17297 Orchiopexy

Overview

Orchiopexy (say: or-kee-oh-PEK-see) is an operation that moves a testicle that has not dropped into the scrotum down into its normal place and fixes it there so it cannot move back up. Before birth, a baby boy's testicles develop inside his tummy. In the last few months before birth, they usually travel down through the groin and settle in the scrotum (the pouch of skin below the penis). Sometimes one or both testicles stop along the way. This is called an undescended testicle, and orchiopexy is the operation used to correct it.

Yes, it is one of the most common operations performed on young boys. An undescended testicle is present in roughly 1 in 100 baby boys born at full term, and it is even more common in babies born early (premature).

It mainly affects newborn and infant boys. It is more common in babies born prematurely and in babies with a low birth weight. Occasionally, an undescended testicle is first noticed in an older boy, teenager, or adult, and surgery can still be helpful then.

Symptoms

Common symptoms

• One side of the scrotum looks smaller or emptier than the other
• The testicle cannot be felt in the scrotum when a doctor examines the area
• Sometimes the testicle can be felt in the groin instead
• Usually there is no pain at all — this is a finding on examination rather than something your child complains about

Symptoms in children

• A scrotum that looks uneven or under-developed on one side
• An empty or partly empty scrotal sac that a parent or health visitor notices during nappy changes
• A small lump or swelling in the groin on the same side
• A testicle that seems to move up and down — sometimes it is in the scrotum and sometimes it disappears. This is often a harmless 'retractile' testicle, but it should still be checked

Symptoms in older adults

• An undescended testicle found for the first time during a routine examination
• A history of childhood surgery for an undescended testicle, with questions about fertility or future risk
• Ache or discomfort in the groin, though most adults with this history have no symptoms at all

Causes

Main causes

• The testicle simply did not finish its journey down into the scrotum before birth — in most cases no specific cause is found
• Hormones and physical factors that guide the testicle's descent did not work as expected
• Sometimes the testicle is missing altogether, or is small and under-developed, rather than truly undescended
• Sometimes the testicle sits outside the normal path and is found in an unusual position

Risk factors

• Being born prematurely or with a low birth weight
• A family history of undescended testicles
• Other problems with the development of the groin or urinary system
• Certain hormonal or genetic conditions that affect a baby's development before birth

When to see a doctor

See a doctor urgently if:

• Sudden severe testicular pain at any age — treat this as an emergency and seek help immediately
• A swollen, red, or very tender scrotum with fever
• Any wound problem, heavy bleeding, or inability to pass urine after surgery

Book a routine appointment if:

• You or a health professional cannot feel one or both testicles in your baby's scrotum
• One side of your son's scrotum looks noticeably smaller or emptier
• Your child has a groin lump that comes and goes
• An undescended testicle was noted at birth and you have not yet been offered a follow-up appointment

Diagnosis

The diagnosis is usually made by a simple physical examination. A doctor will gently feel the scrotum and groin to see whether the testicle can be located and whether it can be guided into the scrotum. This is quick and painless. If the testicle cannot be felt at all, or if there is any doubt, a specialist may arrange a scan or a small procedure to look inside the groin.

Tests that may be done

• Physical examination of the scrotum, groin and tummy
• Re-check examinations over a few months, because some testicles come down on their own
• An ultrasound scan, used only in some cases — it is not routine
• In certain situations, a laparoscopy (a tiny camera look inside the tummy through a small cut) to find a testicle that cannot be felt

What to expect at your appointment

You will usually see a children's surgeon or urologist, who will examine your child and explain the options. If surgery is advised, you will be told when it should happen, what it involves, and what to expect afterwards. You will be able to ask questions and will be asked to give consent for the operation.

Treatment

The main treatment for an undescended testicle is surgery — orchiopexy. It is usually recommended between 6 and 18 months of age if the testicle has not come down by itself. Occasionally, hormone treatment may be discussed for certain children, but surgery is the standard and most reliable approach. The aim is to place the testicle in the scrotum where it can be checked easily, work at the right temperature, and cause fewer problems later in life.

