An undescended testis is when the testis is not fully down in the boy's scrotum.The testis first develops near the kidney when the baby boy is inside the mother's womb. For the testis to drop down into the scrotum there needs to be a passage through the groin area. Sometimes the testis remains inside the tummy cavity, but much more commonly it becomes stuck in or close to the groin passage. An undescended testis is not uncommon at birth, especially in premature boys. The testis may 'drop' of its own accord in the first 6 months of life, but is very unlikely to do so after this time. The testis needs to be located in the scrotum in order for it to be kept cooler than the rest of the body and be able to produce normal sperm when the boy is older. Ideally this operation should be performed before the boy is 12 to 18 months of age.

Preparations

Your child will need to fast for solids and liquids generally for about 4 to 6 hours before the start of the procedure. In breast-fed babies or infants this time may be reduced after consultation with the anesthetist. Please ring the Day Surgery Unit the working day before surgery to confirm these times. It is often helpful to bring your child's favourite toy with you on the day.

Anesthesia

You and your child will meet the anesthetist on the morning of the procedure. After talking to you and briefly examining your child, they will take you through to the operating theatre. The anesthetist puts your child to sleep via a face mask (with children 5 years and over there is the option of a face mask or a needle with numbing cream). You will then be shown the waiting room. Once your child is asleep, the anesthetist will insert a "drip" to allow fluids to be given directly into a vein Usually this is located in the hand or arm, but occasionally may need to be sited in the leg or scalp.

Procedure

The groin area and scrotum is cleaned with an antiseptic solution. A local anesthetic block is injected into the area so that the site of the operation is numb after the operation. This block usually lasts for about 4 to 6 hours.

A cut is made in the groin on the side of the undescended testis, with a second smaller cut at the bottom of the scrotum on the same side. Once the testis has been found, it needs to be carefully released so that it can be brought into the scrotum. This will often involve removing a small hernia near the testis. The hernia must be peeled off two important tubes: the blood vessel to the testis and the sperm tube. This usually allows the testis to be placed in the scrotum. The wounds can then be closed with dissolving stitches which are buried under the skin in the groin but which will be visible in the scrotum. A clear water resistant dressing is then placed over each wound.

Initial Recovery

Once the operation has finished, your child will be taken to the recovery area. Once awake, you will be called into the recovery ward. Often children appear mildly distressed and a little confused initially. There may be several reasons for this, including residual effects of the anesthesia, hunger and some discomfort. Generally they will settle quite quickly, especially if offered a drink or feed. The recovery ward staffs are also able to give pain relief medication once your child is awake and sometimes this is required. Usually this will be about 2 hours after the surgery.

Post Operative Course

Paracetamol should be given on the afternoon and evening of surgery, and in the morning of the following day. After that time, assess your child's pain to see if further doses are required. Follow the manufacturer's dose instruction but never give more than 4 doses in a 24-hour period. Older children may require a stronger medication if over 2 years of age. Your child should not be bathed Showers are safe from 5th day onwards. There may be a small amount of blood that oozes from the wound under the dressing in the first 24 hours. Generally the dressing does not need to be changed, but if you are concerned please discuss with your local doctor or myself. It is quite normal for the scrotum and testis to swell after the operation and there may also be some bruising. This represents the body's normal response to the operation and settles within the first few weeks. You should remove the dressing completely after a long bath on the fifth day after the operation. No further dressings are then required.

Follow Up

Normally I see you and your child about 5 to 7 days following surgery. This is both to ensure that the wounds have healed and that you and your son are satisfied with the results of the operation. Please ring soon after the operation to book the post operative appointment to arrange a convenient time. Boys are normally followed up for about 2 years after their surgery to make sure that the testis stays down as the boy grows.

Problems & Further Surgery

Generally this procedure is straightforward, but there is a 10% chance that the testis may not stay in the scrotum following surgery. In this situation a further operation will be required, usually about 6 to 12 months after the first procedure. During the operation there is a very small risk (less than 1 %) of damage to the blood vessels to the testis and the sperm tube. This risk is minimized by the use of magnification during the procedure and usually can be both detected and repaired at the time of operation should this occur. Any boy that has had an orchidopexy should wear a cricket-box when playing contact sports. Also, after puberty, boys should be instructed to perform testicular self examination on a monthly basis because of the increased risk of testicular cancer in undescended testes. Orchidopexy does not change this risk, but does make it much easier to detect.

A Hydrocoele is a collection of fluid around the testis. The testis first develops near the kidney when the baby boy is inside the mother's womb. For the testis to drop down into the scrotum there needs to be a passage way through the groin area. Normally this closes off around the time of birth. If the passage way stays open, fluid can pass from the tummy cavity and surround the testis. Even when there is a lot of fluid, it does not harm the testis in any way. As the communication may close without an operation, we generally wait until the boy is about 9-11 months of age before recommending surgery. If the Hydrocoele does not resolve by this age, an operation is advised as the fluid collection may become uncomfortable for the boy as he becomes older.

General Description

The aim of the procedure is removal of the communication between the tummy cavity and the testis. The operation is performed as a day case done under general anesthesia. Generally the operation takes about 45-60 minutes.

Preparations

Your child will need to fast for solids and liquids generally for about 6 hours before the start of the procedure. In breast-fed babies or infants this time may be reduced to 4 hours. It is often helpful to bring your child's favourite toy with you on the day.

Anesthesia

You and your child will meet the anesthetist on the morning of the procedure. After talking to you and briefly examining your child, they will take you through to the operating theatre. The anesthetist puts your child to sleep via a face mask. Once your child is asleep, the anesthetist will insert a "drip" to allow fluids to be given directly into a vein. Usually this is located in the hand or arm, but occasionally may need to be sited in the leg or scalp.

