexy performed at an early age significantly decreases the likelihood of future infertility. Undescended testicles, if left untreated, may not develop properly, leading to decreased sperm production. By correcting the position early, the testicle has the best chance to develop normally and maintain its fertility potential.

Decreased Risk of Testicular Cancer

Children with undescended testicles have a higher risk of developing testicular cancer later in life. Orchiopexy helps mitigate this risk by positioning the testicle in the scrotum, where it can be monitored more easily and is less likely to undergo malignant changes associated with being improperly positioned.

Prevention of Testicular Torsion

Testicular torsion is a painful condition that occurs when the testicle twists around the spermatic cord, cutting off its blood supply. By securing the testicle in the scrotum through orchiopexy, the procedure significantly reduces the risk of this emergency situation, which can lead to severe pain and potentially necessitate the removal of the testicle if not treated promptly.

Normal Development

Orchiopexy promotes proper testicular development, which is vital for the production of testosterone and sperm. This is crucial for the child’s physical and sexual development, impacting not only reproductive health but also overall well-being.

Improved Self-Esteem

For older children and adolescents, having a normally positioned testicle can positively impact body image and self-esteem. This can be particularly important during the teenage years, when self-perception plays a significant role in mental health.

Infection

Infection at the surgical site is one of the most common complications. Signs of infection may include increasing redness, swelling, warmth, or discharge from the incision. If an infection occurs, it is usually treatable with antibiotics. In some cases, a more serious infection may require additional medical intervention, such as drainage or further surgical procedures.

Bleeding

While some bleeding during surgery is expected, excessive bleeding can pose a risk. It may occur internally or externally and could require blood transfusions or additional surgical procedures to control the bleeding. Parents should be aware of any unusual swelling or bruising in the area following surgery, as this may indicate bleeding.

Damage to Surrounding Structures

During the surgery, there is a risk of unintended injury to surrounding structures, including blood vessels, nerves, or the vas deferens (the duct that carries sperm). Such damage can lead to complications like chronic pain, altered sensation, or potential fertility issues. Surgeons take great care to avoid such complications, but they are still a possibility.

Recurrence of Undescended Testicle

Although orchiopexy is designed to permanently correct undescended testicles, there is a chance that the testicle may retract back into the groyne. This recurrence may happen due to factors such as insufficient tissue attachment or anatomical variations. If this occurs, a second surgery may be necessary to secure the testicle properly.

Testicular Torsion

Testicular torsion, while less common after orchiopexy, remains a risk. This condition occurs when the testicle twists around the spermatic cord, cutting off its blood supply. Symptoms include sudden severe pain and swelling. 

Scarring

Surgical incisions can lead to scarring. While most scars will fade and become less noticeable over time, some children may develop more prominent scars or keloids, which are raised scars caused by excessive collagen production during healing. If scarring is a concern, parents can discuss options for scar management with their healthcare provider.

Anaesthesia Risks

General anaesthesia carries inherent risks, including allergic reactions, respiratory complications, or adverse reactions related to the child's medical history. The anaesthesiologist will conduct a thorough preoperative assessment to evaluate the child's health and determine the safest anaesthetic approach. Close monitoring during surgery helps ensure the child remains stable throughout the procedure.

Fertility Concerns

While orchiopexy aims to improve fertility, some children may still experience fertility issues later in life. Factors such as the cause of the undescended testicle, the age at which the surgery was performed, and any complications during or after surgery may impact fertility.

1. What causes undescended testicles?

Undescended testicles occur when one or both testicles fail to move down into the scrotum before birth. The exact cause is often unknown, but factors such as premature birth, family history, hormonal imbalances, and certain health conditions in the mother during pregnancy may increase the risk.

2. How is orchiopexy different from other treatments for undescended testicles?

Orchiopexy is the most common and effective treatment for undescended testicles. It involves a surgical procedure to move the testicle into the scrotum and secure it in place. Unlike hormone therapy, which is sometimes used but less effective, orchiopexy provides a permanent solution by physically correcting the position of the testicle.

3. What are the long-term outcomes for children who undergo orchiopexy?

Children who undergo orchiopexy generally have very positive long-term outcomes. The surgery helps ensure normal testicular function, reduces the risk of infertility, and lowers the chances of testicular cancer later in life. Most children go on to lead healthy, normal lives without complications.

4. Can orchiopexy be performed on older children or adolescents?

Yes, orchiopexy can be performed on older children or adolescents if the condition was not corrected earlier. However, it’s ideal to perform the surgery at a younger age, typically before the child turns 1 year old, to achieve the best outcomes. Surgery at an older age may still be effective, but might not fully reverse any damage that occurred due to the delay.

5. What types of surgeons perform orchiopexy?

Orchiopexy is typically performed by paediatric surgeons or paediatric urologists, who are specialists trained in surgeries related to children’s health. In some cases, a general surgeon with experience in paediatric procedures may also perform the surgery. It is always a good idea to look for a reputable orchidopexy hospital in India, as these hospitals often have a track record of successful outcomes and offer access to skilled specialists who provide high-quality care.

6. When can the child return to school or daycare after the surgery?

Most children can return to school or daycare within a week after the surgery, depending on how well they are healing. It’s important for parents to follow the surgeon’s advice and ensure their child avoids strenuous activities, like running or jumping, for a few weeks to allow proper healing.

7. What signs should parents look for to know if their child is healing properly?

Parents should watch for signs of proper healing, such as a decrease in pain and swelling at the surgical site, and the absence of fever or unusual discharge from the incision. The child should also gradually return to normal activities without discomfort. If parents notice excessive redness, swelling, or any signs of infection, they should contact the doctor immediately.

8. Can orchiopexy impact a child’s growth or development?

Orchiopexy does not negatively impact a child’s overall growth or development. In fact, by correcting the position of the testicle, it supports normal testicular development, which is important for hormone production and fertility. The surgery is considered beneficial for a child’s health and development.

9. What are the chances of needing a second surgery after orchiopexy?

The chances of requiring a second surgery after orchiopexy are low. In some cases, the testicle may move back up into the groyne or not stay in the correct position, which might require another procedure. However, most surgeries are successful, and a single operation is sufficient to correct the condition. Regular follow-up appointments with the surgeon help ensure everything is healing as expected.

Reviewed by Dr. P.P Singh - Senior Director & HOD- Urology, Kidney Transplant, Robotic Surgery on 11 Oct 2024.