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Dr. Andrew Rynne

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What causes testicles to twist despite undergoing Orchiopexy surgery?

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Dr. Manuel C See IV

Urologist

Practicing since :2005

Answered : 770 Questions

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Posted on Tue, 22 May 2018 in Urinary and Bladder Problems
Question: I was diagnosed with intermittent testicular torsion 3 years ago and had orchiopexy performed with non absorbable sutures. Before the surgery my testicle would be backwards (180 degrees) 90% of the time or more and I had pain every day from it. After the surgery my testicle stays in the proper orientation for the most part, but I still find it backwards on occasion, at least once a week. What is the most likely reason for the surgery adding support to the testicle with it still having the ability to twist? Since the testicle is able to twist 180 degrees then the surgery didn't work completely, because using absorbable sutures means my surgeon was trying to heal scarred tissue together to anchor the testicle to the scrotal wall, but that doesn't seem to have been successful.
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Answered by Dr. Manuel C See IV 52 minutes later
Brief Answer:
Movement of the testis is expected.

Detailed Answer:
Good day and thank you for being with healthcare magic!

Are you still having pain from your testis? For orchidopexy what we usually do is we create a dartos pouch (a different compartment within the scrotum) and this helps the testis rest in that smaller space thereby limiting it to twist and cause pain. We also fix the testis in 3 points with non absorbable sutures to prevent infection and granuloma in the testis. Movement of the testis within the dartos pouch would be expected as long as you are not suffering in pain.

I would strongly suggest to follow up with your surgeon and raise your concerns to him since he is the most knowledgeable of what happened to you before during and after the surgery.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Manuel C See IV 33 minutes later
I have experienced pain even after the surgery. Before the surgery I don't recall him saying anything about a dartos pouch, just suturing the testicle to the scrotal wall. I'm tired of checking the orientation of my testicle to make sure it isn't backwards every day, I just want it fixed in place. I understand there being movement, but for it to still be able to twist 180 degrees just like before the surgery is bothersome. During the healing phase of 3 months it was in the proper orientation, but just a couple weeks after that was the first time since the surgery I had discovered the testicle was backwards again. I can only assume that the testicle was held in place due to the sutures in place, but once they dissolved it was allowed to move again. The thing that gets me is, if the testicle is sutured to the scrotal wall, which would be the right side of the testicle since it's my right one. For it to turn 180 then the side which should be facing the scrotum is facing the other testicle. Even with the dartos pouch I don't see how it should still be able to do that.
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Answered by Dr. Manuel C See IV 4 minutes later
Brief Answer:
180 degrees is too much movement.

Detailed Answer:
If you are sure that the testis rotates 180 degrees then you are at risk of torsion again. I would suggest again to see your urologist so he will be able to do a complete physical examination on your scrotum.

Absorbable sutures would stay for 70-100days then it will be replaced by fibrosis that would still fix your testis to the scrotal wall.
Above answer was peer-reviewed by : Dr. Kampana
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