Orchiectomy


What Is Orchiectomy?

Orchiectomy is known as the surgical removal of one or both testicles. This procedure is done as an option in the management of several medical conditions that affect the male reproductive system [1, 2, 3].

The surgical procedure known as orchiectomy involves the removal of one or both testicles. The penis and the pouch of skin that previously contains the testicles called scrotum are left intact [1]. The testicles are the glands that produce the hormone testosterone and produce the sperm [3].

Most of the time, only one testicle is removed by the surgeon. Men who underwent a unilateral orchiectomy will not have any problem rearing children because the remaining testicle is still able to produce sperm. The possibility of banking sperm before a unilateral orchiectomy as a precaution can be discussed with the surgeon [4, 5].

A bilateral orchiectomy or removal of both testicles may be advised by the physician if there is a high possibility of testicular malignancy.

There should be no changes in the life of the patient after the surgical procedure except to the fact that he will not be able to father any children. Banking of the sperm should be advised to the patient if they are interested in having children [4, 5].

Orchiectomy

Types

There are 3 different types of orchiectomy that can be performed by the surgeon. They differ on the site of the incision and the parts of the testicle that are removed [1, 2, 3, 4, 5]:

1. Simple orchiectomy

In a simple orchiectomy, the incision is made in the middle of the scrotum and the surgeon cuts through the underlying tissue. The testicle and the spermatic cord through the incision. It will then be closed with 2 layers of suture and will be covered with a surgical dressing.

For patients who want to maintain a normal looking scrotum, a prosthetic testicle may be implanted by the surgeon in place of the removed testicle [2].

2. Subscapular orchiectomy

The incision of a subscapular orchiectomy is similar to that of a simple orchiectomy. The main difference is that only the glandular tissue is removed instead of the whole entire gland. This will give the scrotum a normal looking appearance without the need for a prosthetic testicle [2].

3. Inguinal orchiectomy

The incision in an inguinal orchiectomy is made in the groin of the patient instead of the testicle. This is also called a radical orchiectomy because the whole spermatic cord is removed along with the entire testicle.

A radical orchiectomy is the method of choice if the patient is diagnosed with testicular cancer. The entire cord is removed to prevent the spread of the malignancy from the spermatic cord and into the lymph nodes that are found near the kidneys.

A long suture that is non-absorbable will be left on the stump in case the patient would require another surgical procedure in the future [2].

Indications

An orchiectomy may be performed by the surgeon for the management of testicular cancer or if the patient would like to undergo a gender reassignment [2].

Testicular cancer

The testicles are the most common site of malignancy in males between the ages of 15 and 34. The age groups that are more at risk for testicular cancer are those who are less than 10 years of age, adult males between 20 and 40 years of age and older men who are more than the age of 60 [2].

Gender reassignment

Those individuals who want to have a gender reassignment must undergo a stringent physical and psychological evaluation before they are approved to undergo the procedure. These patients must undergo hormone therapy for several months or several years before the procedure [2].

Risk Factors

The general risks that are associated with orchiectomy are the same with any procedure done under general anesthesia.

These include the possibility of heart or breathing problems, deep venous thrombosis, increased sensitivity to anesthesia drugs, infection, and bleeding. The risks that are specific to orchiectomy include [1, 2, 3, 4, 5]:

  • A reduction or a loss of sensation in the genitals or groin area
  • Loss of sexual desire which can be managed through the use of hormone gel or injections
  • Impotence
  • Tenderness and enlargement of the breasts
  • Weight gain of about 10-15 lbs
  • Presence of hot flashes similar to that felt by women who are in menopause
  • Fatigue
  • Mood swings or depression

Care

The patient may need to stay for a few days in the hospital after undergoing the procedure. Care of the surgical site will be discussed to the patient before they are discharged.

The medications that need to be taken at home will be discussed to the patient as well. The recovery time may take around 4 weeks and there are activity restrictions that will be imposed on the patient while they are still in this phase. These restrictions include [1, 2, 3, 4, 5]:

  • Prevent constipation to minimize or avoid straining with bowel movement
  • The patient should shower 48 hours after the procedure. A tub bath must not be done without the advice of the healthcare team
  • No lifting of more than 10 pounds during the first 4 weeks
  • Jogging, running or engaging in any sports should be avoided for the first month

References

  1. Thompson, E. G. (2015, November 20). Orchiectomy for Prostate Cancer. Retrieved from WebMD: http://www.webmd.com/prostate-cancer/orchiectomy-surgery
  2. Frey, R. (2016). Orchiectomy. Retrieved from Encyclopedia of Surgery: http://www.surgeryencyclopedia.com/La-Pa/Orchiectomy.html
  3. Papanikolaou, F. (2015, November 29). Radical Orchiectomy. Retrieved from Medscape: http://emedicine.medscape.com/
  4. Smith, L. (2016, June 3). Surgical Procedures: Orchiectomy. Retrieved from OncoLink: https://www.oncolink.org/cancers/testicular/surgical-procedures-orchiectomy
  5. TC-Cancer.com. (2006). The Orchiectomy. Retrieved from TC-Cancer.com: http://www.tc-cancer.com/orch.html
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