Orchiopexy for Intra-Abdominal Testis

Introduction

Undescended testis occurs during the stage of fetal development and is characterized by the failure of one or more testis to descend (to move down in a lower place) into the scrotum from the abdomen during the development. Orchiopexy is a surgical technique performed to bring an undescended testicle (a testicle that does not move down in its proper position) into the scrotum and fix its position there. However, if the testicle is located within the abdomen, an alternative approach known as an "abdominal orchiopexy" or "orchiopexy for intra-abdominal testis may be required." The overall success rate of this procedure varies from 65 to 70 percent. This article further discusses the surgical procedure, indications, complications, and clinical outcomes of the orchiopexy procedure.

What Are the Indications of Orchiopexy Procedure?

The primary indication for orchiopexy is the management of undescended testes by repositioning it in the correct position and location. Undescended testes occur when one or both testicles fail to descend from the abdomen into the scrotum during fetal development. Orchiopexy procedure is recommended in the following situations:

• Infertility: Undescended testes are associated with reduced fertility due to reduced or impaired production of sperm. By moving the testicle normally in the scrotum, the orchiopexy procedure can help in preserving fertility.

• Increased Risk of Testicular Cancer: Men with untreated undescended testes have a greater risk of developing testicular cancer later in life. Orchiopexy reduces this risk by placing the testicle in its proper position, which allows for regular self-assessment and prompt detection of any abnormalities.

• Inguinal Hernia: Undescended testes are often associated with the formation of a bulge in the groin area (inguinal hernias), where part of the intestine protrudes through a weak spot in the abdominal wall. The orchiopexy procedure helps prevent inguinal hernias by repositioning the testicle back in the scrotum and closing off the potential pathway for hernia.

• Trauma: Testicles located in the abdomen are more susceptible to injury due to their abnormal position. Orchiopexy relocates the testicle to the scrotum and, in turn, prevents any trauma or damage to the testis.

• Psychosocial Impact: Undescended testes can result in a significant impact on the brain, resulting in psychological distress and embarrassment for the affected individual, particularly during adolescence and adulthood. Orchiopexy can help alleviate these concerns by placing the testicle in its normal anatomical position.

It is important for patients with undescended testes to undergo a thorough evaluation by a healthcare provider or doctor to determine the need for an orchiopexy procedure and to discuss the potential risks and benefits ratio of the procedure.

How Is Orchiopexy Procedure Performed for Intra-Abdominal Testis?

This surgical procedure involves moving the testicle from its abnormal position in the abdomen to the normal position within the scrotum. This is typically done to prevent potential complications associated with undescended testes, such as infertility, testicular cancer, and inguinal hernias. The step-by-step procedure for orchiopexy involves:

• Patient Preparation: The patient will usually undergo preoperative assessments by the healthcare specialist, which may include blood tests, imaging studies (radiographs), and vitals measurements.

• Administration of Anesthesia: General anesthesia is usually administered to the patient to make sure the procedure is painless.

• Surgical Incision: An incision (surgical cut) is placed in the ipsilateral hemiscrotum near the dartos fascia - muscle of the scrotum (near the groin area) using a surgical blade. The location of the cut may differ based on the location of the undescended testis. A minimally invasive approach, such as a laparoscopic approach (a thin tube attached to a camera), can also be performed for increased visibility.

• Dissection: The surgical dissection (layer-by-layer separation of muscles) is done cautiously until the testis is located. The nerves and vessels encountered during dissection are protected.

• Mobilization: After the testis is exposed, the surgeon will move the testis carefully from the abdomen into its normal position in the scrotum. Any associated structures are dissected, and pathologies are managed before the test is repositioned.

• Pathway Creation: If necessary, the surgeon may create a pathway or tunnel from the abdomen to the scrotum to facilitate the descent of the testis.

• Repositioning in the Scrotum: The testicle is then gently pulled down into the scrotum and secured in its normal position using sutures (stitches) or other fixation techniques.

• Surgical Closure: The incisions are closed with black silk sutures or surgical staples, and a sterile dressing may be applied to the surgical site.

• Recovery and Follow-Up: After the procedure is done, the patient will be monitored in the recovery area. Pain medication and antibiotics are prescribed to manage discomfort and prevent post-surgical infection. Patients will usually have to follow-up with the surgeon to monitor healing of the surgical site and ensure that the testicle remains in its new position.

What Are the Potential Complications Associated With Orchiopexy?

A few complications associated with this surgical procedure are:

• Uncontrolled Bleeding: Any damage to the underlying nerves and vessels during the procedure can result in excessive bleeding.

• Recurrence: Although it is rare, recurrence of the undescended testis might occur in a few cases.

• Damage to Vital Structures: There is a chance of damage to the underlying nerves and vessels during the procedure.

Patients and healthcare providers should collaborate to assess the need for orchiopexy on a case-by-case basis, considering individual conditions and weighing the potential risks and benefits of the procedure.

Clinical Outcomes of Orchiopexy Procedure

Clinical outcomes of this procedure for intra-abdominal testis are quite positive. A few positive clinical outcomes achieved from this procedure are:

• Successful testicular descent.

• Improved fertility of the affected individual.

• Mitigation of the risk of testicular cancer.

• Prevention of formation of inguinal hernias.

• Protection against external trauma.

• Enhancing patients' psychosocial or mental well-being.

Conclusion

Orchiopexy serves as a crucial approach for correcting undescended testes. This surgical procedure is warranted to mitigate potential complications associated with the condition, including infertility, increased risk of testicular cancer, inguinal hernias, susceptibility to trauma, and psychosocial distress. Early intervention with orchiopexy is key to achieving optimal outcomes and improving the long-term health and well-being of individuals with undescended testes. Through timely and appropriate surgical management, orchiopexy offers a promising solution for addressing undescended testes and enhancing overall reproductive health and quality of life.