Rigi10™ Malleable Penile Prosthesis
Also Known As
Orchiopexy, Testicular Fixation, Undescended Testicle Repair Surgery, Cryptorchidism Repair, Fowler-Stephens Operation (for intra-abdominal testicle specifically), Testicular Repositioning Surgery
Definition
Orchidopexy is a surgical procedure that involves the fixation of an undescended testicle (cryptorchidism) into the scrotum.1 This intervention is performed when a testicle has not naturally descended from the abdomen or inguinal canal into its proper anatomical position in the scrotum.2 The procedure aims to relocate and secure the undescended testicle in the scrotal sac, thereby preserving testicular function, improving fertility potential, and facilitating future examination for early detection of testicular abnormalities.3
The procedure typically involves making a small incision in the groin or scrotum, locating the undescended testicle, freeing it from surrounding tissues, creating a pathway to the scrotum, and securing it within a surgically created pouch (Dartos pouch) in the scrotum.4 Orchidopexy is recommended to be performed between 6 and 18 months of age to minimize the risk of impaired fertility and other long-term complications associated with undescended testes.5
Clinical Context
Orchidopexy is primarily indicated for the management of cryptorchidism (undescended testicles), which is the most common congenital defect of male genitalia, occurring in approximately 3% of full-term male infants and up to 30% of premature male neonates.1 Testicular descent through the inguinal canal normally starts during the 28th week of gestation, with about 80% of undescended testes noted at birth migrating into the scrotum by 3 months of age.2 Undescended testes that remain outside the scrotum by 6 months of age will likely require surgical intervention.3
Patient selection criteria for orchidopexy include:
- Infants with undescended testicles that have not spontaneously descended by 6 months of corrected age4
- Children or adolescents diagnosed with cryptorchidism at any age5
- Patients with testicular torsion requiring fixation of the affected and/or contralateral testicle1
The American Urological Association (AUA) guidelines recommend surgical orchidopexy between 6 and 18 months of age.5 Early intervention is crucial as there is an increased loss of germ cells and potential future infertility problems the longer the orchidopexy is postponed.2 Research indicates that for every 6-month delay in performing the surgery, there is approximately a 1% drop in fertility, a 5% increased need for assisted reproductive services, and a 6% increase in testicular cancer risk.1
Surgical approaches for orchidopexy vary based on the location of the undescended testicle:
- Inguinal approach: Most common technique for testicles located in the inguinal canal
- Scrotal approach: Used when the testicle is at the top of the scrotum
- Laparoscopic approach: Preferred for intra-abdominal undescended testicles1
Expected outcomes following orchidopexy include:
- Successful positioning of the testicle in the scrotum in approximately 95% of cases3
- Preservation of testicular function and potential improvement in fertility prospects when performed at an early age2
- Facilitation of testicular examination for early detection of malignancy5
- Psychological benefits related to normal scrotal appearance4
Potential complications include wound infection, bleeding, testicular atrophy, and recurrent cryptorchidism.1 Long-term follow-up is recommended to monitor testicular development and function.