Thursday, May 03, 2007

Orchiopexy update--Recovery, diaper changes, and other answers to unasked questions

"There is an amazing array of things people do to botch a study," says Rebecca Maynard of the University of Pennsylvania.

For instance, 153 out of 167 government-funded studies of bisphenol-A, a chemical used to make plastic, find toxic effects in animals, such as low sperm counts. No industry-funded studies find any problem. It's not that the taxpayer-funded scientists are hallucinating, or that the industry scientists are blind. But here's a clue: many industry studies tested this estrogenlike chemical on a strain of rat that is insensitive to estrogen. That's like trying to measure how stress affects lactation ... using males.
This quote is from a Newsweek article that is not about bisphenol-A or phthalates, two of my least favorite chemicals for painful, personal reasons like they may have caused my six-month old son to get his squishy bits cut open. However, the article is about a related topic: all the bad science that the religious right has used to justify wasting taxpayer money on abstinence-only sex education programs, which are about as effective at stopping people from having sex as giving free beer to alcoholics is at getting them to stop drinking.

But this post is about 3B's orchiopexy, which was the result of his cryptorchidism, and I'm offering it as a public service to all those people who have been finding this blog with their searches for "diaper change after orchiopexy," "orchiopexy recovery," "undescended testicle," and the like. I'm sure that they're just as nervous as we were going into surgery, and I sincerely wish for them the same luck that we had with surgery. If there are questions that aren't answered in my account of the surgery or in this post, please let me know.

A few notes and caveats--I assume that the surgical procedure that 3B underwent was standard, he was six months old at the time of surgery (having been diagnosed at birth), he was in good health at the time of surgery, surgery was successful (they located his missing testicle and sutured it in place), and there were no anomalies or complications following surgery. If your situation is different--or even if it's not--your mileage may vary. Also, in case this is your first time reading this blog, I'm no doctor, a fact that my six loyal readers can surely attest to, based on any of my other posts.

Starting with the asked questions: diaper changes after surgery were just about the same as before. Both incisions--one was made to go get the testicle, the other was made to stitch it in place--were covered in a waterproof dressing that dissolves over about a week. That protected them from the contents of 3B's diapers until the incisions had sufficiently healed. We did, however, have a small concern about 24 hours after the surgery, when one of 3B's incisions bled just a little as we wiped around it. We figured that the slight pressure of wiping had caused it, but the surgeon had told us that he wanted us to call if there was "any bleeding." So we did, even though it was a weekend night. He called right back and said that, from our description, he wasn't too worried, but to keep an eye on it and let him know if it continued. It didn't continue, and 3B's recovery continued as the surgeon had described.

Orchiopexy recovery was, for us, as advertised. We were able to keep 3B comfortable with regular--every four hours--doses of Infant Tylenol for the first 24 hours. In the next 24 hours, we let the doses slide out to about every six hours, and he still seemed comfortable. After the first 48 post-operation hours had passed, we could see no signs that 3B had undergone surgery, other than his incisions. He was just as active, hungry, and happy as he had been before. His mobility and flexibility were unaltered as far as we could see, and continue to be to this day. As a man who had basically one of the same incisions that 3B did when I was 22 to repair an inguinal hernia, I couldn't have been more impressed by 3B's rapid recovery. As a 22-year-old, I think it took me two days before I could breathe without pain, much less engage in the wild gymnastics that 3B did just 48 hours after his surgery--and I had Vicodin helping me out.

As for the success of the surgery itself--that's, of course, something that I can't predict for you. Our surgery was as successful as we could hope for. 3B's second testicle is healthy and normal, although smaller than his other one. Because the surgeon was careful not to put strain on the recovered testicle's connecting tissue, he sutured it in slightly higher than the other one. However, as he observed, no man's testicles are perfectly symmetrical. The incisions are small and slightly faded even now. By the time anyone other than doctors or family will be looking at 3B's testicles, the incisions should be invisible.

