How is the Surgery for Undescended Testes Performed? What Happens After the Surgery?: Undescended testes, also known as cryptorchidism, is one of the most common congenital anomalies seen in male infants. It affects approximately 1% to 3% of full-term and up to 30% of preterm male neonates. In most cases, the condition corrects itself within the first few months of life. However, when spontaneous descent does not occur by six months of age, surgical intervention is usually recommended. This article provides a comprehensive overview of how surgery for undescended testes is performed, what to expect after the surgery, and the long-term outlook for affected individuals.
Understanding Undescended Testes
During fetal development, the testes form in the abdomen and gradually descend into the scrotum through the inguinal canal. In cases of undescended testes, one or both testes fail to descend completely. The condition may be classified into:
- Palpable undescended testes: The testis can be felt in the inguinal canal or just outside the scrotum.
- Non-palpable undescended testes: The testis cannot be felt during physical examination; it may be intra-abdominal, absent, or atrophic.
If untreated, undescended testes can lead to infertility, increased risk of testicular cancer, inguinal hernia, and psychological impact due to asymmetrical scrotal appearance.
Indications for Surgery
According to the American Urological Association (AUA) and European Association of Urology (EAU) guidelines, surgical correction—known as orchidopexy—is recommended between 6 and 18 months of age. Delaying treatment may reduce the chances of preserving fertility and increase long-term complications.
Preoperative Evaluation
Before surgery, the following evaluations are typically carried out:
- Physical Examination: To determine whether the testis is palpable.
- Ultrasound or MRI: For non-palpable testes to identify intra-abdominal location.
- Hormonal Tests: In select cases, to differentiate between absent and undescended testes.
- Informed Consent: The parents are educated about the procedure, risks, and expected outcomes.
Surgical Techniques
1. Open Orchidopexy
This is the most common procedure used for palpable testes. It involves the following steps:
- Inguinal Incision: An incision is made in the groin to access the testis.
- Mobilization: The testis and spermatic cord are carefully mobilized.
- Placement: The testis is then placed and fixed within a pouch in the scrotum.
2. Laparoscopic Orchidopexy
This approach is used when the testis is non-palpable or intra-abdominal.
- Diagnostic Laparoscopy: A camera is inserted through a small incision to locate the testis.
- Two-Stage Fowler-Stephens Procedure: If the testis is high and cannot be mobilized in one stage, this technique involves dividing blood vessels in the first stage and repositioning the testis in the second stage, after 6 months.
- Single-Stage Orchidopexy: When adequate cord length is achieved during the same surgery.
3. Microsurgical Techniques
Advanced centers use microsurgical techniques to preserve the delicate vas deferens and testicular vessels, especially important in bilateral cases to preserve fertility.
Anesthesia and Duration
- Surgery is performed under general anesthesia.
- The procedure usually takes 45 minutes to 1 hour.
- It is commonly done as a day-care surgery, meaning the child can return home the same day in most cases.
Postoperative Care and Recovery
1. Pain Management:
- Mild discomfort is expected, managed with oral painkillers like paracetamol.
2. Wound Care:
- The incision site should be kept clean and dry.
- Stitches, if non-absorbable, may be removed in a week.
3. Activity Restrictions:
- The child should avoid strenuous activity for 2-3 weeks.
- Diapering and gentle handling are advised in infants.
4. Follow-Up:
- A follow-up visit is usually scheduled within a week to monitor healing.
- Long-term follow-up may be needed to assess testicular growth and position.
Expected Outcomes
- The success rate of orchidopexy is over 95% in experienced hands.
- Early surgery (before 12-18 months) offers better preservation of spermatogenic function.
- Psychological and cosmetic outcomes are excellent in most cases.
Complications
Although rare, the following complications may occur:
- Testicular Atrophy: Due to compromised blood supply.
- Recurrence: The testis may re-ascend if not adequately fixed.
- Infection or Hematoma: At the surgical site.
Long-Term Monitoring
Children who undergo orchidopexy should be monitored through adolescence to:
- Confirm testicular position and volume.
- Screen for early signs of testicular malignancy, especially in high-risk cases.
- Evaluate fertility status in adulthood if needed.
Recent Trends and Research
- Hormonal Therapy (e.g., hCG or GnRH): Once considered as a non-surgical treatment, but now largely discouraged due to poor efficacy and potential testicular damage (Kollin et al., J Urol, 2007).
- Laparoscopy vs. Open Surgery: A study in the Journal of Pediatric Urology (2020) found that laparoscopic orchidopexy offers superior cosmetic results and quicker recovery for non-palpable testes.
- Fertility Outcomes: Recent meta-analyses confirm that early orchidopexy significantly improves fertility potential, especially if done before 1 year of age (Thorup et al., Lancet Child Adolesc Health, 2017).
Why Choose Institute of Urology, Jaipur?
At the Institute of Urology (IOU), Jaipur, the management of congenital conditions like undescended testes is conducted with exceptional precision and empathy. Dr. M. Roychowdhury, with over three decades of clinical experience, and Dr. Rajan Bansal, known for his skill in advanced minimally invasive urological procedures, lead a team that specializes in modern, patient-friendly surgical care.
Our hospital is equipped with cutting-edge surgical infrastructure, including high-definition laparoscopy, microsurgical tools, and a child-friendly surgical environment. We believe in individualised treatment plans, conducting only necessary investigations, and focusing on optimum outcomes with minimal discomfort.
In addition to surgery, the Institute offers complete urological and general surgical facilities under one roof, including consultations, diagnostics, imaging, and postoperative care. Our unwavering commitment to clinical excellence, ethical practice, and patient satisfaction makes us the preferred destination for paediatric and adult urological treatments in Rajasthan and beyond.
Conclusion
Surgery for undescended testes is a well-established, safe, and effective procedure. Timely intervention by experienced surgeons not only resolves the physical anomaly but also significantly reduces the risk of infertility and malignancy later in life. With a proactive approach and modern surgical methods, children affected by this condition can look forward to a healthy and confident future.
For trusted and expert care in treating undescended testes and other urological conditions, the Institute of Urology, Jaipur, stands out as a beacon of excellence and reliability.
Our doctors can be reached Monday to Saturday during working hours.
Dr. M. Roychowdhury – 9929513468/ 9829013468
Dr. Rajan Bansal – 8601539297
References:
- Kollin, C. et al. (2007). Surgical treatment for undescended testicles: when and how? Journal of Urology.
- Thorup, J. et al. (2017). Timing of orchidopexy and long-term outcome. Lancet Child Adolesc Health.
- Braga, L.H. et al. (2020). Outcomes of laparoscopic versus open orchidopexy. Journal of Pediatric Urology.
