In human beings testicles are situated inside the sac beneath the scrotum (penis). In a foetus testicles are formed inside the abdomen which descends into its final position by the time the baby is born. In some cases the testicles do not move downwards to its exact location and remains somewhere in between. Such testicles are referred as undescended testicles. Undescended testicles are classified based on the position where they are remaining at the time of birth and whether they can be felt or not (palpable or non palpable)
Abdominal: Testicles which remain inside the abdomen are included in this category. They come under the category of non palpable also.
Inguinal: Testicles which have descended up to the inguinal canal comes under this category. They are not usually palpable.
Prescrotal or prepubic: The testicles which have further descended, but did not reach the scrotum comes under this category. They are usually palpable.
The surgery conducted to move the undescended testicles to its intended position is known as orchidopexy. This surgery is generally carried out in children who are 9 to 15 months old. Orchidopexy is usually done by a paediatric urologist who is a specialist in the urinary problems of the infants. This surgery will be done on adults also if they have undescended testicles.
One or two incisions are made in the groin, scrotum or abdomen depending upon the position of the undescended testicles so that the surgeon can reach the testicle and carry out his intention of moving them to scrotum. But when the testicle is positioned in the abdomen, two separate surgeries will be required and these will be normally conducted months apart. When the testicles are found in higher regions like inguinal canal or in the abdomen, orchidopexy can be conducted as a laparoscopic procedure. Laparoscopic procedure is conducted through three or four small incisions in the body near the area where the testicle is located. Through one of these incisions a laparoscope is inserted and through other incisions special instruments for carrying out laparoscopic surgery are inserted. Laparoscope is an instrument with a camera on one end of a long flexible tube, the other end of which is connected to a video output placed in from of the surgeon in the operation theatre.
By seeing the video of the surgery through the monitor the surgeon carries out the surgery remotely controlling the special instruments inserted for this purpose. After surgery, the instruments and the laparoscope are taken back through the incision through which they were inserted and the incisions are stitched together. Both the open procedure and laparoscopic procedure are conducted under general anaesthesia.
Benefit of this surgery
1. It helps to prevent infertility.
2. It reduces the risk of testicular cancer
3. It boosts the self esteem of the boy
4. It helps to reduce the risk of testicular injuries
What happens after the surgery?
This surgery is usually done as an outpatient service. When the testicles are in lower positions the surgical procedure will be much simpler. After the surgery the boys should avoid taking part in activities like sports, games etc to avoid injury to the genital area. The doctor will conduct post operative examination after two three months to ascertain whether there is any post operative complications.