• Orchiopexy—Open Surgery

    (Orchidopexy—Open Surgery)

    Definition

    Sometimes baby boys are born with one or both testicles inside the abdomen or groin, rather than in the scrotum. This is called undescended testicles . Orchiopexy is a surgery to lower the testicles into the scrotum. The scrotum is the external sac that holds the testicles.
    Undescended testes
    IMAGE
    © 2009 Nucleus Medical Media, Inc.

    Reasons for Procedure

    The procedure is used to treat undescended testicles that do not move down on their own. If left untreated, infertility problems can develop later in life.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. Your doctor will review a list of possible complications, which may include:
    • Testicle moves back up into groin again after surgery
    • Damage to the testicle
    • Bleeding
    • Infection
    • Reaction to anesthesia
    • Injury to surrounding structures
    Factors that may increase the risk of complications include:
    Talk to your doctor about these risks before the surgery.

    What to Expect

    Prior to Procedure

    Your child’s doctor and anesthesiologist will do the following:
    • Examine your child
    • Do imaging, blood, and urine tests
    • Discuss the anesthesia being used and the potential risks
    • Discuss the risks of surgery and answer any questions you have
    Talk to the doctor about your child’s medicines or any recent illnesses. You may be asked to have your child stop or start certain medicines before surgery.
    Other things to keep in mind before the procedure include:
    • Bring special toys, books, and comfortable clothing for your child.
    • Your child will need to avoid eating for a period of time before surgery. Ask the doctor when your child should stop eating and drinking. For children less than one year, it is often recommended that they do not eat after midnight the night before the surgery. Clear liquids (eg, breast milk, water, clear juices) may be allowed up to two hours before the procedure.

    Anesthesia

    General anesthesia will be used. Your child will be asleep during the surgery. He will not feel any pain.

    Description of the Procedure

    Once your child is asleep, the doctor will make a small incision in one or both sides of the groin. The testicle is located and examined. If there is a hernia present, the doctor will also repair this.
    Next, the doctor will create a pouch in the scrotum. The testicle will be pulled down into this new pouch. Stitches will hold the testicles in place. The stitches will dissolve on their own. All other incisions will be closed with stitches.
    In some cases, a small button will be placed on the outside of the scrotum and secured with a suture. This will hold the testicle down until healing occurs. The doctor will remove the button by cutting the suture a few weeks after the procedure.
    In most cases, your child can go home on the same day as the surgery.

    How Long Will It Take?

    One hour per testicle

    How Much Will It Hurt?

    Pain or soreness after the procedure will be managed with pain medicines.

    Post-procedure Care

    At the Care Center
    • Your child will be monitored while he recovers from the anesthesia.
    • The nurse will give pain medicine as needed.
    At Home
    When your child returns home, you may need to do the following to help ensure a smooth recovery:
    • Give medicines as directed to treat pain and prevent infection.
    • Minor bleeding is normal. Care for the incisions as directed.
    • Change your child’s diaper often. Leave it off for short periods to allow air at the incision sites.
    • Ask your doctor about when it is safe to bathe your child.
    • Engage in gentle play. Avoid tiring activities for a few weeks. Sitting on or riding a bicycle should be avoided for about a week after the surgery.
    • Monitor your child for signs of pain. Examples include fussiness, trouble moving, sweating, and pale skin.
    • Be sure to follow the doctor’s instructions.

    Call Your Child’s Doctor

    After leaving the hospital, contact the doctor if any of the following occurs:
    • Increasing pressure or pain
    • Redness, drainage, puffiness, or soreness around the incision site
    • Changes in frequency, odor, appearance, or volume of urine
    • Difficulty urinating
    • Signs of infection, including fever or chills
    • Vomiting
    • Abdominal pain
    • Lack of energy
    • Loss of appetite
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Pediatrics http://www.aap.org/

    American Family Physician http://www.aafp.org/afp/

    CANADIAN RESOURCES

    Canadian Pediatrics Society http://www.cps.ca/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php

    References

    About Kids Health. Orchiopexy: surgery for undescended testicles. About Kids Health website. Available at: http://www.aboutkidshealth.ca/healthaz/Orchidopexy-Surgery-for-Undescended-Testicles.aspx?articleID=10179&categoryID=AZ1k . Updated July 31, 2009. Accessed August 16, 2010.

    Campbell M, Wein A, Kavoussi L. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: WB Saunders; chap 127.

    Children’s Hospital and Clinics of Minnesota. Orchiopexy. Children’s Hospital and Clinics of Minnesota website. Available at: http://www.childrensmn.org/Manuals/PFS/Surg/018757.pdf . Updated March 2009. Accessed August 16, 2010.

    Children’s Hospital of Pittsburgh. Undescended testicle orchiopexy repair surgery. Children’s Hospital of Pittsburgh website. Available at: http://www.chp.edu/cs/Satellite?c=eHA%5FContent%5FC&cid=1209404825839&pagename=CHP/eHA%5FContent%5FC/CHP/Template/CHP%5FLayout%5F04%5FContent%5FPage%5FTemplate . Updated April 7, 2010. Accessed August 16, 2010.

    Elyas R, Guerra LA, Pike J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol . 2010;183(5):2012-2018.

    Smith N, Carmack A. Undescended testes. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Updated July 1, 2010. Accessed August 16, 2010.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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