What does this procedure involve?
Making incisions in the groin and scrotum to bring one (or both) testicle(s) down into the correct position.
An undescended testicle has an increased risk of developing cancer. Bringing the testicle into the scrotum does not decrease the risk of cancer, but it does allow the testicle to monitored more easily. If a testicle is brought down in the first years of life, its sperm-producing capacity may be preserved. The longer an undescended testicle remains out of position, the more its sperm-producing ability reduces.
If, on examination, your testicle is not in your groin, it may lie inside your abdomen (tummy). An MRI scan is then used to locate it. If it cannot be found on MRI, laparoscopic (“keyhole”) surgery, using a special telescope passed through a small incision (cut) just below your umbilicus (belly button), may be used to find it.
A testicle found in the abdomen may need a two-stage (Fowler-Stephens) procedure to bring it down. This is not possible in all patients and may not be appropriate for very small or damaged testicles, especially those discovered in adult life.
What are the alternatives?
- Observation without treatment – this is the only alternative to orchidopexy, but it is associated with:
- a higher risk of testicular cancer appearing later in life
- a risk of the testicle twisting in your groin
- psychological problems (especially in children)
- an increased risk of testicular injury; and
- possible cosmetic embarrassment
- Simple orchidectomy – in adults with a life-long undescended testicle, simple removal is often the most appropriate option, especially if the testicle lies in your abdomen, because it is highly unlikely to recover any useful function
What happens on the day of the procedure?
Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.
An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.
We may provide you with a pair of TED stockings to wear. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.
Details of the procedure
- We normally use a general anaesthetic with local anaesthetic injections to relieve any post-operative discomfort
- We may give you an injection of antibiotics before the procedure, after you have been checked carefully for any allergies
- If your testicle is in the groin area (where most are found), we make a small incision in the groin to free its attachments and bring it down into the scrotum where it is fixed in a pouch under the skin (pictured)
- Some undescended testicles are associated with a small hernia which we tie off, at the same time as we free all the attachments to the testicle
- If your testicle is poorly developed or abnormal, we usually remove it to prevent problems in later life
- We close the wounds with absorbable stitches which normally disappear within two or three weeks
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
|---|---|
| Swelling of the groin and scrotum lasting several days |
 Between 1 in 2 & 1 in 10 patients |
| Infection of the testicle or incision requiring further treatment |
 Between 1 in 10 & 1 in 50 patients |
| If it is not possible to bring the testicle down, it may need to be removed |
Between 1 in 10 & 1 in 50 patients |
| The testicle may still lie high in the scrotum |
Between 1 in 10 & 1 in 50 patients |
| Bleeding needing further treatment |
 Between 1 in 50 & 1 in 250 patients |
| Your future fertility cannot be guaranteed and may be reduced even after surgery |
Between 1 in 50 & 1 in 250 patients |
| Need to repeat the procedure if the operation is not completely successful |
Between 1 in 50 & 1 in 250 patients |
| Chronic pain in your testicle or scrotum |
Between 1 in 50 & 1 in 250 patients |
| Your testis may shrink due to poor blood supply after the operation |
Between 1 in 50 & 1 in 250 patients |
| Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) |
Less than 1 in 250 patients (your anaesthetist can estimate your individual risk) |
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:
- Long-term drainage tubes (e.g. catheters)
- Long hospital stays; or
- Multiple hospital admissions
What can I expect when I get home?
- You will get some swelling and bruising of the groin and scrotum which may last several days
- Simple painkillers such as paracetamol usually help to settle any discomfort
- You will be given advice about your recovery at home
- You will be given a copy of your discharge summary and a copy will also be sent to your GP
- Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
- All the stitches are dissolvable and will usually disappear after two to three weeks
- Try to keep the operation site clean and dry for two to three days, and do not soak it in the bath or shower
- You should not ride a bicycle (children should not ride sit-on toys) for four weeks after the procedure
- Children undergoing the procedure should be able to go back to school within a few days
- You should refrain from any heavy lifting or strenuous exercise (including all sport) for the first six weeks after surgery
- A follow-up appointment will be made for you
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
- An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft)
- A regular prescription for a blood thinning agent (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran)
- A present or previous MRSA infection; or
- A high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment)
Questions you may wish to ask
If you wish to learn more about what will happen, you can find a list of suggested questions called “Having An Operation” on the website of the Royal College of Surgeons of England. You may also wish to ask your surgeon for his/her personal results and experience with this procedure.
Before you go home
We will tell you how the procedure went and you should:
- Make sure you understand what has been done
- Ask the surgeon if everything went as planned
- Let the staff know if you have any discomfort
- Ask what you can (and cannot) do at home
- Make sure you know what happens next; and
- Ask when you can return to normal activities
We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:
- Contact your GP
- Access your local NHS Smoking Help Online; or
- Ring the free NHS Smoking Helpline on 0300 123 1044
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.