Orchidopexy

What this procedure is

Orchidopexy (pronounced or-kee-oh-PEK-see) is a common surgery used to move a testicle from the abdomen or groin into the scrotum. The scrotum is the small sac of skin that normally holds the testicles. This procedure is also sometimes called an orchiopexy.

During the surgery, a specialist carefully moves the testicle into its correct position. They then secure it with stitches so it stays in place. This is usually done through one or two small incisions (cuts) in the groin or the scrotum. The procedure is designed to be as gentle as possible for the patient.

What it treats or fixes

This procedure is used to treat a condition called cryptorchidism (krip-TOR-kih-diz-um), which is the medical term for an undescended testicle. This happens when a testicle does not move down into the scrotum on its own before a baby is born.

Moving the testicle into the scrotum is important for several reasons:

• Future Health: It allows the testicle to develop at a cooler temperature, which is necessary for future fertility (the ability to have children).
• Physical Exams: It makes it easier for a clinician to feel and check the testicle during regular health checkups.
• Preventing Complications: It can help fix a hernia (a bulge of tissue) that often occurs with an undescended testicle. It also helps prevent testicular torsion, which is a condition where the testicle twists and cuts off its blood supply.

How common it is & where it's done

Orchidopexy is the most common surgery performed by pediatric urologists. About 1% to 3% of full-term baby boys and up to 30% of premature baby boys are born with an undescended testicle. While some testicles descend on their own within the first few months of life, your clinician may recommend surgery if the testicle has not moved by the time the child is 6 to 18 months old.

The procedure is typically performed in a hospital or an outpatient surgery center. Because it is usually a "day surgery," most patients are able to go home the same day. The surgery is performed by specialists, such as pediatric urologists or pediatric surgeons, who are experts in treating children.

Recovery: What to Expect

Most patients go home the same day as the surgery. Your clinician may suggest resting for the first 24 to 48 hours. It is common to see some mild swelling or bruising in the groin or scrotum, which usually fades within a week or two.

To help with comfort and healing, your clinician may recommend:

• Using over-the-counter pain relief like acetaminophen or ibuprofen.
• Wearing loose-fitting clothing to avoid pressure on the area.
• Avoiding strenuous play, bike riding, or contact sports for about 2 to 4 weeks.

You should contact your clinician if you notice signs of a possible issue, such as a high fever, redness that spreads, or pain that gets worse instead of better. These are usually easy to manage when caught early.

Risks & Possible Complications

While orchidopexy (surgery to move an undescended testicle into the scrotum) is a common and generally safe procedure, all surgeries have some risks. Your surgical team takes many steps to prevent these. Possible complications may include:

• Infection or bleeding: These are rare and are typically treated with standard care or antibiotics.
• Testicular atrophy: This is when the testicle shrinks or does not grow as expected after the surgery.
• Re-ascent: In some cases, the testicle may move back up toward the groin, which might require a follow-up procedure to move it back down.
• Injury to nearby structures: There is a small risk of injury to the blood vessels supplying the testicle or the tube that carries sperm (vas deferens).

Outcomes & Long-Term Results

The long-term results for orchidopexy are very positive. The main goal is to move the testicle into the scrotum, which helps it stay at the right temperature for health. This procedure is highly successful in keeping the testicle in its proper place.

Moving the testicle down makes it much easier for a person to perform self-exams later in life. Your clinician may schedule follow-up visits to check that the testicle is growing well and staying in the correct position. Early surgery is often linked to better long-term health and fertility potential.

Emotional Support & Reassurance

It is natural to feel nervous when a child or loved one needs surgery. Orchidopexy is one of the most common procedures performed by pediatric specialists. Most children bounce back quickly and return to their normal routine within a few weeks.

Remember that this surgery is a proactive step for long-term health. By addressing an undescended testicle early, you are helping to ensure the best possible future outcomes. If you have concerns, your healthcare team is there to answer questions and provide support throughout the process.