As for predicting success, our surgeon expressed great confidence in finding a whole, functioning second testicle during our first pre-op visit, but then didn't seem so sure that he would find anything at all during our second pre-op visit, which was days before the surgery. I don't know if that was his way of managing our expectations, but it definitely put us in the mindset that this surgery might be successful from a survival-recovery standpoint, but not succeed at the ultimate goal of locating 3B's second testicle. According to our surgeon, and corroborated by our experience, the only way to be sure if there's a second testicle is to perform the surgery and see firsthand. He did, however, offer his reasons for believing strongly, in the first visit, that there was a second testicle:
  • The descended testicle was a normal size. Often, if there's no second testicle, the single testicle is twice as large as expected because it is attempting to make up for the function of the missing testicle.
  • 3B's scrotum was fully formed on both sides, as if a testicle had been present, or was ready to descent. Often, if there's no second testicle, that half of the scrotum is not well formed.
  • 3B's penis, scrotum, and descended testicle were all normal in appearance, meaning that they didn't have any obvious abnormalities, which might be a sign that the second testicle didn't exist.
That said--and remember, I'm no doctor--he was still adamant that there was no way to tell without doing the surgery.

And we clung to that knowledge in the face of every doctor and nurse having a unique opinion:
  • It looks like a testicle is waiting to descend. (This is about as useful as someone declaring that it's "earthquake weather" today. For the record, there can be unseasonable weather, and it can look like it's going to rain, but there's not "earthquake weather," and you can't see my son's testicle through his abdominal wall and the intervening interstitial goop in his gut.)
  • I'm sure he has no testicle. (Based on hard facts like the fact that you've never seen my son before and have now spend approximately 12 seconds in his presence? You must be a seer as well as a doctor.)
  • I believe I can feel it if I press down right here. (Hey, buddy, why don't you stop banging on my son's testicle like it's the "Fire" button in Space Invaders? Or do you want me to slam this medical encyclopedia shut on your nuts?)
Although it's about as futile as asking a jury to strike an answer from their memories, we tried to ignore these opinions and just wait for the surgery. But, of course, we couldn't ignore them entirely, and subsequently went on a roller coaster ride of hopes and emotions. I suggest doing your best to ignore the varied opinions you get, but preparing yourself for the emotional roller coaster ride.

I can't tell if the ride would have been easier to take if 3B had been older at the time of surgery--he was six months old--but I suspect that it wouldn't have been. Regardless of our feelings, we were grateful that our surgeon wanted to do the surgery as soon as possible because that's what all of the research we did recommended. It's well documented that the longer an undescended testicle is allowed to remain in the abdomen, the greater the likelihood of testicular cancer. Estimates varied, but they all were in the 10-20 times more likely range.

Our surgeon was glad that we brought 3B in when he was so young not only because he recommends recovering the missing testicle as soon as possible to lower the risk of later cancer, but also because he believes the best time for the surgery is at six months when, according to him, the body is old enough to withstand the effects of general anesthetic. Before that, babies are too young, and after that, we have an ever-diminishing ability to recover from general anesthetic. However, I work with someone whose son had successful surgery when he was six years old, which was, according to his doctor, the best time for him. It's best to educate yourself about the benefits and risks so you can decide from an educated position if your surgeon's recommendations fit your situation. Don't be surprised, however, if they recommend surgery on your tiny infant. In fact, it might be easier on you to have it done when he's younger, because it will likely make recovery faster.

And again, I can't emphasize this enough--don't listen to the peanut gallery when they're diagnosing your son, and giving you odds on his possession of a pair rather than an ace. I was in the room when they did the ultrasound to try to locate 3B's second testicle the day after he was born. It took the ultrasound tech a full fifteen minutes to find the testicle that was in his scrotum--and that's a testicle that she could feel, see with her eyes, and that was confined to a space about the size of a thimble (no offense, 3B, if you're reading this later--you were much smaller overall when you were born). So when she went shopping around in his abdomen, which is full of all kinds of other things and stuff that can easily block a view of a tiny item like a testicle (again, 3B, you were much smaller then), I fully expected her conclusion, which was that there's no second testicle. That diagnosis hit Mama, who wasn't in the room for the ultrasound, much harder than me because she assumed that those results were conclusive. As far as we can tell, based on the wildly varying diagnoses we got before surgery, the only conclusive results come from surgery.

