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 1 st edition, 2011)
Orchidectomy
Surgical removal of one or both testis.
(Oxford Medical Dictionary, third edition, 2004)
Orchidopexy
Surgical fixation of a testis.
(Oxford Medical Dictionary, third edition, 2004)

Anatomy and Physiology

(Human Anatomy and Physiology, seventh edition, 2011)

Indication

Torsion of testis

In doubt wether
torsion or
infection (for
diagnostic and
exploration)

CONTRA INDICATION

Infectious
conditions

Hernia

Tools

EQUIPMENT
Sterile drapping

Sterile gauze

Hand
Towel clamp gloves

Povidone
iodine
10%

Sterile gown

Sponge
forceps

EQUIPMENT

Kocher
forceps

Blade no
15
Metzenbau
Pinset
m

Needle
Holder

EQUIPMENT
Plain catgut 3.0

Silk 1.0
1

Polyprolene 3-0

PROCEDUR
ES

Preparations and
Desinfections

Incisions
Grasp the scrotum with the
thumb and index finger, and
press the testis forward. The
scrotum maybe edematous.
Make a short transverse
incision,
Alternatively para raphe
incision
(SOP RSU dr Saiful Anwar Malang)

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

(Hinmans Atlas of Urologic Surgery,

third edition, 2012)

Open the tunica vaginalis,

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 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 (polyprolene)
(Hinmans Atlas of Urologic Surgery,
and tie them after all
third edition, 2012)
have been inserted.

NON
VIABLE

Orchidectomy ipsilateral
Orchidopexy contralateral

Orchidectomy
Push the scrotal layers
away 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 1-0
non-absorbable sutures
(Hinmans Atlas of Urologic Surgery,
(Silk).
third edition, 2012)

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 (plain catgut).
Add sterile fluff sheld in place with a snugfitting 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

THANK
YOU