Testicular fusion A safe surgical procedure for treating undescended testicles

Orchidopexy is a safe and commonly performed surgical procedure used to treat an undescended testicle (cryptorchidism). It is also sometimes performed to prevent testicular torsion, a condition that can cause permanent damage if not treated promptly.This procedure not only improves the natural appearance of the genital area, but also plays a crucial role in protecting future fertility and reducing the risk of testicular cancer and other potential complications.For children and adolescents, performing orchidopexy at the appropriate time has a significant impact on long-term testicular health and function. Early intervention helps prevent complications that may occur if treatment is delayed.In this Dalili Medical article, we will discuss everything you need to know about orchidopexy — including its indications, types, surgical techniques, possible risks, recovery process, and essential aftercare tips to ensure a smooth and comfortable healing experience.

What Is Orchidopexy?

Orchidopexy is a surgical procedure performed to reposition and secure an undescended or twisted testicle into its natural position inside the scrotum. It is also referred to as repair of an undescended testicle or surgical correction of testicular torsion.

The procedure involves the testicle itself, the spermatic cord, the scrotum, and the associated blood vessels and nerves to ensure proper function and protect the testicle from permanent damage.

Is Orchidopexy Painful?

After surgery, it is normal for a child or adolescent to experience mild to moderate pain in the scrotal area or upper thigh.

Pain relief:
Discomfort can usually be managed with prescribed pain medications and adequate rest during the first few days after surgery.

When Can Normal Activities Resume?

Light movement, such as walking, is usually possible within one to two days after surgery.
Strenuous sports and heavy lifting should be avoided for 4–6 weeks, according to the doctor’s instructions, to ensure complete healing.

Does Orchidopexy Preserve Fertility?

Yes. Fixing the testicle inside the scrotum helps preserve future fertility, especially when the procedure is performed at an early age.

An untreated undescended testicle is at risk of permanent damage, which may reduce fertility later in life.

Does the Procedure Affect Appearance?

Orchidopexy improves the natural appearance of the genital area and helps maintain normal scrotal size and symmetry.

This often boosts a child’s or adolescent’s self-confidence after recovery.

Is Follow-Up Needed After Surgery?

Yes, medical follow-up is very important to ensure that:

The testicle has successfully moved into and remains in the correct position
No complications have developed

Doctors usually schedule periodic examinations in the months following surgery to confirm long-term success and stability.

Benefits of Orchidopexy

Orchidopexy provides several important health benefits, particularly for children, adolescents, and patients with undescended or torsion-prone testicles.

1. Protecting the Testicle and Preventing Torsion

Securing the testicle reduces the risk of spermatic cord twisting, which can cut off blood supply and cause permanent damage.

It significantly lowers the risk of losing the testicle due to sudden torsion.

2. Improving Future Fertility

An undescended or unstable testicle is exposed to higher temperatures and possible reduced blood supply, which may damage tissue.

Placing it in its natural position within the scrotum supports healthy sperm production and increases fertility potential at puberty.

3. Reducing the Risk of Cancer

An undescended testicle is associated with a higher risk of developing testicular cancer later in life.

Performing orchidopexy at the appropriate time significantly reduces this risk.

4. Enhancing Natural Appearance

The procedure improves the symmetry and appearance of the scrotum.

This can positively impact psychological well-being and confidence during adolescence.

5. Preventing Other Complications

Orchidopexy reduces the likelihood of:

Recurrent torsion
Testicular trauma due to abnormal positioning
Tissue damage from excessive mobility

How to Prepare for Orchidopexy

Proper preparation is essential to ensure a smooth procedure and faster recovery.

1. Surgical Consultation

Before surgery, a comprehensive discussion with the surgeon is required, including:

Reviewing the patient’s medical history
Discussing current medications
Identifying any allergies
Understanding the procedure, its benefits, and potential risks

Clear communication helps parents and patients feel informed and reassured before the operation.

Preoperative Tests and Preparation for Orchidopexy

1. Pre-Surgery Tests

Blood tests to assess general health.
Ultrasound imaging to locate the position of the testicle.
Electrocardiogram (ECG) may be requested for older patients to evaluate heart function.

2. Fasting Instructions

Patients are usually advised to fast for 6–8 hours before surgery.
This includes refraining from food and drink, even water, to minimize risks during anesthesia.

3. Medication Management

Inform the doctor about all medications and supplements being taken.
Certain medications, such as blood thinners, may need to be adjusted or temporarily stopped before surgery.

4. Preoperative Hygiene

Take a shower with antibacterial soap the day before surgery to reduce infection risk, especially around the surgical area.

5. Transportation After Surgery

Since orchidopexy is usually performed under general anesthesia, an adult should accompany the patient home.
It is important to have someone available to assist the child or adolescent on the first day after surgery.

6. Postoperative Care Planning

Know how to manage pain and monitor for any signs of complications.
Follow the doctor’s instructions regarding physical activity and restrictions after surgery.
Attend all follow-up appointments to ensure successful recovery.

Indications for Orchidopexy

Orchidopexy may be medically necessary in several situations:

Undescended Testicle

The main indication is when one or both testicles have not descended into the scrotum by 6 months of age.
Pediatricians monitor this condition during routine checkups to ensure timely intervention.

Retractile Testicles

These are testicles that move between the scrotum and groin due to overactive cremaster muscles.
Surgery is usually not required unless the testicle fails to remain in the scrotum.

Hormonal Imbalances

If tests show that an undescended testicle affects testosterone or other hormone production, surgical fixation may be necessary to restore normal function.

Associated Inguinal Hernia

Some children with undescended testicles also have an inguinal hernia.
Orchidopexy can be performed alongside hernia repair in the same surgery.

