1st order
- For undescended testis, orchidopexy should be performed if hormone therapy fails by 12 months of age.
Treatment regimen: testis palpable or testis not palpable.
| Testis (palpable) | Operative measure |
| palpable | inguinal orchidopexy (see below). |
| nonpalpable: | |
| + Testis near the inner inguinal ring. | Laparoscopic or inguinal orchidopexy |
| + testis > 2 cm from the internal inguinal ring | Operation according to Fowler-Stephens (see below) |
| + vessels end blindly in the abdomen (abdominal cavity) | Vanishing testis* ; no further action |
| + Vessels and ductus deferens (vas deferens) move into inguinal canal. | inguinal exploration |
* XY-gonadal agenesis/complete absence of gonads (synonym: testicular regression syndrome).
Surgical procedures
Inguinal orchipexy: inguinal approach to the inguinal canal; orchidopexy is composed of orchis (gr = testis) and pexia (gr = to attach, sew on) and means “attaching the testis.” It is the surgical fixation of the testicle in the scrotum. Operatively, this may involve funiculolysis (mobilization of the spermatic cord) or two-stage surgery according to Fowler-Stephens or surgery according to Koff and Sethi:
- In Fowler-Stephens surgery, the first step is to mobilize the testis with its vessels from the malposition before transferring it to the scrotum (scrotum) in a second step.
- The operation according to Koff and Sethi differs from that according to Fowler-Stephens in that the testicular vessels (testicular vessels) are placed closer to the testis.
Follow-up
- Follow-up should be performed at least in the first postoperative year.
- From the age of 15, patients should be encouraged to perform regular self-examination, in order to detect early even an emerging testicular tumor (very rare).A guide to self-examination gives the German Society of Urology e.V. in cooperation with the Professional Association of German Urologists e.V. on their Internet portal www.hodencheck.de
Possible complications
The complication rate is low overall. The most serious complication is testicular atrophy. This can be expected in about one percent of cases in standard surgery. The two-stage Fowler-Stephens operation causes it in about 8% of cases.
Other possible complications include postoperative bleeding, infection, and disturbances in wound healing, as well as injury to the ductus deferens (vas deferens) and the ilioinguinal nerve (nerve originating in the lumbar portion (lumbal plexus) of the lumbar-cruciate plexus (lumbosacral plexus)).
