Definition & Overview

Orchidectomy is the surgical removal of one or both testicles. It is typically performed to control the progression of prostate or testicular cancer or as a part of female gender reassignment procedure.

There are several types of orchidectomy: simple, subscapular, and inguinal. Simple orchidectomy is performed to remove both testicles while subscapular is done to remove the glandular tissue lining the testicles, allowing the patient to retain his testicles and scrotum. Inguinal or radical testicle removal, on the other hand, involves making the incision in the inguinal or groin part to remove the testicles.

Who Should Undergo & Expected Results

Patients who are in the advanced stages of prostate cancer are advised to undergo orchidectomy to stop the body from producing testosterone, which has been determined to increase the growth and spread of tumours in the prostate and testes. This procedure also helps relieve bone pain, which is one of the hallmark symptoms of this condition. In some cases, testicle removal is taken advantage of by those who are not yet diagnosed with prostate or testicular cancer but has a prevalent family history of the disease as well as those who have suffered damage or injury to their testicles so complications or possible infections can be avoided.

Testical removal is also one of the many surgical procedures done to complete the transition from male to female during a gender reassignment. This usually involves extensive hormonal therapy before the patient is allowed to undergo surgical removal of his genitals and other associated body parts.

When performed as part of cancer treatment, the results of orchidectomy largely depend on the stage of cancer the patient has. Poorer prognosis is expected for those whose condition has already spread to other parts of the body. However, most cases of orchidectomy for prostate cancer patients resulted in relief from symptoms, increased five-year survival rate, and significant shrinkage of tumours. If performed at early stages, orchidectomy is also known to cure testicular cancer.

For cancer patients and those undergoing gender reassignment, decreased to zero sex drive is reported following the procedure. They also experience a significant reduction of male sexual characteristics such as lesser facial hair and higher pitch of voice.

How Does the Procedure Work

Orchidectomy is considered a simple surgical procedure and typically lasts an hour.

The procedure starts with the administration of local or general anaesthesia before the surgeon makes an incision in the scrotum, along its midpoint. In a simple orchidectomy, the testicles are removed, along with some parts of the spermatic cord. In some instances, the also surgeon inserts prostheses to retain the normal appearance of the testes. The incision is then closed and bandaged.

The same process is performed during a subscapular orchidectomy but a greater part of the testicles is retained as the surgeon focuses on removing on the linings.

Meanwhile, during inguinal testical removal, the surgeon makes an incision in the groin area to remove the entire spermatic cord and the testicles. This technique is typically done when the cancer has spread to nearby parts. In some cases, the inguinal lymph nodes are also excised.

The incision is then closed with sutures and covered with a bandage.

Possible Complications and Risks

Medical personnel should always keep a look out for symptoms of adverse reaction to anaesthesia. There is also the inherent risk of excessive bleeding during the procedure.

Following surgery, there is the possibility of heart or breathing problems, as well as the occurrence of deep vein thrombosis.

Surgery site must be kept clean and sterile to avoid infection to the wound site and the blood.

Some patients have also reported numbing or loss of sensation in the groin area and overall fatigue following surgery. There is also a decrease or loss of libido or sexual appetite due to hormonal imbalance caused by the loss of testosterone production. Associated conditions include erectile dysfunction and infertility. Little or no production of testosterone also leads to a condition called gynecomastia or breast enlargement among men, which is usually treated with hormonal treatment.

Hormonal imbalance also results in episodes of mood swings, depression, and hot flashes similar to those experienced by menopausal women. There is also a tendency to gain weight.

Undergoing hormonal treatment following an orchidectomy also has its own complications, such as greater risk of developing osteoporosis.

References:

  • O'CONOR VJ, SOKOL JK. Bilateral orchiectomy in the treatment of carcinoma of the prostate. Am J Surg. 1960 Apr;99:573–579

  • Vermeulen A, Rubens R, Verdonck L. Testosterone secretion and metabolism in male senescence. J ClinEndocrinolMetab. 1972 Apr;34(4):730–735.

  • Young HH, 2nd, Kent JR. Plasma testosterone levels in patients with prostatic carcinoma before and after treatment. J Urol. 1968 Jun;99(6):788–792

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