Why doctors recommend it

Doctors usually suggest orchidopexy when a testis (testicle) has not moved down into the scrotum on its own. This condition is known as cryptorchidism. While many babies are born with undescended testes, the organs often drop into the correct place during the first few months of life. If they have not moved by about six months of age, your clinician may recommend surgery because they are unlikely to drop on their own after that point.

The main reason for this recommendation is health and development. The scrotum provides a cooler environment than the inside of the body. This lower temperature is necessary for the testis to grow and function correctly as the child gets older.

Urgent vs planned treatment

In most cases, orchidopexy is a planned procedure. This means it is scheduled in advance, usually when the child is between 6 and 18 months old. Planning the surgery during this window helps provide the best environment for the testis to develop.

There are some situations where the timing may change:

• Urgent Care: If a clinician suspects testicular torsion (when the cord that brings blood to the testis twists), surgery is performed immediately to save the tissue.
• Associated Issues: If the undescended testis is found along with an inguinal hernia (a bulge of tissue in the groin), your clinician may suggest performing the repair sooner than originally planned.

Goals of treatment

The primary goal of orchidopexy is to move the testis into the scrotum and secure it there. This helps the body in several ways:

• Future Health: Placing the testis in the scrotum helps preserve its ability to produce hormones and sperm later in life.
• Easier Exams: When the testis is in the correct position, it is much easier for doctors to feel and check during routine physical exams.
• Protection: A testis that is stuck in the groin area may be more at risk for accidental injury compared to one that is protected within the scrotum.

Success generally means the testis remains in its new, lower position and continues to grow at a healthy rate. Your medical team will use follow-up appointments to monitor the area and ensure the best possible outcome.

Who may benefit

Orchidopexy is a surgery used to move an undescended testicle into the scrotum, which is the sac of skin behind the penis. This procedure is most often recommended for infants or young children with cryptorchidism (the medical term for a testicle that has not moved into its proper place before birth).

Your clinician may suggest this surgery to help protect future health. Moving the testicle into the scrotum may improve the chances of having children later in life (fertility). It also makes it much easier for a doctor or the patient to perform physical exams to check for any unusual lumps or changes in the future.

The procedure can also help prevent testicular torsion. This is a painful condition where the testicle twists and cuts off its own blood supply. By securing the testicle permanently in the scrotum, the risk of this twisting is greatly reduced.

When it may not be the right option

Surgery may not be necessary if a child has retractile testicles. This is a normal muscle reflex where the testicle moves up into the groin when the child is cold or nervous but can be easily moved back down during a physical exam. These often settle into the scrotum permanently on their own as the child goes through puberty.

If a testicle is completely missing or is atrophic (severely underdeveloped and not functioning), your clinician may discuss other options. In these cases, the focus may be on removing the non-functional tissue rather than moving it.

Your care team will also look at the patient's overall health. If there are other serious medical concerns, they may suggest waiting until the patient is older or stronger before using general anesthesia, which is the medicine used to keep the patient asleep and pain-free during surgery.

Questions to ask your care team

It is helpful to bring a list of questions to your appointment to help you feel more comfortable with the decision. You may want to ask:

• Why is this surgery recommended for my child at this specific age?
• How can we tell the difference between a retractile testicle and an undescended one?
• What are the long-term benefits for my child's health and fertility?
• What happens if we decide to wait or choose not to have the surgery?
• What does the recovery process look like, and how soon can my child return to normal activities?

In the procedure room

The procedure room is a clean, quiet space where a specialized medical team works together. This team usually includes the surgeon, nurses, and an anesthesiologist (a doctor who manages sleep and pain). The room contains advanced equipment to keep the patient safe and comfortable throughout the process.

High-level steps

The main goal of an orchidopexy is to move a testicle that has not dropped into its natural home in the scrotum (the sac of skin behind the penis). The surgeon usually makes a small opening in the groin area to find the testicle and gently loosen the tissues around it. This helps the testicle reach the scrotum without being pulled back up. If there is a small, open sac near the groin, the surgeon will close it to prevent a hernia from forming later.

Next, the surgeon makes a second small opening in the scrotum to create a subdartos pouch. This is a small pocket under the skin where the testicle will sit. The testicle is carefully moved into this pocket and secured with stitches. These steps help ensure the testicle stays in the correct position for healthy development.

