Orchidopexy & Orchidectomy

Orchidopexy, also known as orchiopexy or testicular fixation, is a surgical procedure performed to correct cryptorchidism, which is a condition where one or both testicles fail to descend into the scrotum. This condition is one of the most common congenital malformations in males; if left untreated, it can lead to complications such as infertility and an increased risk of testicular cancer.

Purpose of Orchidopexy

The main goals of orchidopexy are:

To position undescended testicles into the scrotum: Ensuring that the testicle is properly positioned can aid in normal functioning and reduce the risk of complications.
To secure the testicle: The procedure often involves securing the testicle to the scrotum to prevent retraction.
To facilitate examination and detection of potential abnormalities: Proper positioning allows for easier examination of the testicles for any abnormalities in the future.

Indications for Orchidopexy

Undescended Testicles (Cryptorchidism): Most commonly performed in boys whose testicles have not descended by the age of 6 months to a year.
Retractile Testicles: Sometimes performed if a testicle moves back and forth between the scrotum and the groin and is at risk of becoming an undescended testicle.
Acquired Undescended Testicle: Occasionally, a testicle may ascend back into the groin due to a short spermatic cord or post-surgical complications.

Surgical Procedure

Orchidopexy is typically performed under general anesthesia, often as an outpatient procedure. The steps generally include:

Incision: A small incision is made in the groin area where the undescended testicle resides.
Mobilization: The testicle and spermatic cord are carefully mobilized. The surgeon frees enough of the cord to allow the testicle to reach the scrotum without tension.
Creation of Pouch: A small pouch is created in the scrotum to house the testicle.
Placement and Fixation: The testicle is placed into the pouch and securely stitched into place to prevent retraction.
Closure: The incisions are closed with sutures that typically dissolve over time.

Recovery and Outcome

Postoperative Care: Recovery involves managing minor pain and swelling. Activities may be restricted for a short period to allow healing.
Follow-Up Visits: Are important to ensure the testicle remains in the correct position and is developing properly.
Long-Term Outlook: Most boys who undergo orchidopexy early in life have a good chance of having normal testicle function, which includes potential for fertility and reduced risk of cancer.

Complications

Though generally safe, orchidopexy can have potential complications, including:

Bleeding or infection at the incision site
Damage to the testicle or spermatic cord
Atrophy of the testicle: Rare but may occur if the blood supply is compromised during surgery.

Orchidopexy is a critical procedure for boys born with cryptorchidism, significantly impacting future health and fertility. Parents are encouraged to discuss this procedure with a pediatric urologist to understand the timing, risks, and expected outcomes thoroughly.

Understanding the concerns of families, Dr. Mishra provides detailed explanations about the reasons for the surgery, the expected outcomes, and the importance of follow-up. He ensures that parents are well-informed and comfortable with the care plan for their child.

Dr. Saurabh Mishra's commitment to excellence in pediatric urology makes him a trusted choice for orchidopexy, offering expert care tailored to the unique needs of his young patients and their

Orchidectomy

Orchidectomy, also known as orchiectomy, is a surgical procedure involving the removal of one or both testicles. It is a common treatment for testicular cancer and can also be used in the management of prostate cancer to reduce testosterone levels, which can help slow the growth of the cancer.

Types of Orchidectomy

There are several types of orchidectomy procedures, depending on the purpose and extent of surgery required:

Simple Orchidectomy: Involves the removal of one or both testicles through a small incision in the scrotum. This is often performed for testicular cancer or advanced prostate cancer.
Subcapsular Orchidectomy: Involves removing the glandular tissue that produces testosterone from within the testicles, leaving the outer shell intact. This method is less common but may be used for treating prostate cancer.
Radical Orchidectomy: Typically used to treat testicular cancer, this procedure involves the removal of the entire testicle along with the spermatic cord and, in some cases, nearby lymph nodes. This is more extensive and is intended to prevent the spread of cancer.

Indications for Orchidectomy

Testicular Cancer: The primary treatment for testicular cancer is the removal of the affected testicle, which helps prevent the spread of cancer.
Prostate Cancer: Used to decrease testosterone levels, which can help slow the growth of prostate cancer cells.
Breast Cancer in Men: Rarely, used in the treatment of male breast cancer.
Gender Confirmation Surgery: Part of the transition process for transgender women.
Severe Trauma: Removal of a testicle may be necessary after significant injury.

Procedure Details

The procedure is typically performed under general anesthesia, though local anesthesia and sedation may be used in simpler cases. For a simple orchidectomy, the surgeon makes an incision in the scrotum, removes the testicle, and then closes the incision with stitches. In a radical orchidectomy, the incision may also be made in the groin to access the spermatic cord and lymph nodes if necessary.

Recovery and Aftercare

Recovery time can vary depending on the type of orchidectomy performed:

Postoperative Care: Pain in the surgical area is common, and prescription pain medication may be provided. Swelling and bruising may also occur.
Activity Restrictions: Patients are generally advised to avoid heavy lifting and strenuous activities for several weeks to allow proper healing.
Follow-Up: Regular follow-up visits are necessary to monitor recovery and manage any potential complications. If the orchidectomy was performed for cancer, additional treatments such as chemotherapy or radiation may be needed.

Risks and Complications

Possible complications from orchidectomy include:

Infection
Bleeding
Changes in hormone levels, which can affect sexual function and mood if both testicles are removed.
Psychological Impact: Removal of a testicle can have significant emotional and psychological effects, particularly in terms of body image and sexual identity.

Outcomes

Orchidectomy is typically very effective in removing the source of cancer or in reducing testosterone levels for the treatment of prostate cancer. When performed for testicular cancer, it often results in a high cure rate, especially when combined with other treatments like chemotherapy or radiation if needed.

Individuals considering an orchidectomy should discuss all aspects of the procedure, including potential risks and benefits, with their healthcare provider to make an informed decision based on their specific medical conditions and overall health objectives.