An orchiopexy is a surgical procedure used to correct an undescended testicle or testicular torsion. If a testicle has not descended, a surgeon will move the testicle into the scrotum and fasten it with sutures. Or, if the testicle has rotated and caused the spermatic cord from which it is suspended to twist, an orchiopexy may be performed to disentangle the spermatic cord so that blood can be supplied to the testicle.

The Orchiopexy Procedure

An orchiopexy is performed under general or epidural anesthesia, and is meant to correct two specific urological conditions: testicular torsion and an undescended testicle.

Testicular Torsion

Torsion of the testicle requires immediate intervention to avoid tissue death and removal of the testicle. The condition occurs when the testicle rotates, causing the spermatic cord from which it is suspended to twist and cut off the blood supply to the testicle. Ninety percent of torsions are caused by a birth defect called "Bell clapper deformity." This is when the testis fails to attach to the inner lining of the scrotum, and instead floats freely.

During an orchiopexy, the surgeon makes a cut in the patient's scrotum and manually untwists the spermatic cord. The testicle is then examined to determine if there is any tissue death. If there is considerable necrosis, the entire testicle will likely have to be removed (orchiectomy). If the tissue is healthy, the testicle will be sutured to the wall of the scrotum. In some cases, such as when both testes are unattached to the interior lining of the scrotum, the surgeon may perform the procedure on the unaffected testicle to prevent torsion from occurring.

Undescended Testicle

Undescended testicle is another condition that could require an orchiopexy. During fetal development, the testicles form in the abdomen and move down into their scrotal sack shortly before birth. In approximately 34 percent of infants, one or both of the testicles fail to make the trip down to their permanent home in the scrotum. The testicle becomes "stuck" somewhere along the route, often either in the abdominal cavity or the inguinal (groin) canal.

Still, in more than half of those cases, the testicle(s) will spontaneously move into the scrotum within the first year of life. If the testicle(s) does not relocate by that time, an orchiopexy will be required to reduce the risk of:

To determine the exact location of the testicle(s), sometimes a urologist will perform a diagnostic laparoscopy, whereby a tube with a light source and camera at its tip is inserted through an incision in the abdomen so that the testicle(s) can be located. This is done to determine the surgical approach, which can be in the groin or abdomen.

When the testicle(s) is located in the groin, the surgeon will make a tiny cut in the groin and scrotum. The testicle is moved down from the groin and placed in the scrotum and held in position with sutures that the body will eventually absorb.

Should the testicle(s) be located in the abdomen, an incision is made in the belly and the testicle is moved into the scrotum and held in place with absorbable sutures. In cases where the testicle(s) is located high in the abdomen or in an obscure location within the inguinal canal, the undescended testicle may have to be completely removed and transplanted in the scrotum. Once there, tissues and blood vessels are attached. This type of procedure, known as the Fowler-Stephens technique, may be done in two parts.

Recovery after an Orchiopexy

Recovery after an orchiopexy depends on whether it was used to treat an undescended testicle or testicular torsion. Typically, a patient can go home the same day if the procedure was used to treat an undescended testicle. However, if the procedure was complicated because the testicle was located high in the abdomen or inguinal canal, he may need to stay in the hospital for a few days. In either case, pain medication is usually prescribed for pain, and antibiotics are given to prevent infection.

For two to three weeks following an orchiopexy, the patient should not bike ride or engage in sports or activities that could cause injury to the genitals.

Following an outpatient orchiopexy for testicular torsion, the patient will be instructed to rest for several days. During this time, he will also be advised to consume lots of fluids and raise the scrotum on a pillow to reduce swelling and discomfort. Activities that could lead to genital injury should be avoided.

Orchiopexy Complications and Risks

As with any surgery, there are risks of infection, allergic reaction to anesthesia and bleeding. Possible complications specific to orchiopexy include:

  • Blood clots in the scrotum
  • Damage to the structures and/or tissues of the testicle
  • Inadequate blood supply, which can lead to atrophy (shrinkage)

There is also a small chance that the testes could reascend, which could require another procedure.

Orchiopexy Outcomes

Outcomes of orchiopexy vary depending on the condition and its severity but, overall, the procedure remains highly effective. With an undescended testicle that is located in the inguinal canal, the procedure carries a success rate of 95 percent. For testes found in the lower abdomen, the success of orchiopexy ranges from 85-90 percent, and that goes for both a traditional orchiopexy and the two-stage Fowler-Stephens orchiopexy. Lower success rates are associated with testes found high in the abdomen. Still, despite the procedure's efficiency, there is no way to ensure fertility. Adult men who have had a unilateral orchiopexy may find that their fertility is relatively normal. On the other hand, fertility is drastically reduced after bilateral orchiopexy.

As for testicular torsion, success of the procedure also varies. If an orchiopexy is performed within 4-6 hours of the onset of symptoms, the testicle can be saved in 90 percent of cases. If treatment is delayed due to lack of patient awareness of symptoms, misdiagnosis or other factors, the salvage rate drops to 50 percent at 12 hours after the onset of symptoms, and to 10 percent after 24 hours. Reduced fertility is a potential complication of the condition itself, and may not change following the operation.


Albala DM, Morey AF, Gomella LG, & Stein JP. (2011). Testicular torsion. Oxford American Handbook of Urology.

Albala DM, Morey AF, Gomella LG, & Stein JP. (2011). Undescended testes. Oxford American Handbook of Urology.

Albala DM, Morey AF, Gomella LG, & Stein JP. (2011). Orchiectomy. Oxford American Handbook of Urology.

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