Anesthesia and pain control

Most patients receive general anesthesia, which means they are in a deep sleep and will not feel any pain or remember the surgery. The anesthesiologist monitors the patient closely the entire time.

To help with comfort after the surgery, your clinician may use a local anesthetic. This is a numbing medicine injected near the surgical site or in the lower back. This helps the area feel numb for several hours, reducing the need for strong pain medications immediately after waking up.

Monitoring and safety steps

Safety is the top priority during the procedure. The team uses sensors to track heart rate, blood pressure, and oxygen levels. The surgeon also carefully checks the blood vessels and the vas deferens (the tube that carries sperm) to make sure they are protected and have plenty of room to stretch during the move.

Immediately after the procedure

After the surgery is finished, the patient is moved to a recovery room to wake up slowly. It is normal to feel a bit sleepy or groggy. The groin and scrotal areas may look slightly swollen or bruised, and there might be some mild soreness or a feeling of pressure.

The clinician may use dissolvable stitches that do not need to be removed later. A small bandage or surgical glue might cover the incisions to keep them clean. Most patients are able to go home the same day once they are awake and can drink fluids comfortably.

Typical procedure length

An orchidopexy typically takes between 45 minutes and 90 minutes. The exact time depends on the location of the testicle and whether the surgeon needs to work on one side or both. Your clinician will provide a more specific estimate based on the individual situation.

Common approaches (open vs minimally invasive)

Doctors choose the surgical method based largely on where the testicle is located and whether it can be felt (palpable) during a physical exam.

• Open surgery: This is the standard approach when the testicle can be felt in the groin area. The surgeon typically makes a small incision in the groin or the scrotum. Through this opening, they free the testicle from nearby tissue and move it into the correct position.
• Minimally invasive (Laparoscopic): This approach is often used when the testicle cannot be felt (non-palpable) and is likely located inside the abdomen. The surgeon inserts a tiny camera called a laparoscope through small cuts in the belly to find the testicle. If appropriate, they may proceed to move the testicle using laparoscopic instruments.

Partial vs total

In most cases, the goal is a total repair completed in a single operation. This is known as a single-stage orchidopexy. The surgeon locates the testicle, preserves the blood vessels, and moves the testicle fully into the scrotum all at once.

However, a single-stage repair is not always applicable. If a testicle is located very high in the abdomen, the blood vessels may be too short to reach the scrotum safely in one try. In these situations, the surgeon may use a two-stage approach (sometimes called the Fowler-Stephens technique):

• Stage 1: The surgeon performs a procedure to prepare the blood vessels, allowing collateral blood supply to develop. The testicle is left in the abdomen for a period of time.
• Stage 2: Several months later, a second surgery is performed to finish moving the testicle into the scrotum.

Revision or repeat procedures

Orchidopexy generally has high success rates, but complications can occur that may require additional care. In some cases, a testicle that was surgically brought down may pull back up into the groin. This is called testicular ascent. If this happens, a revision surgery may be recommended to bring the testicle back down and secure it again.

In rare instances, the testicle may shrink (atrophy) if the blood supply is compromised. Your clinician will check for this during follow-up appointments. If the repair is not successful or the tissue is not healthy, further procedures or removal of the tissue (orchiectomy) might be discussed.

Tests and imaging that may be done

The main way a clinician checks for an undescended testicle is through a physical exam. The doctor will carefully feel the groin area to try to locate the testicle. In many cases, this exam is all that is needed to plan the surgery.

Imaging scans, such as ultrasound, CT scans, or MRI, are generally not recommended. Medical research suggests these scans are rarely helpful in finding a testicle that cannot be felt during a physical exam. Instead, if the testicle cannot be located by touch, the surgeon may use a small camera (laparoscope) during the procedure to look inside the abdomen. This is considered the most accurate way to find the testicle.

Blood tests might be ordered in specific situations. For example, if both testicles are undescended, hormone tests may be done to check how well the testicles are working.