And although we may sound like we're in the peanut gallery when we say it now, I suggest that future and expectant parents pay closer attention to their exposure to bisphenol-A, phthalates, and other chemicals with similar effects on people to help avoid cryptorchidism altogether. It's also probably a good idea to keep your kids from them because I suspect that, even though we sound like we're in the peanut gallery now, when the chemical capitalists are done botching studies, the truth about those chemicals, and their effects on all of us, young and old, will be revealed.

Papa Bradstein is going to ride 200 miles across Massachusetts in two days to help fight cancer. If you found this post helpful, please consider supporting his ride.

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  1. Thank you for this post! My son just had this surgery this morning at 9 months and this is great help! I am concerned about giving him a bath too, but we were told to sponge bathe for two days. Thanks again!

  2. Anonymous2:34 AM

    my son is 16 months old and has upcoming sergery and im kindda nervous so this feed back is helping alot!

  3. Anonymous11:32 AM

    My 9 month old son just had an orchiopexy 4 days back and wanted to share our experience with other moms in the same situation.

    At 6 months my sons doc told us we need to show him to an urologist as most likely he will have to be operated since he still had one Undescended testicle. At 7 months the urologist saw him and his right side testicle was not too far off from his scrotum, it was in the groin. The doctor confirmed that he needs to go through orchiopexy before he turns one. This is so that the testicle is not damaged and will not cause any fertility issues for him later in life. We were also very nervous but getting the orchiopexy done was the best decision for my son. We scheduled his procedure for when he was going to turn 9 months just so that he is a bit older.

    I was super nervous but at the same time was anxious to get done with the procedure and move on. Then came the day of the procedure. The nurse had instructed that he can have formula only till 1am the night before and only clear liquids until 4:30am and then nothing until 7:30 which is when he was scheduled to go into OR. The night went ok. My son used to sleep through the night but that night I gave him 2oz at 1am And some water at 4am. We had to be there at 6:15 and so left the house at 5 am. I was very very nervous that my son just in a couple of hours will be struggling with pain. We were there in time. The nurse checked us in. The doctor came and spoke to us. My son was with us in this outpatient room. Then I changed him in his gown. And we waited in that room till it was time. Then the OR nurse came and we had to hand him off. This was the toughest moment of the whole procedure by far. We said bye and off he went. We waited in that room the whole while and he was brought back to us in the nurses arms trying to wake up at 9am. He seemed to be in pain as I took him in my arms. He was fighting for a few minutes just then the nurse gave him pain killer prescription by mouth. He continued to sleep and wake up uncomfortable. Went on for half hour and then he fell asleep for like half hour. Then when he woke up he was grouchy but not crying in pain. He then accepted some water in his favorite sippy. We checked out and put him in his car seat and left. He was fast asleep in the car. An hour later we reached home.

    He was quite sleepy and slow the rest of the day had some more water. At around 3 pm had 2oz formula. I was alternating prescription pain med and ibuprofen every 3 hours. He had no problem falling asleep. So kept alternating little milk, sleep, some baby food fruit and the day ends. At night he slept well, we just woke him up for his meds.

    Today I am glad we did it and it's over. He was back to himself wanting to crawl everywhere and jump the next day. He is still on Tylenol and Ibuprofen but every 8 hrs. His scrotum swelling reduced 50 percent and if someone dint know can't tell he has had a surgery 4 days back. All is well that ends well. No major issues with diapering as well just keep doing normal cleaning. Hope this helps.