Orchiopexy (also known as orchidopexy or orchidorraphy) is surgery to move an undescended testicle into the scrotum. It is usually done when babies are about 12 months old by a pediatric urologist. In some cases, the child may be older than that, but it is rarely done in teenagers or adults because the condition is often diagnosed and resolved within a few months after birth.

Undescended Testicle
An undescended testicle is a testicle that does not move into its proper position in the scrotum, the bag of skin hanging below the penis, before birth. The testicle may be in the abdomen, groin, or somewhere near the pubic area. An undescended testicle may occur on one or both sides, but more commonly affects the right testicle. A doctor can usually palpate to find where the testicle is, but sometimes an ultrasound, magnetic resonance imaging (MRI), or even laparoscopy may be needed to locate it.
When testicles are not found in scrotum
  1. A retractile testicle is a testicle that may move back and forth between the scrotum and the groin. It is most commonly found in children between six and seven years of age and almost never once a child becomes a teenager. It often occurs to both testicles. It is common for the testicles to descend back into the scrotum when the child is asleep. Testicles are usually of normal size and can be moved into the scrotum manually. The problem only lasts a brief time and does not require treatment.
  2. An ectopic testicle is one that moved from the retroperitoneum through the external ring and away from the scrotum. In 80% of cases, only one testicle is affected, and in 75% of cases, the testicle is found in the superficial inguinal pouch. The testicle is usually of normal size and spermatogenesis and androgen function are normal. The treatment is surgery. Hormone replacement therapy is ineffective.
  3. Monorchia or anorchia (absence of testes) is rare and only found in 3.3 to 5.2% of cases of undescended testes. It usually affects one side (monorchia) and may be caused by the testicle not developing due to vas deferens hypoplasia or agenesis of the kidneys and/or ureters or due to testicular torsion, causing loss of blood flow and ultimately atrophy, leading to “vanishing testes.”
  1. To maintain the testicle’s ability to produce sperm and hormones. The temperature in the scrotum is 1.5-2.5 degrees Celsius lower than that in the abdomen. The higher temperature affects sperm production. Adults with an undescended testicle that is not treated will only have a 30% chance of conceiving. Adults with two undescended testicles are infertile.
  2. Reduce the risk of prostate cancer by 40-50 times since the inappropriate temperature can stimulate the chance of normal cells into malignant cells.
  3. Allow easier examination of the testicles.
  4. Increase confidence in masculinity.
  5. Reduce the risk of injury from sports or wearing a belt.
  6. Reduce the risk of inguinal hernia or torsion of the undescended testicle, which can be very painful.
A complete health screening will be carried out before the procedure, including blood tests, chest x-ray, electrocardiogram (EKG) and the levels of tumor markers. You will need to avoid all food and water for six to eight hours before the surgery, or as recommended by the doctor. The doctor may explain the importance of biopsy in some patients. If you are taking any prescribed medicines, discuss it with your doctor. You may need to stop taking it before the procedure.
Depending on the location of the undescended testicle, the incision may be made in the crease of the groin or in the lower abdomen to pull the testicle down into the scrotum. In some cases, the doctor may use a laparoscope. Both types of surgery require general anesthesia so you will be asleep during the procedure. One surgery is often enough to resolve the issue, but sometimes another surgery may be required after a few months if the testicle is too high or in the abdomen.
Since this is a simple procedure, you will likely only spend one night at the hospital. If the testicle was located higher in the abdomen, a longer hospital stay may be required.

Avoid contact sports and strenuous activities for a couple of weeks after the procedure. A follow-up appointment will be made for two to three months after the surgery.
  • Excessive bleeding or hematoma.
  • Injury to blood vessels or spermatic cord, leading to atrophy.
  • Recurrence, requiring additional surgery.
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least two to five days or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
This procedure is not complex or complicated and outcomes are generally good, successfully moving the testicle back into the scrotum. Rate of success varies with the location of the undescended testicle(s).
What if this procedure is not performed?
There is a risk of cancer and infertility.
  • In the case of a newborn whose testicle(s) cannot be detected with a physical examination, in two out of three cases, the testicle will descend on its own. If a year has passed and the testicle has not descended, surgery is often required.
  • Hormones may be used as the hypothamus-pituitary testicular axis is a hormonal factor that affects the descent of the testicle. Replacing this hormone may move the testicle into the scrotum without requiring surgery. There are two types of hormones that may be used: human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (Gn-RH) (LHRH: lutenizing hormone-releasing hormone). For children over 12 years old that have reached puberty and the testicle still has not descended, surgery is recommended to prevent cancer.
  • Testicular transfer is the autotransplantation of the testicle that is in the abdomen to the scrotum and connecting the blood vessels using microsurgery techniques.

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