Orchydopexy is a surgical procedure in which a testicle is located above the scrotum where it should be. This common condition, affecting around 2% of male infants, is important to treat in view of potential problems that might otherwise arise, such as issues with proper sperm production in the future. Moreover, the risk of developing testicular cancer is higher in an undescended testicle compared to a normally descended one.
Diagnosis
The testicles generally descend from the abdomen into the scrotum during the fetal stage (around the 28th week of the mother's pregnancy). This descent is believed to be driven by the male hormone testosterone. If after birth a testicle is not found within the scrotum but remains in the groin area, no immediate action is necessary; the testosterone level in newborns remains elevated for about six months and there is a good chance (around 80%) that the testicle will descend spontaneously during this time. It is however advisable that the condition be monitored by a pediatrician or a family doctor.
Around the age of six months, if the testicle is still undescended into the scrotum, parents should consult with a pediatric urologist. If the urologist can palpate the testicle within the scrotum or, alternatively, if the testicle descends into the scrotum during the doctor's examination, surgery is not needed. However, if the testicle is not palpable and remains undescended during the examination, the child should undergo surgery to bring down the testicle into the scrotum and secure it there. Delaying this surgery could lead to complications, such as impaired testicular development resulting in a smaller testicle compared to the normal one.
The surgical procedure involves making a small incision in the groin, gently separating the testicle while preserving its blood vessels and spermatic cord, and then securing the testicle within the scrotum. After the surgery, the incision is closed, usually with adhesive materials, ensuring good cosmetic results. The child can resume regular activities after a few days, and the dressing can be removed after around five days.
Undescended Testicle within the Abdomen
If, at the age of six months, the testicle is not palpable at all during a physical examination by a pediatric urologist, the child should undergo a diagnostic laparoscopy to locate the testicle within the abdomen. In this procedure performed under general anesthesia, a tiny camera is inserted into the abdomen to visualize the internal structures. If the testicle is found within the abdomen, it can be brought down into the scrotum and secured using a laparoscopic approach without making a standard incision.
Retractable Testicle
If in the initial examination, the testicle is found within the groin but can be easily maneuvered into the scrotum during the examination, this condition is called a retractable testicle. Generally, this condition resolves on its own over time and doesn't require surgery. Annual follow-ups with a pediatric urologist can ensure that the testicle continues to descend into the scrotum. The estimated time for the testicles to stabilize and stop being retractable is around age 12-13, with the onset of puberty.
