Orchiectomy

Diagram showing how the testicle is removed (orchidectomy) CRUK

Orchiectomy is a surgical procedure involving the removal of one or both testicles. It is a significant operation in the field of urology and is performed for various medical reasons, including testicular cancer, advanced prostate cancer, testicular torsion, and gender reassignment.

Overview

• Also Known As: Orchidectomy, Testicular removal
• Specialty: Urology
• Indications: Testicular cancer, Prostate cancer, Testicular torsion, Gender reassignment, Trauma, Infection
• Procedure Type: Surgical

Indications

Testicular Cancer

One of the primary indications for an orchiectomy is testicular cancer. Removal of the affected testicle is crucial in preventing the spread of cancerous cells.

Prostate Cancer

In advanced cases of prostate cancer, orchiectomy may be performed to reduce the production of testosterone, which can fuel the growth of prostate cancer cells.

Testicular Torsion

Testicular torsion, a condition where the testicle twists on its spermatic cord, may necessitate an orchiectomy if blood flow is not restored in time.

Gender Reassignment

Individuals undergoing male-to-female gender reassignment surgery may opt for orchiectomy as part of their transition process.

Other Indications

Orchiectomy may also be performed in cases of severe trauma, infection, or in certain cases of benign prostatic hyperplasia (BPH).

Procedure

Preoperative Considerations

Prior to the surgery, a thorough evaluation is performed, including medical imaging (e.g., ultrasound, CT scan) and blood tests. Informed consent is obtained, discussing the risks, benefits, and alternatives.

Types of Orchiectomy

1. Simple Orchiectomy: Removal of one or both testicles through a small incision in the scrotum. Commonly used for testicular cancer and gender reassignment. 2. Radical Orchiectomy: Removal of the entire testicle along with the spermatic cord. Typically performed for testicular cancer. 3. Subcapsular Orchiectomy: Removal of the glandular tissue from the testicles, leaving the tunica albuginea intact. Used primarily in prostate cancer management.

Surgical Technique

The specific surgical technique depends on the type of orchiectomy. The procedure is usually performed under general anesthesia or spinal anesthesia. The surgeon makes an incision, removes the testicle(s), and may place a prosthetic testicle if desired by the patient.

Postoperative Care

Postoperative care includes pain management, wound care, and monitoring for complications. Patients are advised on activity restrictions and follow-up appointments.

Complications

Potential complications include bleeding, infection, hematoma, scrotal edema, and psychological impact. Long-term implications, particularly hormonal changes, are also discussed with the patient.

Prognosis

The prognosis after orchiectomy depends on the underlying condition being treated. For testicular cancer, the prognosis is generally good if detected early. Hormonal effects, particularly in cases of bilateral orchiectomy, are managed with hormone replacement therapy.

Summary

Orchiectomy is a crucial surgical intervention in urology with diverse indications. Its success and prognosis largely depend on the underlying condition, timely diagnosis, and comprehensive postoperative care. Understanding the procedure, its indications, and implications is essential for medical professionals in providing optimal patient care.

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