Family History of Testicular Problems

If there is a family history of testicular cancer or infertility, early surgical intervention may be recommended to reduce future risks.

Age and Prevention of Complications

If the child is approaching one year of age and the testicle has not descended, surgery is usually advised to prevent long-term complications such as reduced fertility or increased risk of infections.

Types of Orchidopexy

The procedure can be performed in several ways depending on the position of the testicle and the patient’s age:

Open (Conventional) Orchiopexy

Description: Surgical incision in the scrotum or upper groin.
Use: For undescended testicles in the groin or scrotum.
Benefit: Allows precise fixation of the testicle in its natural position.

Laparoscopic Orchiopexy

Description: Small incisions with a camera to guide fixation of an intra-abdominal testicle.
Use: For testicles located inside the abdomen or hard-to-reach cases.
Benefit: Less pain, faster recovery, smaller scars.

Staged Orchiopexy

Description: Two-step procedure for very high testicles or short spermatic cords.
Use: For complex or high undescended testicles.
Benefit: Reduces tension on the spermatic cord, preserves blood flow, and increases success rate.

Prophylactic Fixation

Description: Fixation of a healthy testicle to prevent future torsion.
Use: For patients at risk of torsion on the opposite side.
Benefit: Reduces risk of torsion and protects the health of both testicles.

Surgical Techniques for Orchidopexy

Open (Conventional) Orchiopexy

Small incision in the scrotum or upper groin.
Free the testicle from surrounding tissues.
Fix the testicle in the scrotum with absorbable sutures.
Benefit: Safe, commonly performed, allows precise fixation.

Laparoscopic Orchiopexy

Small abdominal incisions to insert a camera and surgical instruments.
Free the testicle from surrounding tissues and pull it into the scrotum.
Fix it with fine sutures.
Benefit: Less pain, faster recovery, small scars, high precision.

Staged Orchiopexy

Performed in two stages for high-riding testicles or short spermatic cords.
Stage 1: Partial mobilization of the testicle.
Stage 2 (after months): Final fixation in the scrotum.
Benefit: Reduces tension on the spermatic cord, preserves blood flow, increases success rate.

Prophylactic Fixation

Fixation of the healthy testicle using conventional or laparoscopic methods.
Benefit: Prevents future torsion and maintains the health of both testicles.

Contraindications for Orchidopexy

Several conditions may delay or prevent orchidopexy:

High Anesthesia Risk

Patients with a history of severe reactions to anesthesia or underlying heart/lung issues require careful evaluation.

Active Infection

Genital or urinary infections may postpone surgery to reduce complications.

Unidentified Mass or Tumor

Suspicion of a tumor requires further evaluation with imaging or biopsy.

Severe Growth Delay

Children with significant growth delays may not be suitable until health improves.

Bleeding Disorders

Patients with clotting issues or on blood thinners have higher surgical risks.

Uncontrolled Chronic Illness

Conditions such as poorly controlled diabetes, obesity, or other chronic illnesses increase complication risk.

Parental Concerns or Anxiety

Lack of understanding or apprehension from parents may delay or prevent surgery.

Risks and Complications of Orchidopexy

Direct Surgical Complications

Bleeding: Minor scrotal hematoma; rarely requires intervention.
Wound infection: Usually treatable with antibiotics.
Swelling and bruising: Common and resolves within a few days.

Testicular or Functional Complications

Failure of fixation: Sometimes the testicle does not remain in position, requiring reoperation.
Change in scrotal shape or size: Minor differences may be noticed.
Impact on fertility: Very rare, usually occurs if the testicle is already damaged or only one testicle is present.

Neurological Complications

Temporary numbness or tingling in the surgical area.
Rare chronic mild pain in the scrotum or upper thigh.

Psychological Complications

Anxiety or stress is normal post-surgery, especially in children and adolescents.
Family support and counseling help with emotional adjustment.

Recovery After Orchidopexy

Day 1–3:

Mild to moderate pain, swelling, bruising, tension.
Use prescribed painkillers, cold compresses, and elevate the scrotum.
Complete rest and monitor for bleeding or infection.

Week 1 (Days 4–7):

Gradual reduction in swelling and bruising; pain improves.
Light walking allowed; careful movement.
Maintain wound hygiene, gentle bathing, and wear scrotal support if advised.

Week 2–3:

Most pain disappears, swelling minimal, mobility improves.
Resume light daily activities; avoid strenuous sports or lifting.

Week 4–6:

Basic wound healing complete; bruising mostly gone.
Resume most normal activities, but avoid high-intensity exertion as advised.

After 6 Weeks:

Full recovery; the testicle is usually stable in its position.
Most patients return to normal life.
Follow-up ensures proper positioning and absence of complications.

Postoperative Care Tips

Wound Care:

Keep the incision clean and dry.
Use antiseptic or sterile dressings if advised.
Avoid rubbing or scratching.
Contact the doctor if redness, severe swelling, discharge, or foul odor appears.

Pain and Swelling Management:

Take only prescribed pain medications.
Cold compresses for the first 2–3 days.
Elevate the scrotum while resting.

Physical Activity:

Start light walking after 1–2 days.
Avoid strenuous sports or lifting for 4–6 weeks.
Gradual return to daily activities is recommended.

Clothing and Support:

Wear loose clothing or a scrotal support (suspensory) to reduce discomfort.
Avoid tight clothes or belts pressing on the surgical area.

Diet and Hydration:

Drink plenty of water to prevent constipation.
Eat protein- and vitamin-rich meals to aid healing.

Medical Follow-Up:

Attend all scheduled appointments.
Ensure the testicle remains in the correct position and watch for complications.
Report any signs of infection or other issues promptly.