Orchydopexy is a surgical procedure in which a testicle is located above the scrotum where it should be. This condition is common, affecting around 2% of male infants. It's essential to understand the significance of treating orchydopexy due to potential implications of not addressing this condition. For instance, in untreated cases, there could be issues with proper sperm production in the future. Moreover, the risk of testicular cancer development is higher in an undescended testicle compared to a normally descended one.
Diagnosis of undescended testicle
During pregnancy, the fetal testicle is found within the abdomen and gradually descends into the scrotum around the 28th week. This descent is thought to be driven by the male hormone testosterone. If after birth, the testicle is not found within the scrotum but remains in the groin area, no immediate action is necessary. It's advisable to monitor the child's condition with a pediatrician or a family doctor. The likelihood of spontaneous descent of the testicle into the scrotum during the first six months of life is high, around 80%. The testosterone level in newborns is elevated and then declines after six months. Virtually no spontaneous descent is expected after the age of six months.
Around the age of six months, if the testicle is still undescended into the scrotum, parents should seek consultation 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, which is the beginning of puberty.