ORCHIDECTOMY AND ORCHIDOPEXY

ON TESTICULAR TORSION

RIZKI HANIFAN NUGRAHA

Definitions
Torsion of testis
Testicular torsion is a twist of the spermatic cord,
resulting in strangulation
(Oxford American Handbook of Urology 1st edition,
2011)

Anatomy

(Human Anatomy and Physiology, seventh edition, 2011)

Cause of Acute Scrotal Pain and Swelling

Ischemia
Trauma
Infectious conditions
Inflammatory conditions
Hernia
Acute on Chronic events

HISTORY TAKING
age of the child: neonatal, prepubertal, adolescent
onset and severity
trauma
fever
prior genitourinary surgeries

(Royal Childrens Hospital Melbourne, 2013)

PHYSICAL EXAMINATION
observation of the patients gait and resting position
natural position of the testis in the scrotum while

standing
presence or absence of cremasteric reflex (this is
absent in torsion)
palpation of lower abdomen, inguinal canal and cord
palpation of scrotum and contents, compare with
unaffected hemiscrotum
Phren test (positive in testicular torsion)
(Royal Childrens Hospital Melbourne, 2013)

Tools
Sterile gauze

Metzenbaum scissor

Sterile linen

Needle holder

Povidone iodine 10%

Iodine cup

Blade and blade holder

Silk 3-0

Pincets

Plain catgut 3-0

Kocher forceps

Polypropilene 3-0

Sponge forceps
Towel clamp

EQUIPMENT
Sterile drapping

Sterile gauze Towel clamp

Sterile gown Hand

gloves

Povidon
e iodine
Sponge forceps
10%

EQUIPMENT
Plain catgut 3-0

Metzenbaum

Needle
Holder

Prolene 3-0 &

Silk 2-0

Kocher
forceps

Blade no
Pinset
15

PROCEDURES

Preparations and Desinfections

Informed consent to the patient
Patient in general anesthesia or spinal block.
Patient in supine position, a right-handed surgeon

stands on the right side of the table.

Evaluate the SSC (Surgical Safety Checklist).
Desinfects the abdomen, penis, scrotum, and both
inner thigh with Povidone Iodine 10% then cover it
with sterile towel.

Incisions
Grasp the scrotum with the

thumb and index finger,

and press the testis
forward. The scrotum
maybe edematous.
Make a para raphe incision
Continue the incision to
the tunica vaginalis, which
may appear darkened from
contained bloody serum.
(Hinmans Atlas of Urologic Surgery,
third edition, 2012)

Identification and evaluation

Open the tunica vaginalis,

(Hinmans Atlas of Urologic Surgery,

third edition, 2012)

evacuate the accumulated

hydrocele fluid, and extrude the
testis.
Observe its color after untwisting
it clockwise on the right,
counterclockwise on the left.
Wrap it in warm saline sponges
and observe it for 10 or 15
minutes.
If the testis become red and
sanguinous, proceed with
orchidopexy. If the testis
remains dark, proceed with
orchidectomy.

VIABLE
ORCHIDOPEXY BILATERAL

Orchidopexy
If the testis is to remain,

trim the excess tunica

vaginalis.
Obtain hemostasis along
the edge with thorough
fulguration
Place two or three
interrupted suture in the
cut edges of the tunica
vaginalis to approximate
the edges behind the testis
(Hinmans Atlas of Urologic Surgery,
third edition, 2012)

Orchidopexy
Invert the scrotal septum

into the wound with a

finger inserted from the
opposite side, and fix the
tunica albuginea to the
septum in three places.
Use interrupted mattress
3-0 non-absorbable
sutures and tie them
after all have been
inserted.
(Hinmans Atlas of Urologic Surgery,
third edition, 2012)

NON VIABLE
ORCHIDECTOMY IPSILATERAL
ORCHIDOPEXY CONTRALATERAL

Orchidectomy
Push the scrotal layers away

(Hinmans Atlas of Urologic Surgery,

third edition, 2012)

with sponge dissection, and

deliver the testis within the
tunica vaginalis into the
wound.
Alternatively, open the
tunica vaginalis before
delivering the testis. Draw
the testis down to expose the
epididymis and cord.
Doubly clamp each part, and
ligate them with a 3-0 nonabsorbable sutures.

Closure
Before closing, electrocoagulate any bleeders in the

dartos and subcutaneous tissue to avoid a distressing

scrotal hematoma.
Close the dartos layer with a running absorbable
sutures, and close the skin, together with the
subcutaneous tissue, with interrupted 3-0 sutures.
Add sterile fluff sheld in place with a snug-fitting
scrotal supporter.

Complications
Intra Operatives

Post-operative
Bleeding

Injury of testicular vessels and nerves

Early :
Hematome
Wound infection
Epididymitis and/or orchitis
Excessive pain

Late :
Congestive epididymitis and/or orchitis
Persistent pain syndrome
Testicular atrophy

Post Surgical Care

Rest and avoidance of vigorous activity help

minimize discomfort.
Scrotal support for 3 5 days.
Oral antibiotics and analgetics.

THANK YOU