Orchidopexy is a procedure performed for testicular torsion or intermittent testicular torsion. In this condition, the testicles, which are typically held down in the bottom of the scrotum by a fibrous ligament called the gubernaculum are more “free floating” in the scrotal sac due to a defect in the formation of the gubernacular ligament. This is termed the “bell clapper deformity” as it mimics the ringer in the center of a handheld bell. This means that the testicle is therefore free to swing around held only by the spermatic cord above it, and more importantly is free to rotate about its axis. When the testicle rotates more than twice around its own axis, then it cuts off its own blood supply, much like wringing out a dishtowel will compress its internal structure. This condition can be prompted by sudden changes in temperature, surprise, scared feelings, trauma to the scrotum or even occur in the sleep. Testicular torsion is a surgical emergency as any organ deprived of its blood supply will eventually suffer permanent damage. The testicle is no exception and will be unrecoverable after about 8-12 hours of ischemia. Of course, the patient will be acutely aware that something is wrong as it is usually intensely painful, with the testicle becoming pulled up into the upper scrotum or groin area, swollen and very tender to touch. Alternatively, some males have intermittent torsion in which they have repeated episodes of smaller attacks of pain which resolve themselves as the testicle winds, and then unwinds on its own relieving its twist an resupplying the testicle with blood again. The danger is that one of these episodes may not relieve itself and become a full-on unrecoverable torsion.
The patient who presents with torsion will be brought to the operating room, where he will be given general anesthesia and put in the supine position. An incision will then be made in the scrotal skin and the offending testicle delivered from the scrotal sac for inspection. The testicle will be rotated in an attempt to “detort” the spermatic cord and blood supply, and if this is successful, then the testicle will be observed for a time to make sure that the blood supply is steady. If the testicle remains black, then it will be deemed dead, and removed entirely. If it is survived then a couple permanent sutures will be placed at strategic points around the testicle wrapping, and then through the inside wall of the scrotum itself at the bottom in such a way so that when the testicle is put back into the scrotum, it will not be able to rotate anymore and scar down permanently into the right position.
The same procedure will be performed on the other side under the same anesthetic as a congenital defect on one side affecting the gubernaculum, is possible on the other side as well, thus fixing it preemptively is considered beneficial.
This operative procedure usually take about 30minutes or so, and then you will be recovered in the PACU for another hour for monitoring and discharged home following.
You will then have a followup clinic appointment made for you with the attending Urologist where you will review the findings of the procedure as well the elements performed in your case. The incision in the scrotum will take about 2 weeks to heal well and you will require a couple days to a week to recover fully from the procedure.
Complications follow that for any general scrotal surgery such as for hydrocele.
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