Procedure

The groin area is cleaned with an antiseptic solution. A local anesthetic block is injected into the area so that the site of the operation is numb after the operation. This block usually lasts for about 4 to 6 hours. A cut is made in the groin on the side of the Hydrocoele. Once the communication between the tummy cavity and the testis has been found, two important tubes need to be peeled off it: the blood vessel to the testis and the sperm tube. The communication can then be tied off and fluid removed from around the testis. The wound is then closed with dissolving stitches which are buried under the skin. A clear water-resistant dressing is then placed over the wound.

Initial Recovery

Once the operation has finished, your child will be taken to the recovery area. Often children appear distressed and a little confused initially -there may be several reasons for this including residual effects of the anaesthetic, hunger, and some discomfort. Generally they will settle quite quickly, especially if offered a drink or feed. The recovery and ward staffs are also able to give pain relief medication once your child is awake, and this is sometimes required. The nursing staff will check the wound and make sure you are happy before you go home. Usually this will be about12-24hours after the surgery.

Post Operative Course

Paracetamol should be given on the afternoon and evening of surgery, and in the morning of the following day. Older children may require a stronger medication such as Ibuprofen. After that time, assess your child's pain to see if further doses are required. Your child should not be bathed on the first night, but nappies can be changed as required and a "wet-wipe" of similar cloth used. Showers are safe from the fifth day onwards. There may be a small amount of blood that oozes from the wound under the dressing in the first 24 hours. Generally the dressing does not need to be changed, but if you are concerned please discuss with your local doctor or myself It is quite normal for the scrotum and testis to swell after the operation and there may also be some bruising. It is not the Hydrocoele returning but the body's normal response to the operation and settles within the first few weeks. You should remove the dressing completely after a long bath on the fifth day after the operation. No further dressings are then required.

Follow-Up

Normally I see you and your child about 3 to 4 weeks following surgery. This is both to ensure that the wound has healed and that you and your son are satisfied with the results of the operation.

For patients from rural areas, this review may be deferred to your own general practitioner if you prefer.

Problems & Further Surgery

Generally this procedure is straightforward, but there is a 5% chance that the Hydrocoele may not resolve completely following the surgery. In the majority of these cases the fluid is re-absorbed by the body over the next 6 to 12 months. Rarely, a further operation will be required. During the operation there is a very small risk (less than 1 %) of damage to the blood vessels to the testis and the sperm tube. This risk is minimized by the use of magnification during the procedure and usually can be both detected and repaired a t the time of operation should this occur.

General Description

The aim of the procedure is surgical removal of the foreskin. The operation is performed as a day case under general anesthesia. The operation usually takes about 30-40 minutes.

Your child will need to fast for solids and liquids for about 6 hours before the start of the procedure. In breast-fed babies or infants this time may be reduced after consultation with the anesthetist. It is often helpful to bring your child's favourite toy with you on the day of surgery.

Anesthesia

You and your child will meet the anesthetist prior to the procedure. After talking to you and briefly examining your child, they will take your baby to the operating theatre. The anesthetist puts your child to sleep via a face mask. Once your child is asleep, the anesthetist will insert a "drip" to allow fluids to be given directly into a vein. Usually this is located in the hand or arm, but occasionally may need to be sited in the leg or scalp. The anesthetist will then inject some local anesthetic to numb the penis. Usually this is injected around the base of the penis, but occasionally it may be given near the base of the spine near the "tall" bone, termed a "Caudal".

Procedure

The penis is cleaned with an antiseptic solution. The foreskin is removed and any bleeding stopped with an electrical cautery instrument. The wound is then closed using pale yellow stitch materials that will dissolve slowly over the next 2 to 4 weeks. No dressing is used, but an antibiotic ointment is applied to the wound to help prevent infection.

Initial Recovery

Once the operation has finished, your child will be taken to the recovery area. One they are awake, you will be called into the recovery ward. Often children appear distressed and a little confused initially - there may be several reasons for this including residual effects of the anesthesia, hunger, and some discomfort. Generally they will settle quite quickly, especially if offered a drink or feed. The recovery and ward staffs are also able to give pain relief medication once your child is awake, and this is sometimes required. The nursing staff will check the wound and make sure you are happy before you go home.

Post Operative Course

There may be small amount of blood that oozes from the wound, enough to lightly stain a nappy or pair of underpants. Any further bleeding should be discussed with your local doctor or myself. Paracetamol should be given on the afternoon and evening of surgery, and in the morning of the following day. After that time, assess your child's pain to see if further doses are required. Your child should not be bathed on the first night, but nappies can be changed as required and a "wet-wipe" or similar cloth used. Normally bathing is safe from the 4th day onwards. It is important to apply topical antibiotic cream to the wound 3 times a day. In addition, to help prevent the tip of the penis from sticking to underpants or nappies, a thin layer of Vaseline or petroleum jelly is helpful. Often the tip of the penis, called the glans, will appear red, swollen and ulcerated in the first few weeks after surgery. This is normal and does not represent infection. The covering of the glans needs to change from a protected moist covering, like the inside of the mouth, to dry skin like the rest of the body. The swelling improves considerably after the first week but does not resolve completely for up to 8 weeks after surgery.

Follow-Up

Normally I see you and your child about 5 to 7 days following surgery This is both to ensure that the wound has healed and that you and your son are satisfied with the results of the operation. For patients from rural areas, this review may be deferred to your own general practitioner.