Radical Orchiectomy - Indications, Contraindications, and Procedure

What Is Radical Orchiectomy?

Orchiectomy or radical orchiectomy is a surgical procedure in which one or both testicles are removed. The doctors mainly perform this procedure to manage and prevent testicular cancers, male breast cancers, and problems associated with the prostate gland. This procedure is also performed in transgender females willing to change from a male to a female. Radical orchiectomy is nothing but a procedure in which the testicles and a bundle of tissues known as the spermatic cord is removed. It is an outpatient procedure, so the patient will be discharged the same day after the procedure is complete. Radical orchiectomy is not only a therapeutic procedure but also a diagnostic procedure for testicular cancer.

Why Would a Patient Require Radical Orchiectomy?

The patient might require an orchiectomy under the following circumstances:

• Management of Cancer - Orchiectomy is the initial diagnostic and treatment procedure for testicular cancer. Radical orchiectomy removes cancer and allows the pathologist to visualize the tissue and diagnose the condition. It can also be used to manage prostate cancer and male breast cancer. Orchiectomy aims to cut off the male hormones that help in the growth of testicular tissues.

• Gender Transition - As a part of the gender transition procedure, many transgender males choose to undergo orchiectomy. The doctor might do the procedure as a single surgery or might perform it along with the gender reassignment surgery. Orchiectomy induces physical changes in the body and reduces the level of the male hormone testosterone in the body.

• Removal of the Damaged Testicles - Sports injuries, car accidents, road rash, or other injuries cause severe damage to the testicles. If the doctor does not repair the testicles, he might remove them and suture the surrounding tissues. Sometimes, the doctors might remove the undescended testicles.

What Are the Contraindications of Radical Orchiectomy?

There are no major contraindications of radical orchiectomy. However, antibiotics must be administered before the surgery if the patient has a testicular mass due to other reasons and not testicular tumors. For example, suppose the patient has a congenital adrenal gland enlargement history. In that case, a biopsy must confirm that the lesion is related to the adrenal gland and not the testicles.

How Should the Patient Prepare for Radical Orchiectomy Procedure?

The patient must follow the instructions mentioned below to avoid any complications during the surgery:

1. The doctor will discuss the pros and cons before initiating the surgery.

2. The patient must consult the doctor and inform him about all the medications or any allergies or disorders he is suffering from. For example, the doctor might recommend the patient stop consuming drugs like Aspirin before the surgery, as they can increase the bleeding.

3. The antibiotics are commonly administered before the surgery.

4. The doctor might ask the patient to undergo alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase tests.

5. The antibiotics are administered either orally (by mouth) or parenterally (the medication is directly injected into the body).

6. The patient must avoid eating anything the night before the surgery and only take his prescribed medication before coming for the surgical procedure.

What Happens During the Radical Orchiectomy Procedure?

Radical orchiectomy is a simple procedure, and the patient will not have much surgical trauma after the procedure. The procedure is carried out under the following steps:

• First, the doctor will clean the site and make an incision. The site of the incision depends upon the technique the doctor uses.

• For example, the doctor might make an incision in the inguinal area (inguinal orchiectomy) or the scrotal regions (simple orchiectomy).

• After this, the doctor might remove one or both testicles.

• The procedure is referred to as radical orchiectomy, and the doctor will remove the testicles and the spermatic cord.

• If the patient wishes to choose a prosthetic testicle, the doctor will place the new testicle inside the scrotum.

• Finally, the prosthetic testicle will be filled with saline or salt water.

• After the procedure is complete, the doctor will close the incision with sutures.

• The entire procedure gets completed in 30 to 60 minutes.

• After the procedure, the patient will have to wait for some time in recovery before getting discharged.

What Happens After a Radical Orchiectomy?

The patient might feel alright after the procedure quickly, but he will need some weeks to recover completely. The patient might follow the below-mentioned instructions after the procedure:

• Avoid physical activities for a few days after the surgery.

• Do not lift weights or heavy objects for two to three weeks.

• Wear loose-fitting cotton clothes and refrain from getting engaged in sports activities.

• Make sure that the operated site is clean and dry.

• Wear scrotal support undergarments for 48 hours after the procedure.

• Patients having pain, tenderness, discomfort, and swelling after the surgery must take over-the-counter drugs or non-steroidal anti-inflammatory drugs.

• Apply an ice pack over the area after every 20 minutes or one hour.

• Drink plenty of water daily to avoid bacterial infection.

• Eat fiber-rich foods to have regular bowel movements and avoid constipation.

What Are the Side Effects of Radical Orchiectomy?

All surgical procedures are associated with side effects and complications. Bleeding and infections are the major complications of radical orchiectomy. In addition, some patients might develop swelling in the scrotal region. The complications and side effects of radical orchiectomy depend upon the type of surgery the patient had. People who underwent bilateral radical orchiectomy or had both testicles removed remain infertile as they cannot produce sperm. Some side effects might occur due to the reduction in testosterone levels. The following complications lead usually occur due to the decrease in testosterone levels:

1. Reduced sex drive.

2. Fatigue.

3. Depression.

4. Hot flashes.

5. Low muscle mass.

6. Osteoporosis (reduced bone density).

7. Erectile dysfunction (problems related to erection).

Under What Circumstances Should the Patient Consult the Doctor After Radical Orchiectomy Procedure?

The patient can approach the doctor under the following circumstances:

• Fever.

• Severe pain.

• Difficulty in passing urine.

• Loss of sensation in the scrotum.

• Redness near the incision.

• A purple spot near the scrotum.

• Blood or pus coming out from the incision.

Conclusion:

Radical orchiectomy is an invasive procedure in which the testicles are removed along with the spermatic cord. It is mainly done to treat testicular tumors and prostate cancer. The biggest advantage of the procedure is that the patient need not stay in the hospital for long and will be discharged the same day. Though side effects and complications are associated with the procedure, the patient must not worry because all these side effects will subside once the healing is complete.