What is orchiopexy (surgical procedure to move an undescended testis into the scrotum)?

From the Guidelines

Orchiopexy should be performed in prepubertal boys with cryptorchidism, ideally between 6-18 months of life, to reduce the risk of infertility and testicular cancer. This procedure involves making small incisions to locate the testicle, freeing it from surrounding tissues, creating a path to the scrotum, and securing it in the proper position with stitches 1. The American Urological Association (AUA) guideline recommends that surgical specialists perform scrotal or inguinal orchidopexy in prepubertal boys with palpable cryptorchid testes, with a success rate of greater than 96% 1.

Key Points to Consider

• The AUA guideline states that imaging for cryptorchidism is not recommended prior to referral, which should occur by 6 months of age 1.
• Hormonal therapy is not recommended for the treatment of cryptorchidism 1.
• Early intervention with orchiopexy helps preserve fertility potential and allows for proper testicular examination throughout life for cancer screening 1.
• Parents should watch for signs of infection including fever, increasing pain, redness, or drainage from the incision site, and pain management typically involves children's acetaminophen or ibuprofen as needed.

Long-term Risks and Benefits

• Boys with a history of cryptorchidism have an increased risk of developing testicular cancer and subfertility 1.
• Orchiopexy performed before puberty decreases the risk of testis cancer compared to those boys with cryptorchidism who undergo orchidopexy after puberty 1.
• The previously cryptorchid boy should be taught how to perform a monthly testicular self-examination after puberty to potentially facilitate early cancer detection 1.

From the Research

Orchiopexy Overview

• Orchiopexy is a surgical procedure recommended for undescended testes to protect fertility potential and decrease the risk of malignant changes 2.
• The American Urological Association guidelines recommend orchiopexy by age 18 months to ameliorate the risk of subfertility 3.

Timing of Orchiopexy

• International guidelines recommend orchiopexy between 6 and 18 months at the latest 2.
• A study found that nearly 70% of boys with undescended testes in the United States are undergoing orchiopexy at least 6 months later than the recommended age 3.
• Another study found that timely orchiopexy has improved among patients 0-5 years, but the majority of patients are still not undergoing timely orchiopexy 4.

Outcomes of Orchiopexy

• Success of orchiopexy for inguinal testes has been >95% and for abdominal testes >85-90% in most series 5, 6.
• Having a palpable testis in the scrotum does not assure fertility, as there are iatrogenic factors that may adversely affect the outcome 5.
• The risk of testicular carcinoma is increased by a factor of 3.7 to 7.5 times in patients with a history of undescended testis 5.

Factors Affecting Orchiopexy

• Demographic factors such as race, ethnicity, and insurance status can affect access to timely orchiopexy 4.
• Hispanic, African American, Native American, and uninsured males are less likely to have timely orchiopexy compared to non-Hispanic White males 4.