By: Janice Taylor MD, MEd, FAAP
As a baby boy grows in the womb, the testicles first develop in the abdominal cavity. Then, they work their way down into the scrotum, which is the sac of skin on the outside of the body that holds the testicles. When one or both of the testicles do not make it into the scrotum by the time a baby is born, the condition is called undescended testicle.
Children diagnosed with undescended testicles often need surgery to prevent certain health problems later. The surgery to repair an undescended testicle is called orchiopexy.
What is undescended testicle repair surgery (orchiopexy)?
Orchiopexy surgery is done to move a young boy's testicle(s) from their abdomen into the scrotum. Sometimes, just one surgery is needed. If the testicle is still in the abdomen and not close to the groin, however, your child may need two surgeries to get it into the right place. Your surgeon will tell you if this is what your child needs.
Why does my child need surgery for an undescended testicle?
Surgery to bring the testicle down into the scrotum is for more than just to make the sides "match." If the testicle is not in the scrotum, it is difficult to check for abnormal lumps or tumors in the testicle, particularly later in life. Undescended testicles have a higher rate of getting certain types of cancer, so having them in an easy-to-find area is important.
There may also be worries about fertility in the boy's future, especially if both testicles are undescended. Surgery to bring down the testicle(s) then gives the boy the best chance to have children in the future. If the testicle is not attached in the scrotum, there is a higher chance that it could twist on its blood vessels (called testicular torsion), with the risk of the testicle dying. If the undescended testicle is located abnormally up at the level of the pubic bone, it may have a higher risk of trauma since it is not in the scrotum.
How is the surgery performed?
For typical surgeries, a small incision is made in the groin area and the testicle is found. It is freed up and brought down into the scrotum. Usually, another small incision is made at the bottom of the scrotum so that the testicle can be brought down to the correct level, and sewn in place.
If the undescended testicle is found when your child is an infant, surgery may be delayed until at least 6 months of age. If the testicle begins to drop on its own during the first 6 months, then many surgeons will allow more time to see if the testicle(s) will fully drop into the scrotum on their own by your child's first birthday.
What happens around the time of surgery?
Your surgeon's office will give you specific details, but generally your child should not have any solid food (including formula and milk) for 8 hours before surgery. Stop drinking clear liquids (apple juice, water) by 2 hours before surgery.
If your child has other medical conditions, they may be required to come to the hospital the day before or stay longer after surgery.
When can we go home after surgery?
Unless your child needs to stay in the hospital overnight because of other medical conditions, you will be sent home from the recovery area on the day of surgery.
What will recovery be like for my child?
Instructions for care after surgery can be different based on the child or type of surgery.
Generally, pain will be helped with over-the-counter medicines like Tylenol. Your surgery team may have also injected numbing medicine under the skin of the incision while your child is asleep during surgery, and this will help with pain on the first day. Expect some swelling or bruising in the surgery area, which can take up to a few weeks to go away.
Most patients will be able to eat right after surgery. Bathing instructions will be given to you by your surgeon, but typically your child will be able to fully bathe within a week of surgery. Activity should be light for the first 1-2 weeks after surgery, and your surgeon will give you their specific instructions.
When should I call the surgeon's office?
Your surgeon will give you specific instructions for calling their office. Typically, the instructions are to call for:
Bleeding or drainage from the incision(s)
Redness around the incision(s)
Fever above 101 F
Less peeing than usual or fewer wet diapers than usual
Will my child need to see the doctor after surgery?
You should notify your pediatrician's office of your child's surgery for any needed follow-up with them.
For your surgeon, you will be given specific instructions to see them after surgery. They may want to see your child for a follow-up exam after any swelling has gone down after surgery. If your child needs more than one planned operation for the undescended testicle, the surgeon may also want to see them again before the next surgery.
About Dr. Taylor
Janice Taylor MD, MEd, FAAP is an associate professor of surgery in the division of pediatric surgery at the University of Florida College of Medicine. She is a specialty fellow of the American Academy of Pediatrics (AAP) who serves on the AAP Section on Surgery, Patient-Family Education Subcommittee. Dr. Taylor is also a member of the Association for Surgical Education, Association for Academic Surgery and the American Pediatric Surgical Association, American College of Surgeons.