Self-care at home

• Follow the aftercare instructions your surgical team gives you — they will be specific to your child
• Keep the wound area clean and dry, and change dressings as advised
• Give simple pain relief as directed by your child's care team, following the instructions on the packet
• Gentle baths are often fine after a day or two, but check with your team first
• Avoid rough play, cycling, and straddling toys for the first couple of weeks
• Loose, comfortable underwear and clothing will help reduce rubbing
• Attend the follow-up appointment so the surgeon can check healing and the position of the testicle

Medical treatments

There is no medicine that reliably brings a testicle down, and treatment is not about drugs. In some circumstances a children's specialist may discuss a course of hormone treatment, but this is not routine and works only in a small number of cases. For most children, the decision is simply between waiting a little longer to see if the testicle descends naturally and going ahead with a planned operation. Your specialist will explain what is suitable for your child.

When is surgery considered?

Surgery is usually recommended if the testicle has not come down by around 6 to 18 months of age, or if it is found later in childhood. It is also done for a testicle that keeps moving out of the scrotum, or to fix a testicle found in an unusual place. In older boys and adults, surgery may still be offered to lower the risk of future problems and to make the testicle easier to examine. The operation itself takes about an hour, is done under general anaesthetic, and usually means a small cut in the groin and sometimes a tiny stitch in the scrotum. Most children go home the same day.

Living with this condition

Most children are back to normal within a week or two. For a few days there may be some swelling, bruising, and mild soreness, which settles with ordinary pain relief. Your child can usually return to nursery or school within about a week, once they are comfortable, and back to sports and swimming after a few weeks — your surgical team will tell you exactly when.

Lifestyle tips

• Encourage normal play once healing is well under way — movement is good for recovery
• Teach older boys to check their testicles gently once a month, and to tell someone straight away about any sudden pain
• Keep up routine check-ups with your GP so the testicle's position can be confirmed as your child grows
• Avoid tight clothing or heavy lifting for the first few weeks after surgery

Diet and exercise

There is no special diet needed. Encourage normal healthy eating and drinking, and make sure your child drinks plenty after the anaesthetic. Gentle walking is fine soon after surgery. Wait until your surgical team says it is safe before returning to rough play, cycling, swimming, or contact sports — usually a few weeks.

Mental health and emotional wellbeing

This can feel worrying for parents, and older boys may feel anxious about their body, about surgery, or about being different from their friends. These feelings are normal and usually settle. It often helps to talk openly and simply, to reassure your child that the operation is to help their body work well, and to let them ask questions. If worries are affecting sleep, mood, or school, speak to your GP — support is available.

Prevention

An undescended testicle cannot usually be prevented — it happens because of how a baby develops before birth, and it is not caused by anything a parent did or did not do. What can be prevented are the complications, by having the testicle checked and, if needed, treated at the recommended age.

Screening programmes

Every newborn baby is examined soon after birth, and this check includes looking and feeling for both testicles in the scrotum. This newborn examination is the main screening step. If a testicle cannot be felt, your baby will be checked again at around 6 to 8 weeks and referred to a specialist if it has not come down.

Complications

If left untreated

• A higher chance of fertility problems later in life, especially if both testicles are affected
• A higher risk of a twisted testicle (torsion), which is very painful and needs emergency treatment
• A higher chance of developing a groin hernia
• An increased — though still small — lifetime risk of testicular cancer, which is one reason the testicle is placed where it can be checked easily
• Possible emotional or body-image concerns, particularly in older boys and teenagers

Long-term outlook

The outlook after orchiopexy is very good. The operation successfully places the testicle in the scrotum in the great majority of cases, and most children recover quickly with no lasting problems. Having the surgery at the recommended age lowers the chance of future complications and makes the testicle easy to examine as your child grows. Some boys may need a second, smaller operation if the testicle moves back up, and your surgeon will keep an eye on this at follow-up. Most people treated for an undescended testicle go on to live completely normal, healthy lives.

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