Case Files: Orchidopexy

Presenting Scenario: A 7 year old boy presents to the outpatient surgeon due to a referral from the Primary Care Pediatrician. He has a suprapubic lump on the left side. Patient's mother denies pain, nausea, vomiting, diarrhea. On physical exam, there is a palpable lump, easily movable, located just above and lateral to the penis.

Diagnosis: Prepubic undescended testicle on the left side.

Surgical Procedure(s) Ordered: Orchidopexy; the surgeon first makes an incision near the site of the undescended testicle, similar to how he might make an incision to fix a hernia. We carefully dissect through the layers of the fascia and muscle until we reach the testicle. Next, through a series of maneuvers that see the gubernaculum (100 points to whoever defines what this is in the comments) released from the testicle and pushing back the perineum and other structures in order to free up more of the spermatic cord so we can pull the testicle down through the scrotal sac. Finally, we stitch the testicle into place and then stitch the outer skin of the scrotum over it to make it look like normal.


Results: This patient had no surgical complications and is fine post-operatively! However, it should be noted that patients with undescended testicles have an increased risk for testicular cancer - even after we fix the undescended testicle. Therefore, this patient will need to be followed closely for the rest of his life. If there are any signs of the cancer, removal of the testicle will become necessary immediately. Some signs of testicular cancer include:

• A lump or mass in either testicle
• Any enlargement or swelling of a testicle
• A collection of fluid in the scrotum
• A dull ache in the lower abdomen, back, or in the groin
• A feeling of heaviness in the scrotum
• Discomfort or pain in a testicle or in the scrotum
• Enlargement or tenderness of the breasts