Orchiopexy is a surgical procedure used to treat testicular torsion, primarily aiming to promptly restore blood supply to the testis and prevent tissue necrosis caused by vascular occlusion. When the testis twists due to spermatic cord rotation, compressing arteries and veins, if not treated within the critical 6-hour window, irreversible testicular atrophy or loss of function may occur.
This procedure is usually performed in an emergency setting, where the surgeon repositions the testis and fixes it within the scrotum to reduce recurrence risk. In addition to addressing the acute crisis, the surgery also allows examination of the contralateral testis to prevent bilateral involvement.
The surgery mainly divides into two types: open surgery and laparoscopic surgery. Open surgery involves making an incision in the scrotum or groin to directly observe the spermatic cord and testis; laparoscopic surgery uses an endoscopic instrument through small incisions for precise operation.
The mechanism involves: 1. untwisting the spermatic cord to restore blood flow, 2. fixing the testis within the scrotum to prevent re-torsion, and 3. repairing any damaged vascular structures. The procedure is typically performed under general anesthesia, with an average duration of 45-90 minutes.
Primarily indicated for patients with confirmed acute testicular torsion, presenting with sudden severe scrotal pain, abnormal testicular position (such as elevation), and ultrasound showing blood flow obstruction. Additionally, fixation of the contralateral testis is recommended to prevent future risks.
Emergency signs include: pain lasting more than 6 hours, ultrasound confirmation of absent blood flow, or physical examination revealing the testis fixed at an abnormal angle. If signs of tissue necrosis are present, orchiectomy may be necessary.
The surgical process includes: 1. disinfecting the incision area after anesthesia, 2. dissecting the spermatic cord structures, 3. fixing the testis within the deep tissues of the scrotum, and 4. closing the wound and monitoring for bleeding. The procedure must be performed in a sterile environment, often with Doppler ultrasound to monitor blood flow recovery.
The concept of dosage does not apply to this surgery; however, timing is critical. Delays beyond 6 hours decrease testicular viability by approximately 10-15% per hour. Surgeons will adjust fixation techniques based on patient age and anatomy, such as using different fixation points in infants.
Compared to conservative management, surgery offers over 90% testicular survival rate, with small incisions and short recovery periods. Most patients can resume normal activities within 1-2 weeks.
Extreme cases may involve thrombosis or anesthesia-related complications, but these occur at a rate below 0.5%. Postoperative monitoring is essential for signs of persistent severe pain or fever.
Emergency contraindications: Patients with severe coagulation disorders or allergies require assessment of anesthesia risks. Diabetic patients should control blood sugar to reduce infection risk.
Postoperative care includes: 1. avoiding strenuous activity within 48 hours, 2. wearing supportive underwear to reduce scrotal pressure, and 3. regular follow-up of testicular function. Contraindications include allergy to anesthesia drugs or uncontrolled systemic infection.
The surgery may interact with anticoagulants (such as warfarin), which should be discontinued 72 hours before the procedure. Patients on steroid therapy need dose adjustments to avoid impairing tissue repair.
Imaging examinations (such as Doppler ultrasound) should be coordinated with surgery; preoperative results influence surgical strategy. Combining with other invasive procedures simultaneously is not recommended to reduce complication risks.
Medical studies show that patients treated within 48 hours have a testicular survival rate of 85-95%. Long-term follow-up indicates that over 80% of successfully treated patients maintain normal fertility, with no significant difference in contralateral testicular function.
Systematic reviews suggest that laparoscopic surgery reduces tissue damage by 30% compared to traditional open surgery. Five-year follow-up shows a patient satisfaction rate of 92%, demonstrating the clinical value of this approach.
Manual reduction in emergency settings (such as in the emergency room) can temporarily restore blood flow but has a recurrence rate of up to 40%, serving only as a temporary measure before surgery. Pharmacological treatments (like anticoagulants or analgesics) cannot fundamentally resolve vascular occlusion and are only used for symptom relief. If more than 6 hours have elapsed, necrotic tissue removal may be necessary, making surgery the only effective option.
Patients should complete blood tests, urinalysis, and scrotal ultrasound before surgery to confirm diagnosis and assess testicular blood flow. Fasting for 8 hours before surgery is required, and patients should inform the doctor of any medications or allergies. If in the active phase, surgery should be performed within 6 hours to reduce tissue damage risk.
How to relieve pain and swelling after surgery?Postoperative pain is usually managed with analgesics (such as NSAIDs), and ice packs can be applied to the scrotum to reduce swelling. Wearing supportive underwear can lessen discomfort, and avoiding strenuous activities or heavy lifting is recommended. If pain worsens or fever occurs, medical attention should be sought immediately.
Does the surgery affect fertility?If blood flow interruption causes tissue necrosis, orchiectomy may be necessary, impacting fertility. If the surgery is timely and testicular function is preserved, fertility is usually unaffected. Follow-up at 3-6 months is advised to evaluate testicular function and sperm quality.
How long does it take to recover normal life after surgery?Light activities like walking can usually resume within 1-2 days, but strenuous exercise should be avoided for at least 4 weeks. Full recovery for normal sexual activity and sports typically takes over 6 weeks. Recovery time varies per individual and should follow medical advice gradually increasing activity levels.
Is regular follow-up necessary after surgery?Yes, a follow-up within the first month is necessary to check scrotal blood flow recovery, and within 6 months to assess testicular function. Patients with a history of unilateral torsion should perform regular self-examinations for abnormal swelling or pain and follow medical advice for preventive surgery (such as contralateral fixation).
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