Мұстаушаны бекіту хирургиясы немесе Орхиопексия

Surgery to fix a testicle into the scrotum

Orchiopexy (or orchidopexy) is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.

Undescended testicles affect 1% of males and are 10% bilateral. The cause is unknown, with a small percentage associated with developmental abnormalities or chromosomal aberrations. Early orchiopexy reduces the risks for cancer and sterility in males with cryptorchidism, or undescended testes. Cryptorchidism is definitively diagnosed after 1 year of age, as testicular descent may occur after birth. Surgical placement into the scrotum is recommended by 18 months to decrease the likelihood of testicular cancer, testicular atrophy, and sterility. Cryptorchidism is associated with tubular atrophy and sterility. In addition, cryptorchid testes carry a three to five times higher risk for testicular cancer (germ cell neoplasia in situ within the atrophic tubules). Patients are at increased risk for the development of cancer and atrophy in the contralateral, normally descended testes as well. There are multiple different orchiopexy techniques used to correct an undescended testicle due to the large variation in location where the testes may present. The procedures have a high overall success rate.

Two distinct techniques used for surgical fixation are the sutured point fixation and Jaboulay tunica plication. Multiple studies have shown that both are effective techniques for fixation with limited evidence favoring either in acute torsion.

The first attempts at surgical correction of cryptorchidism began in the early 1800s. Before this, inguinal testis were managed with the use of truss or castration, if at all. The theory of orchiopexy is attributed to the observations of Baron Albrecht von Haller and John Hunter in the 1700s, who began to elucidate the anatomy and mechanism of testicular descent. The first recorded attempt for surgical correction of an undescended testis was performed by James Adams in the London Hospital in 1871, although there are reports of attempts by several German doctors (J. F. Rosenmerkel in 1820 and M. J. von Chelius in 1837). The patient died due to infectious complications of the procedure. Thomas Annandale completed the first successful orchiopexy in 1887 on a three year old boy. He discussed the care of this patient in The British Medical Journal, crediting Thomas Curling (who had worked with James Adams) with the idea of anchoring the testis to the bottom of the scrotum. Notably, Annadale was a close acquaintance of Joseph Lister, and practiced antiseptic techniques that had been absent from previous attempts by other physicians. The postoperative course was reported to be “satisfactory in every way”. Max Schüller, Arthur Dean Bevan, and John K. Lattimer further contributed to the current techniques for orchiopexy between the late 1800s and early 1900s, with the steps for standard orchiopexy being established before the 1960s. At this point, the standard orchiopexy applied to most undescended testes had a high success rate ranging from 89% to 92% Attention was then turned to the treatment of high undescended testes, which the standard orchiopexy did not adequately treat. In 1979, Jones and Bagley suggested a high inguinal incision for high canalicular or intra abdominal testes. Fowler and Stephens devised a means to preserve the blood supply of high undescended testes through collateral circulation. Their technique was modified into a two staged operation. Later, one stage laparoscopic orchiopexy was reported first to reveal the location of non palpable testes and then as a therapeutic treatment.