Medication adjustments

To keep the patient safe during surgery, the care team needs a complete list of current medications. This includes prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

• Review your list: Go over all medications with the anesthesia team or surgeon.
• Ask about changes: Ask if any specific medicines need to be paused in the days leading up to the surgery.
• Follow instructions: Only stop medicines if your clinician instructs you to do so. Do not stop taking necessary medication unless told otherwise.

Day-before and day-of instructions

Most orchidopexy procedures are performed under general anesthesia, meaning the patient is asleep. Because of this, strict eating and drinking rules must be followed to prevent complications.

• Fasting: You will be given specific times to stop eating solid foods and drinking clear liquids. It is vital to follow these rules exactly, or the surgery may need to be rescheduled.
• Hygiene: You may be asked to bathe or shower the night before or the morning of the surgery to reduce the risk of infection.
• Clothing: Wear loose, comfortable clothes that are easy to put on and take off.
• What to bring: Bring insurance cards, identification, and a comfort item (like a toy or blanket) if the patient is a child.

General surgical risks

Like any operation, orchidopexy carries a few standard risks. While serious problems are uncommon, your surgical team will take steps to prevent them and monitor your child closely. General risks associated with surgery include:

• Bleeding or hematoma: A collection of blood may form under the skin, causing bruising or swelling in the scrotum or groin.
• Infection: Bacteria may enter the incision site, leading to redness, warmth, or discharge. This is generally rare.
• Wound issues: Sometimes the incision may not heal as expected or may open slightly (dehiscence).
• Anesthesia reactions: Some patients may feel groggy or nauseous after waking up from anesthesia.

Procedure-specific complications

Because orchidopexy involves moving the testicle and working near delicate structures, there are specific risks related to the reproductive system. Your surgeon will work carefully to protect these areas.

• Testicular atrophy: In some cases, the blood supply to the testicle may be affected during the move. This can cause the testicle to shrink or not grow properly over time.
• Ascent of the testis: Occasionally, the testicle may pull back up into the groin after surgery. This is sometimes called a "failed" repair.
• Vas deferens injury: The vas deferens is the thin tube that carries sperm. Although surgeons are very careful, there is a small risk of damage to this tube, which could affect future fertility.

How complications are treated

Most complications are mild and can be managed easily. Your clinician will schedule follow-up appointments to check healing and ensure the testicle remains in the correct position.

• Medication: If an infection occurs, it is typically treated with antibiotics. Pain or swelling is often managed with over-the-counter pain relievers.
• Observation: Minor bruising or swelling usually goes away on its own with time and rest.
• Additional procedures: If the testicle moves back up (ascends) or if a hernia develops, a second surgery may be needed to correct the position.

Pain control medicines

Your clinician will create a plan to keep your child comfortable during and after the orchidopexy (the surgery to move an undescended testicle). During the procedure, the care team often uses general anesthesia so the patient is in a deep sleep. They may also use a local anesthetic block, which is medicine injected near the nerves to numb the surgical area and provide relief for several hours after the operation.

After going home, your clinician may suggest common over-the-counter pain relievers, also called analgesics. These often include:

• Acetaminophen: A common medicine used to lower fever and reduce mild to moderate pain.
• Ibuprofen: A medicine that helps with both pain and swelling (inflammation).

It is important to tell your care team about any known allergies or past reactions to pain medications. They will tailor the specific types and timing of these medicines to meet your child's needs.

Antibiotics

Antibiotics are medicines used to prevent or treat infections caused by bacteria. To help lower the risk of a surgical site infection, your clinician may give a dose of "prophylactic" (preventative) antibiotics just before the surgery begins.

In most cases, children do not need to continue taking antibiotics once they go home. However, your clinician will decide if a short course of oral antibiotics is necessary based on the specific details of the surgery. Always let the medical team know if there is a history of allergies to specific antibiotics, such as penicillin.

Blood thinners and clot prevention

Blood thinners (anticoagulants) are medicines that help prevent blood clots. While these are not commonly used for children undergoing a routine orchidopexy, your clinician will review your child’s medical history to see if they are needed. They will check for any history of easy bruising or bleeding issues.

