Orchiectomy: A Walkthrough

What Is Orchiectomy?

An orchiectomy is a surgical procedure that involves the removal of one or both testicles. It is typically performed for various medical reasons, such as treating testicular cancer or reducing the production of testosterone in cases of transgender individuals undergoing gender confirmation surgery. Orchiectomy procedures can vary in terms of the extent of the surgery and the technique used. The main types of orchiectomy include:

• Simple Orchiectomy: In this procedure, one or both testicles are removed, leaving the scrotum intact. This is the most common type and is often performed in the treatment of testicular cancer.

• Subcapsular Orchiectomy: This method involves removing the inner part of the testicle while preserving the outer tissue. It is typically used for transgender individuals as part of gender confirmation surgery to reduce testosterone production while maintaining the scrotal structure.

• Bilateral Orchiectomy: Both testicles are removed in this procedure. It can be done as part of cancer treatment or gender confirmation surgery.

• Unilateral Orchiectomy: Only one testicle is removed, often for medical reasons like the treatment of testicular cancer.

When Is Orchiectomy Indicated?

Orchiectomy is a surgical procedure that may be indicated for several medical conditions. Some common indications for orchiectomy include:

• Testicular Cancer: Orchiectomy is often performed as part of the treatment for testicular cancer. Removing the affected testicle (unilateral orchiectomy) may be necessary to prevent the cancer from spreading.

• Prostate Cancer: In some cases of advanced prostate cancer, orchiectomy may be recommended to reduce the production of testosterone, which can fuel the growth of cancer cells.

• Gender Confirmation Surgery: Transgender individuals may opt for orchiectomy as part of their gender confirmation process to reduce the production of testosterone and achieve a more feminine appearance.

• Testicular Torsion: In cases of testicular torsion, where the blood supply to the testicle is compromised, emergency orchiectomy may be necessary if the blood flow cannot be restored in time.

• Severe Testicular Trauma or Infection: In rare cases, severe testicular trauma or infections that cannot be effectively treated with antibiotics may require orchiectomy.

• Hormone Replacement Therapy (HRT): Some transgender women undergoing HRT may opt for orchiectomy to reduce the need for anti-androgen medications and achieve better hormonal balance.

How to Get Prepared for Orchiectomy?

Preparing for an orchiectomy involves several steps, and the specific preparations may vary depending on the type of orchiectomy and the underlying medical condition. Orchiectomy is an outpatient procedure done under either local anesthesia or general anesthesia. It takes about 30 minutes to an hour to do this procedure. Here are some general guidelines to consider when preparing for the procedure:

• Consultation with a Specialist: Start by consulting with a urologist or surgeon who specializes in the type of orchiectomy the patient will be undergoing. Discuss the medical history, any medications being taken, and the reasons for the procedure.

• Medical Evaluation: The healthcare provider will perform a thorough medical evaluation, which may include blood tests, imaging scans, and physical examinations to assess the overall health and the condition of the testicles.

• Informed Consent: The healthcare provider will explain the procedure, its potential risks, benefits, and alternatives and ask to provide informed consent, indicating the understanding and agreement with the surgery.

• Medication Review: Inform the healthcare provider about taking medications or supplements. Some medications may need to be adjusted or temporarily stopped before the procedure.

• Preoperative Instructions: The healthcare provider will give specific preoperative instructions, which may include fasting (not eating or drinking for a certain period before the surgery), taking prescribed medications, and other preparations.

• Postoperative Care: Discuss postoperative care and recovery with the healthcare provider because there is a need to follow certain instructions for wound care, pain management, and activity restrictions.

What Is the Procedure for Recovery of Orchiectomy?

After the orchiectomy, the individual can return home in a couple of hours, and a general check-up is needed on the next day. During the initial week following the procedure,

• The surgeon may advise to wear a scrotal support for two days.

• Apply ice to lessen the swelling around the area of the incision.

• Take a bath using mild soap, and make sure to keep the area dry.

• Take the prescribed medications and ointment to alleviate the symptoms.

• Avoid straining during bowel movements.

• Stay hydrated and consume high-fiber foods to ease constipation.

• It is recommended not to lift heavy objects for two weeks to months because complete healing takes that much time.

Does Orchiectomy Pose Any Side Effects?

Orchiectomy is generally considered a safe procedure when performed by a skilled surgeon. However, like any surgical intervention, there are potential side effects and complications to be aware of. Some of these may include:

Common Side Effects:

1. Pain and Discomfort: It is common to experience pain, swelling, and discomfort in the scrotal area immediately after the surgery.

2. Swelling and Bruising: Swelling and bruising around the incision site are normal and usually subside over time.

3. Scarring: There will be a scar at the incision site, which will fade with time but may remain visible.

Less Common Complications:

1. Infection: Infection at the surgical site is possible but relatively rare. Proper wound care and hygiene are essential to minimize this risk.

2. Bleeding: Excessive bleeding during or after the procedure is uncommon but can occur. It may require medical attention.

3. Hematoma: A collection of blood (hematoma) can form at the surgical site, potentially causing discomfort and requiring drainage.

4. Seroma: Fluid accumulation (seroma) may occur around the incision, but this is typically resolved on its own.

5. Nerve Damage: There is a slight risk of damage to nearby nerves, which could lead to numbness or altered sensation in the scrotal area.

6. Hernia: Inguinal hernias can occur as a rare complication of orchiectomy, especially in bilateral procedures.

7. Complications Related to Anesthesia: Adverse reactions to anesthesia, although rare, can occur.

Specific to Gender Confirmation Surgery: For individuals undergoing orchiectomy as part of gender confirmation, there are additional considerations:

1. Hormone Changes: Orchiectomy will result in a significant reduction in testosterone production. Hormone replacement therapy (HRT) will need to be adjusted to maintain a balanced hormone profile.

2. Emotional and Psychological Impact: Adjusting to changes in hormone levels and body image can have emotional and psychological effects. It is important to have a support system and access to mental health resources.

Conclusion:

Male breast cancer, prostate cancer, and testicular cancer can all be successfully treated with an orchiectomy. During their transition from male to female, transgender women may also choose to have an orchiectomy. One or both testicles can be surgically removed during an orchiectomy. A surgeon may also remove the tissue surrounding the testicles and the spermatic cord, depending on the type of orchiectomy the patient has. An option to implant a prosthetic testicle during an orchiectomy for cancer treatment is available to patients.