• Orchiopexy—Laparoscopic

    (Orchidopexy—Laparoscopic)

    Definition

    Testiscles should lower from the abdomen into the scrotum before birth. Some boys are born with one or both testicles still inside the abdomen or groin. This is called undescended testicles. Orchiopexy is a surgery to lower the testicle(s) into the scrotum.
    Undescended testes
    IMAGE
    © 2009 Nucleus Medical Media, Inc.

    Reasons for Procedure

    Orchiopexy is done to treat undescended testicles. The surgery may improve fertility. Undescended testicles also have a higher risk of developing cancer later in life. Having the testicle in the scrotum makes it easier to check for early signs of cancer.

    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 move back up into groin after surgery
    • Damage to the testicle
    • Bleeding
    • Infection
    • Reaction to anesthesia
    • Injury to surrounding structures

    What to Expect

    Prior to Procedure

    Your child’s doctor will do the following before the surgery:
    • Physical exam
    • Imaging, blood, and urine tests
    • Discuss the anesthesia being used and the risks of surgery
    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.
      • For children younger 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. It will keep your child asleep during the surgery and block pain.

    Description of the Procedure

    Small keyhole incisions will be made in one or both sides of the groin and in the abdomen. Long, thin tools will be passed through the incisions. They will allow the doctor to view and operate inside the body. First, the testicle will be examined.
    Next, a pouch will be created in the scrotum. The testicle will be pulled down into the newly created pouch. Stitches will hold the testicle in place. The stitches will dissolve on their own. All other incisions will also be closed with stitches.
    In some cases, a small button will be placed on the outside of the scrotum. The button will hold the testicle down until healing occurs. The doctor removes the button by cutting the stitches a few weeks after the procedure.
    A medication may be given during the surgery to help manage discomfort after the procedure. In most cases, your child can go home from the hospital on the same day as the surgery.

    How Long Will It Take?

    1 hour per testicle

    How Much Will It Hurt?

    Anesthesia prevents pain during the procedure. Medication will be given after the surgery to manage pain.

    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, do the following to help ensure a smooth recovery:
    • Give medicines to treat pain and prevent infection as directed.
    • Minor bleeding is normal. Care for the incisions as directed by the doctor.
    • If you child wears a diaper, change it often. Leave it off for short periods to reduce any irritation to the area.
    • Follow your doctor's direction for incision care. You may be asked to put an ointment or cream on the incisions.
    • Ask your doctor about when it is safe to bathe your child.
    • Engage in gentle play. Avoid tiring activities for a few weeks. Your child should avoid sitting on or riding a bicycle for about a week after the surgery.
    • Monitor your child for signs of pain. These may include fussiness, trouble moving, sweating, or pale skin.
    Be sure to follow the doctor’s instructions.

    Call Your Child’s Doctor

    After you leave the hospital, contact the doctor if any of the following occurs:
    • Increasing pressure or pain
    • Redness, drainage, puffiness, or soreness around the incision site(s)
    • 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

    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.

    Cryptorchidism. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 13, 2011. Accessed December 28, 2012.

    Orchiopexy. Children’s Hospital and Clinics of Minnesota website. Available at: http://www.childrensmn.org/Manuals/PFS/Surg/018757.pdf . Accessed December 28, 2012.

    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 . Accessed December 28, 2012.

    Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007.

    Revision Information

    • Reviewer: Mike Woods, MD
    • Review Date: 12/2012
    • Update Date: 12/28/2012
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