If the patient is an older teen or has specific health conditions, the care team may discuss ways to keep the blood flowing well, such as moving around soon after surgery. It is vital to tell your clinician about any supplements or medications the patient is currently taking, as some can affect how the blood clots during and after the procedure.

Emergency warning signs

While serious complications are rare, it is important to act quickly if you notice signs of a severe problem. Seek immediate medical help or go to the nearest emergency department if the patient experiences:

• Severe bleeding: Bright red blood soaking through the bandages that does not stop with gentle pressure.
• Extreme pain: Pain that is sudden, severe, and not relieved by the prescribed pain medication.
• Difficulty breathing: Trouble breathing or chest pain, which can be a rare reaction after general anesthesia.

Call your surgeon or clinic if…

Contact your healthcare provider if you notice signs that the wound is not healing as expected. Your clinician may want to check for infection or other issues if you observe:

• Signs of infection: Spreading redness, increased warmth around the incision, or foul-smelling drainage (pus).
• Fever: A temperature higher than 101°F (38.3°C), or as defined by your surgeon.
• Worsening swelling: A scrotum that becomes very swollen, tight, or dark purple, which could signal a collection of blood known as a hematoma.
• Nerve issues: New or lasting numbness and pain in the inner thigh or scrotum.

Expected vs concerning symptoms

Recovery takes time, and some changes are a normal part of the healing process. Knowing the difference between expected recovery signs and potential complications can help you stay calm.

• Expected: It is common to have mild swelling, slight bruising, and manageable soreness for a few days. The testicle should remain in the scrotum.
• Concerning: Be sure to report if the testicle appears to pull back up into the groin (re-ascent) or if the testicle seems to be getting smaller over time (atrophy). These are rare but require medical attention.

Non-surgical treatments

In some cases, a clinician may suggest hormone therapy as an alternative to surgery. This treatment typically involves using a hormone called human chorionic gonadotropin (hCG). The goal is to stimulate the body to move the testicle into the scrotum (the sac of skin behind the penis) on its own.

While this is an option, it is used less frequently today because it has a lower success rate than surgery. Research suggests that hormone therapy works in fewer than 20% of cases. Your clinician may only consider this if the testicle is already positioned very close to the scrotum.

Watchful waiting

It is very common for infants to be born with an undescended testicle, a condition known as cryptorchidism. In many babies, the testicle will move down into the correct position naturally during the first few months of life without any medical help.

Your clinician may recommend "watchful waiting," which means monitoring the child with regular exams to see if the testicle descends on its own. This period of waiting usually lasts until the child is about 6 months old. If the testicle has not reached the scrotum by this time, it is unlikely to move down without treatment.

When surgery becomes the best option

If the testicle remains undescended after the child is 6 months old, surgery is usually the recommended next step. This is because the chances of the testicle moving on its own drop significantly after this age. Your clinician may suggest scheduling the procedure, called an orchidopexy, before the child reaches 18 months of age.

Surgery is often the best choice to protect the child’s future health. Moving the testicle into the scrotum helps with the following:

• Fertility: Testicles need a slightly cooler environment than the rest of the body to produce healthy sperm later in life.
• Early Detection: Having the testicle in the scrotum makes it easier to feel for any unusual lumps or changes during routine exams as the child grows.
• Preventing Injury: A testicle that stays in the groin area may be more likely to be injured or experience "torsion," which is a painful twisting of the blood vessels.

Hospital services that commonly perform this surgery

Orchidopexy is the surgical procedure used to move an undescended testicle into the scrotum. This surgery is most often performed in hospitals with specialized Pediatric Urology departments. These specialists focus specifically on the urinary and reproductive health of children and infants.

Your clinician may also suggest a Pediatric Surgery department. These surgeons are trained to handle various operations for children, including orchidopexy. Many facilities perform this as an outpatient procedure, which means the patient can usually return home the same day as the surgery.

