Orchidopexy (bringing down of an undescended testis)

Q 1. What does the procedure involve?

A. This involves incisions in the groin and in the scrotum to bring the testis down into the correct position within the scrotum.

Q 2. What are the alternatives to this procedure?

A. Observation risks the development of cancer in the undescended testis, twisting of the testis in the groin, psychological problems (in children).

Q 3. What should I expect before the procedure?

A. You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc
• You are taking prescription drugs like-
  • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
  • Anti-epileptics like phenytoin, valproate etc.

Q 4. What happens during the procedure?

A. A full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) may be used. Your anaesthetist will explain the pros and cons of each type of anaesthetic to you.

A small incision is made in the groin to locate the testis and free its attachments so that it can be brought down into the scrotum. There is usually a small hernia in the groin associated with the testis which needs to be tied off. A second incision is then made in the scrotum to receive the testis where it is anchored to prevent twisting and further retraction.

Q 5. What happens immediately after the procedure?

A. You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal.

Q 6. What is the duration of stay?

A. The average duration of stay is 24 to 36 hours.

Q 7. What are the side effects/complications?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

• Swelling of the scrotum lasting several days
• Seepage of yellowish fluid from the wound several days after surgery

Occasional (between one in 10 and one in 50)

• Infection of the testis or the incision requiring further treatment
• The testis may remain slightly high in the scrotum
• It may not be possible to bring the testis down and this may mean removal of the testis
• Chronic pain in the testicle or scrotum

Rare (less than one in 50)

• Bleeding requiring further treatment
• The testis may shrink (atrophy) due to poor blood supply after the operation
• Future fertility cannot be guaranteed
• The procedure may need to be repeated if the operation is not wholly successful

Q 8. What should I expect when I get home?

A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.

In young adults, a period of 10 to 14 days off work is advisable.

Q 9. What else should I look out for?

A. If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.

Q 10. What are other important points?

A. Ideally, the surgery should be performed before the child reaches the age of two to give the best chance of testicular development.

A successful operation reduces the risk of testicular cancer but not to a completely normal level. Future fertility may still be impaired, even if only one testis is affected and, when both testicles are affected, impairment of fertility in later life is common.

A follow up outpatient appointment will be arranged within first week of discharge, followed by six to eight weeks after the operation to assess the cosmetic result.