Orchiectomy

Orchiectomy (also named orchidectomy, and sometimes shortened as orchi) is a surgical procedure in which one or both testicles are removed (bilateral orchiectomy), as a form of castration. The surgery is typically performed as treatment for testicular cancer, in some cases of testicular torsion, as a gender-affirming procedure for trans women,[1] and is sometimes used in the management of advanced prostate cancer.[2]

Orchiectomy
Diagram of the incisions in an orchiectomy
Other namesOrchi
Specialtyurology

There are three main types of orchiectomy: simple, subcapsular, and inguinal. The first two types can be done under general, local, or epidural anesthesia, and take about 30 minutes to perform. An inguinal orchiectomy is sometimes done under general anesthesia, and takes from 30 minutes to an hour to complete.

Simple orchiectomy
The scrotum of a transgender female patient six months after receiving simple bilateral orchiectomy without other genital surgery.

A simple orchiectomy is commonly performed as part of sex reassignment surgery (SRS) for transgender women, or as palliative treatment for advanced cases of prostate cancer. Orchiectomy may be required in the event of a testicular torsion as well. The patient lies flat on an operating table with the penis taped against the abdomen. The nurse will shave a small area for the incision. After anesthetic has been administered, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue. The surgeon removes the testicles and parts of the spermatic cord through the incision. The incision is closed with two layers of sutures and covered with a surgical dressing. If the patient desires, a prosthetic testicle can be inserted before the incision is closed to present an outward appearance of a pre-surgical scrotum.[3][4][5]

Subcapsular orchiectomy

A subcapsular orchiectomy is also commonly performed for treatment of prostate cancer. The operation is similar to that of a simple orchiectomy, with the exception that the glandular tissue that surrounds each testicle is removed rather than the entire gland itself. This type of orchiectomy is done primarily to keep the appearance of an ordinary scrotum.[3][4][5]

Inguinal orchiectomy
Main article: Inguinal orchiectomy

Inguinal orchiectomy (named from the Latin inguen for "groin," and also called radical orchiectomy), is performed when an onset of testicular cancer is suspected, in order to prevent a possible spread of cancer from the spermatic cord into the lymph nodes near the kidneys.[3][4][5]

An inguinal orchiectomy can be either unilateral or bilateral. The surgeon makes an incision in the patient's groin area (in contrast to an incision in the scrotum, as is done in both simple and subcapsular orchiectomies). The entire spermatic cord is removed, as well as the testicle(s). A long, non-absorbable suture may be left in the stump of the spermatic cord in case later surgery is deemed necessary.[3][4][5]

After the cord and testicle(s) have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged.[3][4][5]

Effects

Unilateral orchiectomy results in decreased sperm count but does not reduce testosterone levels.[6][7][8] The side effects of a bilateral orchiectomy include: infertility, loss of sexual interest, erectile dysfunction, hot flashes, breast enlargement (gynecomastia), weight gain, loss of muscle mass and osteoporosis.[9] The administration of hormone replacement therapy after orchiectomy can help to mitigate the negative side effects.

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See also

References
  1. Washington, S.; Bayne, D.; Butler, C.; Garcia, M. (1 February 2017). "215 Bilateral Orchiectomy For Transgender Patients: An Efficient Surgical Technique That Anticipates Future Vaginoplasty and is Associated with Minimal Morbidity". The Journal of Sexual Medicine. 14 (2): e91–e92. doi:10.1016/j.jsxm.2016.12.203. ISSN 1743-6095.
  2. "Medical Dictionary of Health Terms". Harvard Medical School. Harvard Health Publishing. Retrieved 9 April 2019.
  3. Frey, Ph.D, Rebecca (2004). "Orchiectomy". Gale Encyclopedia of Surgery. Heathline.com: The Gale Group, Inc. Archived from the original on 8 December 2013. Retrieved 28 August 2013.
  4. "Orchiectomy". Health Information Library. Providence Health & Services. Retrieved 28 August 2013.
  5. "Surgical Procedures: Orchiectomy — radical/simple". UrologyMatch.com. Retrieved 26 February 2018.
  6. "Orchid | Testosterone Replacement". Orchid. Retrieved 28 October 2019.
  7. Ferreira, U.; Netto Júnior, N. R.; Esteves, S. C.; Rivero, M. A.; Schirren, C. (1991). "Comparative study of the fertility potential of men with only one testis". Scandinavian Journal of Urology and Nephrology. 25 (4): 255–259. doi:10.3109/00365599109024555. ISSN 0036-5599. PMID 1685802.
  8. "Orchiectomy for Prostate Cancer". myhealth.alberta.ca. Retrieved 1 July 2019.
  9. "Orchiectomy for Prostate Cancer". myhealth.alberta.ca. Retrieved 1 July 2019.

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