Patient resources and support services

Many pediatric hospitals provide Child Life Specialists. These professionals are trained to help families and children understand medical procedures through age-appropriate explanations and play. They can help reduce stress and prepare the family for what to expect on the day of the surgery.

Other support services often available include:

• Pre-operative education: Many centers offer videos or booklets that explain the surgery in simple terms.
• Nursing hotlines: Hospitals often provide a direct phone number to reach a nurse for questions about recovery or home care after the procedure.
• Social work and financial services: These departments can help families navigate insurance questions or find local resources for travel and lodging if the hospital is far from home.

Questions for choosing where to have surgery

When deciding where to have the procedure, it is helpful to gather information about the facility and the surgical team. You may want to use this checklist when speaking with your clinician:

• Does the surgeon specialize in pediatric urology or pediatric general surgery?
• How many orchidopexy procedures does this facility perform annually?
• Is there a pediatric anesthesiologist (a doctor who specializes in sedation for children) on-site?
• Does the hospital have a dedicated recovery area specifically for children?
• What are the hospital's policies for parents staying with their child before and after the surgery?

Conditions commonly treated by this procedure

Orchidopexy is most often used to treat cryptorchidism, which is the medical term for an undescended testicle. This occurs when a testicle has not moved into its proper position in the scrotum (the skin sac below the penis) before birth. Your clinician may recommend this procedure to move the testicle into the scrotum and secure it there.

A clinician may also perform this surgery to treat testicular torsion. This is a condition where the spermatic cord, which provides blood flow to the testicle, becomes twisted. In these cases, the procedure is used to fix the testicle to the scrotum wall to help prevent it from twisting again in the future.

Other conditions that may be treated include:

• Ectopic testes: This is when a testicle has moved away from its normal path and ended up in an unusual location.
• Retractile testes: This happens when a testicle moves back and forth between the groin and the scrotum. While often monitored, a clinician may suggest surgery if the testicle stops moving back down on its own.

Related symptoms people search for

Many people first notice signs of these conditions during a routine exam or while changing a diaper. Common symptoms that may lead a clinician to suggest an evaluation include:

• An "empty" scrotum, where one or both testicles cannot be felt in the skin sac.
• The scrotum appearing smaller or less developed on one side.
• A painless lump in the groin area, which may be the testicle resting in the wrong place.

While an undescended testicle itself usually does not cause pain, some related issues can cause discomfort. For example, sudden or severe pain and swelling in the scrotum can be associated with twisting. If you notice these symptoms, it is important to have them evaluated by a healthcare professional quickly.

Evidence overview

Orchidopexy is widely accepted as the standard treatment for undescended testicles (cryptorchidism) and testicular torsion. Medical guidelines and research support performing this surgery to help preserve fertility and to make it easier to monitor the testicle for future health issues. Studies suggest that performing the procedure at the recommended age—often between 6 and 18 months—can improve long-term outcomes.

The procedure generally has a high success rate. Success is defined by the testicle remaining in the scrotum without shrinking (atrophy). Evidence shows that outcomes often depend on the initial location of the testicle. For example, testicles located in the groin area typically have higher success rates compared to those located higher up in the abdomen.

Safety notes and individualized care

While orchidopexy is a common and generally safe procedure, all surgeries involve some risks. Your clinician will discuss general surgical risks, such as bleeding, bruising, or infection at the incision site. They will also explain specific risks related to moving the testicle.

Potential complications specific to this procedure may include:

• Testicular atrophy: In some cases, the testicle may shrink or lose tissue volume after surgery.
• Ascent: Rarely, the testicle may move back up out of the scrotum, which might require further attention.
• Structural injury: There is a small risk of damage to the vas deferens (the tube that carries sperm) or the blood vessels that supply the testicle.

Surgical care is tailored to each patient. The surgeon will decide on the best approach—such as open surgery or laparoscopic surgery (using a small camera)—based on where the undescended testicle is located. Long-term follow-up is often recommended to ensure the testicle heals properly and remains in the correct position as the child grows.

Sources used

The medical information in this section is based on clinical reviews and summaries provided by the National Center for Biotechnology Information (NCBI) and StatPearls.