Orchiopexy is a surgical procedure used to correct congenital cryptorchidism, primarily aimed at relocating undescended testes into the scrotum. This surgery effectively reduces the risks associated with ectopic testes, such as malignancy, impaired fertility, and psychological effects. It is generally recommended to be performed during infancy (6 to 12 months) to ensure proper development of testicular tissue at normal body temperature.
The goal of the procedure is to improve blood supply and position of the testes, placing them in the scrotum's optimal temperature environment to reduce abnormal sperm production caused by high temperatures. This treatment is also suitable for adolescents or adults with testicular retraction due to trauma or pathological factors, and should be evaluated and performed by urologists or pediatric surgeons.
Orchiopexy mainly divides into open surgery and laparoscopic surgery. Open surgery involves small incisions in the groin or scrotum to directly locate and fix the testes; laparoscopic surgery uses endoscopic techniques, reducing tissue damage and shortening recovery time.
The surgical mechanism involves three steps: first, cutting the ligament restricting testicular movement; second, placing the testis in the appropriate position within the scrotum; and third, suturing and fixing to prevent retraction. This process can improve blood flow to the testes and place them at an appropriate temperature, promoting normal physiological function.
The main indications include congenital unilateral or bilateral cryptorchidism, with surgical age typically between 6 and 18 months. If untreated beyond 2 years old, testicular tissue may have irreversible damage, but surgery is still recommended to reduce health risks.
Other applicable cases include intra-abdominal cryptorchidism, cases unresponsive to hormonal therapy, and temporary testicular retraction caused by trauma or inflammation. Treatment plans should be determined after ultrasound or physical examination confirms testicular position.
This surgery requires general anesthesia, with hospitalization lasting about 1 to 3 days. The duration depends on complexity: approximately 1-2 hours for unilateral and 2-3 hours for bilateral procedures. Postoperative care includes using compression bandages to reduce swelling and regular follow-up on testicular position and function.
There are no medication dosage issues, but antibiotics are used to prevent infection. Postoperative care involves avoiding strenuous activities for 4-6 weeks, with regular semen analysis and ultrasound examinations to ensure normal testicular recovery.
The laparoscopic approach results in smaller incisions and faster recovery, with less visible scarring. Long-term follow-up indicates that over 90% of patients achieve anatomical correction.
Common short-term risks include local hematoma (about 5-10%), infection (0.5-2%), and anesthesia-related complications. Rare cases may lead to testicular atrophy or ischemia, requiring immediate reoperation for correction.
Serious complications include vascular injury causing testicular necrosis and scrotal thrombosis, with an incidence below 1%, but requiring emergency treatment. Postoperative monitoring for fever, persistent bleeding, or testicular pain is essential.
Contraindications include acute infection, coagulation disorders, or contraindications to general anesthesia. Preoperative assessment of testicular viability is crucial; if the tissue has become fibrotic, surgery may not be recommended.
Postoperative restrictions include avoiding heavy lifting for 3 weeks. Pediatric patients should delay vigorous activities for 2-4 weeks to prevent suture rupture. Patients with diabetes or immune deficiencies require adjusted antibiotic dosages and closer monitoring.
Patients on anticoagulants should discontinue medications like warfarin 7 days before surgery. Hormonal treatments (such as human chorionic gonadotropin) may have synergistic effects and should be stopped 4 weeks prior to surgery.
Timing with other abdominal surgeries should be spaced at least 6 months apart to avoid increased surgical difficulty due to adhesions. Anesthetic drugs may interact with chronic medications (e.g., cardiac drugs), requiring joint assessment by anesthesiologists.
Large studies show that 85-95% of patients operated on within 6 months achieve normal anatomical positioning. Twenty-year follow-up indicates that the risk of testicular cancer post-surgery decreases to approximately 0.3-0.5%, similar to that of the general population.
Fertility outcomes show an average increase of 40% in sperm count and motility after surgery, with testicular function maintained into adulthood. Randomized controlled trials confirm that laparoscopic procedures have 30-40% fewer complications compared to traditional surgery.
Hormonal therapy with human chorionic gonadotropin can be attempted within 6 months for cryptorchidism, but success rates are only 15-20%, with potential cardiovascular side effects. For adults with atrophic tissue, orchiectomy may be necessary to prevent malignancy.
Observation and waiting are suitable only for infants with spontaneous descent, but medical guidelines recommend surgery if descent does not occur by 12 months to prevent long-term complications.
Before surgery, a detailed physical examination and imaging tests (such as ultrasound) are necessary to confirm testicular position and blood vessel status. Pediatric patients typically need to fast for 6 to 8 hours, and adults may need to stop anticoagulant medications. Medical staff will explain the surgical process and anesthesia risks, and obtain informed consent.
What discomfort might occur after surgery? How can it be alleviated?Postoperative symptoms may include scrotal swelling, mild pain, or fever, which are normal. Painkillers will be prescribed, and wearing tight underwear for support is recommended. If fever exceeds 38.5°C, bleeding increases, or pain worsens, immediate medical attention is required.
How soon can normal activities resume after surgery?Adult patients can usually resume light activities within a week but should avoid heavy lifting for at least 4 weeks. Children should reduce vigorous activities for 2 to 4 weeks to prevent suture rupture. Recovery times will be adjusted based on individual healing progress.
Is the success rate of testicular fixation high?The success rate for unilateral cryptorchidism is approximately 90-95%, and for bilateral cases around 85-90%. If the testes are not fixed in the scrotum or retraction recurs, a second surgery may be necessary. Regular follow-up helps detect abnormalities early and ensures normal testicular development.
Why is ongoing follow-up necessary after surgery?Follow-up monitors testicular position, size, and the formation of hard lumps, preventing complications such as atrophy or malignancy. Pediatric patients require follow-up until after puberty, and adults should have examinations every 6 months to a year to ensure surgical success and reproductive health.
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