Ejaculation

A special operation - testicle rejuvenation (orchiopexy) - is performed to correct such a congenital defect in the male genitalia as an abnormal testicle arrangement, when at the time of the birth of the boy one or both testicles do not descend into the scrotum.

According to statistics, this testicular anomaly - cryptorchidism - is noted in two to three full-term male infants out of a hundred, and when the baby is premature the defect is detected ten times more often.

[1], [2], [3], [4], [5]

Indications for the procedure

In most cases, the testicle is lowered in cryptorchidism, if the undesired testicle does not spontaneously take the desired position at the age of 5-8 months of the boy, which usually occurs with testicular retraction-pseudocryptorchidism. On the retraction of the testicle, which is due to the increased cremasteric reflex in boys from birth to the year, account for almost two thirds of cases, and it does not require surgical treatment, since almost 80% of the testicles are already there where it is supposed to be.

With  cryptorchidism, the  operation can be performed when the child reaches the age of 15-18 months, and experts do not advise delaying it and carrying out the re-entry of the testicle to a child over three years old.

Such an operation can be preventively carried out by adults in cases when there is an unresolved retraction of the testicle or its ectopia, but surgical intervention is not recommended in all cases and is not performed after 32 years.

In addition, indications for this operation in a teenager or an adult male include a testicle dislocation with closed scrotal injury or groin area, as well as torsional twisting -  torsion of the testicle. In the latter case, the operation is urgent: if the cessation of blood flow to the testicle does not exceed six hours, the probability of its preservation is almost 90%, and the delay to twelve hours is only 50%.

[6], [7], [8], [9]

Preparation

Preparations for the operation of ovarian implantation involves ultrasound of the scrotal area and the delivery of blood tests (general clinical and coagulogram coagulation).

Orhiopecia is performed under general anesthesia, so the last meal should be no later than five to six hours before the scheduled operation time.

When a testicle is brought down during its twisting or dislocation, an endoscopic operation under local or epidural anesthesia, and taking food is not recommended three to four hours before the procedure.

Before the forthcoming operation, the surgeon should, in general terms, explain to the parents of the child its essence and give them full information on leaving in the postoperative period.

[10], [11], [12], [13], [14], [15]

Technique of the ejaculation

Clinically substantiated and for many decades the proven technique of carrying out the operation of the re-entry of the testicle can differ by the technique of various surgical manipulations.

And there are a lot of techniques for carrying out this operation (in one or two stages): Torek-Herzen, Sokolov, Cartwright-Schneider, etc. In each specific case, the method chosen by the surgeon for removing testicles to anatomically normal position depends on the location of the undescended testicle in the patient.

The simplest case is when the testicle is in front of the scrotum (scrotum) or just above it; The technique of surgery is much more complicated when the testicle is located in the inguinal canal (which is almost 90% of cases) or intra-abdominally, that is, behind the peritoneum (where the testicle is not palpable during a manual examination and is detected by ultrasound or laparoscopy).

The technique of movement and fixation of the testicles in the scrotum is widely known, which is known as the descent of the testicle according to Petrivalskiy (more precisely, according to Shumeker-Petrivalsky). If the testicle is in the groin area, the surgeon produces a small dissection in the groin and a second small incision in the scrotum, connecting them and forming an anastomosis, along which the testicle moves down from the groin without complete separation from the inguinal ligament. In the scrotum - between her skin and the subcutaneous smooth muscle fascia - a small "pouch" (bed) is formed, where the testicle is placed, held there with the help of absorbable sutures. The operating field is sutured from the outside in the usual way.

If the testicle is localized much higher than the scrotum or behind the peritoneum, and also in the case of short testicles, a two-stage reductions in the testicle by Fowler-Stevens are performed with separation of the spermatic vessels, temporary fixation of the displaced testicle by the ligature on the inner side of the thigh - in the first stage, and then by placing the testicle in scrotum - on the second. In recent years, this technique has been modernized, and now such less invasive orchiopexy is carried out without the separation of testicular vessels, even with a very high intra-abdominal location of an abnormally located testicle.

If the length of the spermatic cord is insufficient, a two-stage operation is also performed. In the first stage, the testicle, after the maximum possible movement, is fixed with a ligature without tension on the sections of the periosteum above the pubis or pubic symphysis. The testicles and the spermatic cord can be insulated with a silicone membrane to reduce adhesion and facilitate the second stage of the operation, performed in a few months.

Endoscopic or laparoscopic testicle lowering, the technique of which was developed in the early 1990s, is currently the most commonly used type of surgical treatment for cryptorchidism, especially with non-palpable intra-abdominal testes. Two-port orchiopexy is used, as well as a single-port (via a 5-millimeter umbilical port). The advantages of this method, given the feedback

Specialists, are the minimal trauma of tissues, the reduction of pain, the reduction of the risk of complications and the simpler postoperative care.

Contraindications to the procedure

The main contraindications to this surgical intervention are poor blood coagulability, hyperthyroidism, infectious diseases, acute inflammatory processes of any localization with elevated body temperature, as well as some genetic neurological syndromes.

[16], [17], [18]

Consequences after the procedure

The main aftereffects after the testicle lowering procedure include the appearance of nausea as a consequence of general anesthesia, swelling of the scrotum, the appearance of bleeding, intense pain, temporary difficulties with urination, secondary infection of the suture and its inflammation.

[19], [20], [21], [22]

Complications after the procedure

The most likely complications after this operation are:

• the location of the testicle in the upper part of the scrotum when it is incorrectly fixed;
• violation of the integrity of the spermatic cord or its excessive tension;
• damage to the cervical or inguinal part of the vas deferens;
• violation of the blood supply of the testicle, leading to ischemia of its tissues and atrophy;
• development of fibrosis of interstitial tissue of the testicle with loss of its functions.
• inflammation of the testis and epididymis (its appendage).

[23], [24]

Care after the procedure

Bed rest is observed within three days after the traditional operation and one or two days after laparoscopic.

Care after the procedure is carried out:

• aseptic seam treatment;
• anesthesia (taking analgesics inside or by parenteral administration);
• prevention of the development of secondary infection (with the use of broad-spectrum antibacterial drugs and uroseptic drugs).

Sutures are usually removed on the seventh-tenth day after the operation, and the total recovery lasts up to one and a half months. The main recommendations for care during this period concern the increase in water consumption, the prohibition of washing with hot water and bathing in water bodies, physical activity restrictions (for boys - any moving games and cycling).

Post-operative examinations by a doctor are carried out regularly to make sure that the testicle is in a normal position and that there are no complications.

Surgical lowering of the testicle with cryptorchidism is a necessary procedure that reduces the risk of male infertility, the appearance of inguinal hernia and the development of testicular oncology.

[25], [26]