Orchidopexy (pronounced or-kid-o-pexy) is the operation used to bring an undescended testicle down into the scrotum. It's one of the most common elective (optional) surgical procedures in childhood.
If your son has undescended testicles, you'll probably have questions that need answering.
Professor David Thomas, consultant paediatric urologist at Leeds Teaching Hospitals NHS Trust, suggests some questions that you might want to ask your specialist.
What are undescended testicles?
The testes (testicles) develop inside the abdomen and drop (descend) into the scrotum during the second half of pregnancy. Normally, both testicles should be down in the scrotum at the time of birth.
Is an undescended testicle the same as a retractile testicle?
No. Retractile testicles are testicles that have descended at birth, but move around between the scrotum and the groin (this often happens between the ages of three and seven). In most cases, they will stop moving and settle in the scrotum. But a small percentage of retractile testicles don't stay in the scrotum and spend more and more time in the groin. This requires an operation.
What is an ascending testicle?
Some testicles that are fully descended at birth can move back into the groin and stay there. These are called ‘ascending’ testicles. Ascending testicles are believed to account for the second wave of undescended testicle operations for boys aged around 8 to 10 years.
Do undescended testicles hurt?
No, they don’t.
What if it's left undescended?
It’s best not to let it stay undescended. Testicles left in the groin or abdomen gradually lose the ability to produce sperm in later life. They also have a substantially increased risk of developing cancer in adult life.
Will he need an operation?
There's a small chance that an undescended testicle can descend during your son’s first year. However, if it hasn’t come down by this age, he will need an operation called an orchidopexy. This is normally carried out between the age of 12 and 24 months in specialist paediatric centres and at a slightly older age in district hospitals.
What happens?
An orchidopexy is usually performed as day surgery under general anaesthetic. It involves a small incision in the groin, and the testicle is carefully freed from the surrounding tissues. A tunnel is made to the scrotum, taking care to preserve the blood vessels and the vas (the tube that connects the testicle to the urethra). The testicle is repositioned in the scrotum, using a second incision.
What are the complications?
The most serious complication is atrophy, which is when the blood supply to the testicle can’t sustain it in the new position. This causes the testicle to wither away. Other complications include injury to the vas, or the testicle retracting into the groin. A second operation will be necessary for these. The overall risk of these complications is 5% to 7%.
Can having undescended testes affect my son’s future fertility?
If there's one healthy testicle in the scrotum, fertility is largely unaffected. But if both testicles are undescended, research shows that normal fertility is reduced. However, this research is based on surgery that was done 20 to 30 years ago when it was carried out on older boys rather than on infants.
Will it work?
This depends on where the testicles are. If the testicle is fairly close to the scrotum there's a good chance of success. The success rate is reduced for testes that are high in the groin. If the testicle is inside the abdomen, a straightforward operation is rarely possible.
