Orchiopexy is a surgical procedure used to treat testicular torsion, primarily aiming to immediately restore blood supply to the testis and prevent tissue necrosis caused by vascular occlusion. When the testis twists due to spermatic cord rotation, if not treated within the golden window of 6 hours, irreversible testicular atrophy or loss of function may occur.
This surgery is typically performed in an emergency setting. The surgeon repositions the testis and fixes it within the scrotum to reduce the risk of recurrence. In addition to addressing the acute crisis, the procedure also allows examination of the contralateral testis to prevent bilateral involvement.
The surgery mainly divides into two types: open surgery and laparoscopic surgery. Open surgery requires an incision in the scrotum or groin to directly observe the spermatic cord and testis; laparoscopic surgery uses an endoscopic instrument through small incisions for precise operation.
The mechanism involves: 1. untwisting the rotated spermatic cord to restore blood flow, 2. fixing the testis within the scrotum to prevent re-torsion, 3. repairing any damaged vascular structures. The procedure is usually performed under general anesthesia, with an average duration of 45-90 minutes.
Primarily indicated for patients with confirmed acute testicular torsion. Clinical symptoms include sudden severe scrotal pain, abnormal testicular position (such as elevation), and ultrasound showing blood flow obstruction. Additionally, fixation of the contralateral testis is recommended to prevent future risks.
Emergency indicators include: pain lasting more than 6 hours, ultrasound confirmation of absent blood flow, or physical examination revealing the testis fixed at an abnormal angle. If signs of tissue necrosis are present, orchiectomy may be necessary.
The surgical process includes: 1. disinfecting the incision area after anesthesia, 2. dissecting the spermatic cord structures, 3. fixing the testis within the deep tissues of the scrotum, 4. closing the wound and monitoring for bleeding. The procedure must be performed in a sterile environment and may be combined with Doppler ultrasound to monitor blood flow recovery.
The concept of dosage does not apply to this surgery; however, timing is critical. Delay beyond 6 hours decreases testicular survival rate by approximately 10-15% per hour. Surgeons will adjust fixation methods based on patient age and anatomy, such as using different fixation points in infants.
Compared to conservative treatment, surgery offers over 90% testicular survival rate, with small incisions and short recovery periods. Most patients can resume normal activities within 1-2 weeks.
Extreme cases may involve thrombosis or anesthesia-related complications, but the incidence is below 0.5%. Postoperative monitoring is essential for signs of persistent severe pain or fever.
Emergency contraindications: Patients with severe coagulation disorders or allergies should first evaluate anesthesia risks. Diabetic patients need blood sugar control to reduce infection risk.
Postoperative care includes: 1. avoiding strenuous activity within 48 hours, 2. wearing supportive underwear to reduce scrotal pressure, 3. regular follow-up of testicular function. Contraindications include allergies to anesthesia drugs or uncontrolled systemic infections.
The surgery may interact with anticoagulants (such as warfarin), which should be discontinued 72 hours prior. Patients on steroid therapy need dose adjustments to avoid impeding tissue repair.
Imaging examinations (such as Doppler ultrasound) should be coordinated with the surgery; preoperative results influence surgical strategy. It is not recommended to perform invasive procedures simultaneously to avoid increased complication risks.
According to medical studies, patients treated within 48 hours have a testicular survival rate of 85-95%. Long-term follow-up shows that over 80% of successfully treated patients maintain normal fertility, with no significant difference in contralateral testicular function.
Systematic evaluations indicate that laparoscopic surgery reduces tissue damage by 30% compared to traditional open surgery. Five-year follow-up shows a patient satisfaction rate of 92%, demonstrating the clinical value of this approach.
Manual reduction in emergency settings (such as in the emergency room) can temporarily restore blood flow but has a recurrence rate of up to 40%, serving only as a temporary measure before surgery.
Medications (such as anticoagulants or analgesics) cannot fundamentally resolve vascular occlusion and are only used for symptom relief. If the golden window of 6 hours is missed, necrotic tissue removal may be necessary, making surgery the only effective option.
Patients should complete blood tests, urinalysis, and scrotal ultrasound before surgery to confirm diagnosis and assess testicular blood flow. Fasting for 8 hours before surgery is required, and patients should inform the doctor of any medications or allergies. If the condition is acute, surgery within 6 hours is crucial to reduce tissue damage.
How to relieve pain and swelling after surgery?Postoperative pain is usually managed with analgesics (such as NSAIDs), and ice packs can be applied to the scrotum to reduce swelling. Wearing supportive underwear to minimize scrotal pressure and avoiding strenuous activity or heavy lifting are recommended. If pain worsens or fever develops, medical attention should be sought immediately.
Does surgery affect fertility?If blood flow interruption causes tissue necrosis, orchiectomy may be necessary, impacting fertility. If the surgery is timely and testicular function is preserved, fertility is usually unaffected. Follow-up 3 to 6 months post-surgery is advised to evaluate testicular function and sperm quality.
How long does it take to resume normal life after surgery?Light activities such as walking can usually resume within 1-2 days, but strenuous activities should be avoided for at least 4 weeks. Full recovery of normal sexual activity and sports typically takes over 6 weeks. Recovery time varies among individuals and should be guided by the physician’s instructions.
Is regular follow-up necessary after surgery?Yes, a follow-up visit within the first month is necessary to check scrotal blood flow recovery. Within 6 months, testicular function should be monitored. Patients who experienced unilateral torsion are at increased risk of future contralateral torsion; regular self-examination of the scrotum for swelling or pain and prophylactic surgery (such as contralateral fixation) are recommended.
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