What is it?
In the time before a male baby is born, the growing testicles have to travel from just below the ribs at the back, to their proper place in the scrotum. Sometimes one or both testicles do not get down as far as they should. Most often they lodge in the groins. Sometimes they are higher. Then they are called undescended or maldescended testicles. It is not the fault of either parent.
Your child will have a general anaesthetic, and will be completely asleep. A cut is made overlying the groin. There is sometimes a small hernia (weak spot or gap in the muscles in the front of the tummy) just next to the testicle which is fixed and then closed with stitches. The testicle is found. Its artery and vein (the pipes that give and drain blood respectively) and connecting tubes are freed off as much as possible. This will make them long enough to allow the testicle to sit in the scrotum without any tension. A second cut is made in the scrotum and some space is created under the skin and the supporting tissues of the skin. . The testicle is then fixed with stitches in the scrotum in its proper place. The skin is then stitched up in both places. The operation takes about 20 minutes a side.
If you leave things as they are, the testicle will not come down any further. It can get damaged by being in the wrong place. There may be a problem with your child fathering children in the future. Hormone treatment does not work. Sometimes it is best to wait for a few months until your child is bigger. This makes the testicle easier to free and the anaesthetic is easier to administer. If the surgeon cannot find the testicle, a special examination inside your child's tummy will need to be done at a later date to help locate it. If the testicle will not come down far enough at the first attempt, a second operation at a later date will be needed. Some surgeons stitch the testis and the skin of the scrotum to the side of the thigh. This is hardly ever needed.
Before the operation
Your child must have nothing to eat or drink for about six hours before the operation. This means not even a sip of water. Your child's stomach needs to be empty so that the anaesthetic can be administered safely. If your child has a cold in the week before admission to hospital, please telephone the ward and let ward sister know. The operation will usually needs to be put off. Your child has to get over the cold before the operation can be done because by having an anaesthetic the cold could turn into a serious infection in the chest.
Sort out any tablets, medicines, and inhalers that your child is using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, your child may be checked for past illnesses and may have special tests to make sure that he is well prepared and that your child can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you and your child visit for an hour or two, a week or so before the operation for your child to have these checks.
After - in hospital
Your child may not notice any particular pains. If necessary he can take paracetamol liquid. By the end of one week the wound should be virtually pain-free. Your child will be able to drink again two to three 2-3 hours after the operation. He should be able to eat normally the next day. Usually you can take your child home on the day after the operation. You may be given an appointment to bring your child to the outpatient department a month after leaving hospital for a check-up. Sometimes the family doctor checks the wound.
After - at home
Your child may need frequent sleeps for a day or two. Although it is usually difficult to limit what he does, try to help your child avoid any excess physical activity for four to six weeks after the operation. The groin wound is usually held together with stitches underneath the skin that dissolve and don’t need to be removed. There may be stitches in the groin wound and in the little wound in the scrotum. These stitches should melt away after 7 to 10 days. It is rare for the stitches to need taking out. There may be some bruising of the surrounding skin which improves in two to three days. This is expected and you and your child should not worry about it. Your child can wash after the operation but try to keep the wound area dry until the stitches melt away or for about a week if there only stitches under the skin. Salt water is not necessary. If your child goes to school, he can return to lessons after about 10 days. He can restart any sport in four to six weeks.
As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs. The tests that your child will have before the operation will make sure that he can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
There is often some swelling and even some redness around the wound. These usually settle in three or four days. Bleeding is very rarely a problem and gets settled with some extra pressure on the wound area. Extremely rarely, another operation may be needed to stop the bleeding. Infection in the wound area is a rare problem and settles down with antibiotics in a week or two. The same is true for some swelling of the testicle, which happens rarely and is usually settled by taking antibiotics for a week or two. Sometimes the stitches take a month or more to drop out of the wound. This happens and you and your child should not worry about it.
In about 10% of cases, one or both testicles cannot be brought down into the scrotum or the testicle draws back up into the groin again. Another operation is necessary to fix this problem. In 5% of cases, there may be some shrinkage of the testicle after the operation or, very rarely, the testicle can become necrotic (dying). This happens because the blood supply to the testicle can be partly or completely damaged during the operation. The surgeon will discuss these problems with you and your child if they happen.
Another rare complication that can happen during this operation is damage to the structures that carry the sperm from the testicle. This can have an affect on your child’s fertility in the future (his ability to father children) since one of his testicles will not contribute sperm. You should discuss the possibility of this rare complication with your surgeon.
One important thing to keep in mind is that children with undescended or maldescended testicles have a higher risk (some studies show as much as 10 times higher) of developing testicular cancer compared with children who don’t have this problem. This risk is the same for the testicle(s) that needs to be brought down as well as for the testicle that is in the correct place. The orchidopexy does not reduce the chances of cancer developing but allows for both testicles to be examined easily, properly and regularly to detect any developing tumour as early as possible.
The operation can be a little painful for a week or two. You and your child will need to be patient. These notes should help you and your child through his operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.