Testicular descension

A special operation – testicular descent (orchiopexy) – is performed to correct such a congenital defect of the male genitalia as abnormal positioning of the testicles, when by the time a boy is born one or both testicles do not descend into the scrotum.

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

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Indications for the procedure

In most cases, testicular descent is performed in cryptorchidism if the undescended testicle does not spontaneously take the desired position by the age of 5-8 months, which usually occurs with testicular retraction - pseudocryptorchidism. Testicular retraction, which is caused by an increased cremasteric reflex in boys from birth to one year, accounts for almost two thirds of cases, and it does not require surgical treatment, since in almost 80% of cases, by one year, the testicles are already where they should be.

In case of cryptorchidism, the operation can be performed when the child reaches the age of 15-18 months, and experts do not advise delaying it and performing testicular lowering on a child older than three years.

This operation can be performed preventively in adults in cases where there is unresolved testicular retraction or ectopia, but surgical intervention is not recommended in all cases and is not performed after the age of 32.

In addition, indications for this operation in a teenager or adult man include testicular dislocation due to a closed injury to the scrotum or groin area, as well as torsional twisting - testicular torsion. 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 a delay of up to twelve hours - only 50%.

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Preparation

Preparation for testicular lowering surgery involves an ultrasound of the scrotum and blood tests (general clinical and coagulation tests – coagulogram).

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

When testicular descent is performed due to torsion or dislocation, the operation is endoscopic under local or epidural anesthesia, and it is not recommended to eat for three to four hours before the procedure.

Before the upcoming operation, the surgeon should explain the essence of the operation to the child's parents in general terms and give them complete information regarding postoperative care.

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Technique testicular retraction

The clinically proven and proven technique for performing testicular lowering surgery over many decades may differ in the method of certain surgical manipulations.

There are quite a few methods for performing this operation (in one or two stages): according to Torek-Gertsen, Sokolov, Cartwright-Schneider, etc. In each specific case, the method chosen by the surgeon for bringing the testicles into an anatomically normal position depends on the location of the undescended testicle in the patient.

The simplest case is when the testicle is located in front of the scrotum (scrotum) or slightly above it; the surgical technique 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 palpated during manual examination and is detected by ultrasound or laparoscopy).

A common technique for moving and fixing the testicle in the scrotum is known as Petrivalsky testicular descent (more precisely, Shumeker-Petrivalsky). If the testicle is in the groin area, the surgeon makes a small incision in the groin and a second small incision in the scrotum, connecting them and forming an anastomosis through which the testicle is moved down from the groin without completely separating it from the inguinal ligament. A small "sac" (bed) is formed in the scrotum - between its skin and the subcutaneous smooth muscle fascia - into which the testicle is placed, held there by absorbable sutures. The surgical field is sutured externally in the usual way.

When the undescended testicle is located much higher than the scrotum or behind the peritoneum, and also in the case of short testicular vessels, a two-stage testicular descent is performed according to Fowler-Stevens with division of the spermatic vessels, temporary fixation of the displaced testicle with a ligature on the inner thigh - at the first stage, and then placing the testicle in the scrotum - at the second. In recent years, this technique has been modernized, and now such a less invasive orchiopexy is performed without division of the testicular vessels, even with a very high intra-abdominal localization of the abnormally located testicle.

If the spermatic cord is insufficient in length, a two-stage operation is also performed. In the first stage, the testicle, after maximum possible movement, is fixed with a tension-free ligature on the periosteum above the pubis or pubic symphysis. The testicles and spermatic cord can be isolated with a silicone sheath to reduce adhesion and facilitate the second stage of the operation, which is performed several months later.

Endoscopic or laparoscopic testicular reduction, a technique developed in the early 1990s, is currently the most commonly used type of surgical treatment for cryptorchidism, especially with non-palpable intra-abdominal testicles. Two-port orchiopexy is used, as well as single-port (through a 5-mm umbilical port). The advantages of this method, taking into account reviews

Specialists, are minimal tissue trauma, pain reduction, reduced risk of complications and simpler postoperative care.

Contraindications to the procedure

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

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Consequences after the procedure

The main consequences after the testicular lowering procedure include nausea as a result of general anesthesia, swelling of the scrotum, bleeding, intense pain, temporary difficulty urinating, secondary infection of the suture and its inflammation.

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Complications after the procedure

The most likely complications after this operation include:

• the location of the testicle in the upper part of the scrotum due to its incorrect fixation;
• violation of the integrity of the spermatic cord or its excessive tension;
• damage to the funicular or inguinal part of the vas deferens;
• disruption of the blood supply to the testicle, leading to ischemia of its tissues and atrophy;
• development of fibrosis of the interstitial tissue of the testicle with loss of its functions.
• inflammation of the testicle and epididymis (its appendage).

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Care after the procedure

Bed rest is observed for three days after traditional surgery and one to two days after laparoscopic surgery.

Post-procedure care is carried out:

• aseptic treatment of the suture;
• pain relief (by taking analgesics orally or by parenteral administration);
• prevention of the development of secondary infection (using broad-spectrum antibacterial drugs and uroseptic agents).

The stitches are usually removed on the seventh to tenth day after the operation, and the overall recovery lasts up to one and a half months. The main recommendations for care during this period concern increasing water consumption, prohibiting washing with hot water and swimming in bodies of water, limiting physical activity (for boys - any active games and cycling).

Postoperative check-ups with your doctor are performed regularly to ensure that the testicle is in a normal position and that there are no complications.

Surgical testicular reduction in cryptorchidism is a necessary procedure that reduces the risk of male infertility, inguinal hernias and the development of testicular oncology.

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