Orchiectomy and cancer

ALSO KNOWN AS: Radical orchiectomy, inguinal orchiectomy, bilateral orchiectomy, unilateral orchiectomy, orchidectomy, surgical castration

DEFINITION: Orchiectomy is a surgical procedure to remove one or both of the testicles in men with testicular or prostate cancer.

Cancers treated:Testicular cancer, prostate cancer

Why performed: Orchiectomy is used to remove one or both testicles as a diagnostic procedure and treatment for testicular cancer. The testicles are the male sex organs that produce sperm and the hormone testosterone. The testicles are located in the scrotum. Nearby may also be removed at the time of orchiectomy. Artificial testicles, which have radically improved in the mid-2020s, may be placed at the time of surgery or in a later reconstructive procedure. Radiation therapy and for the treatment of testicular cancer may follow orchiectomy. Orchiectomy may be the only treatment needed to cure early-stage testicular cancer.

A radical or inguinal orchiectomy includes removing one or both testicles and the spermatic cord. The spermatic cord is removed to prevent the cancer from spreading to the lymph nodes and the kidneys. An inguinal orchiectomy involves removing the testicles through an in the groin area rather than directly through the scrotum.

Orchiectomy may be used to remove both testicles in men with prostate cancer. The growth of prostate cancer cells requires testosterone, and removing the testicles eliminates the source of this hormone. Without testosterone, the prostate tumor decreases in size, and symptoms are relieved. Orchiectomy does not cure prostate cancer, but it can help prolong the lives of men with advanced prostate cancer.

Patient preparation: Patients having both testicles removed will not be able to father children after an orchiectomy. Patients with one testicle should be able to do so. Patients can choose to bank their sperm if they wish to have children in the future. It is recommended that men with one testicle consider sperm banking as a precaution in case the second testicle needs to be removed in the future.

Orchiectomy can be an outpatient or inpatient procedure. It can be performed at an outpatient surgical center, urology clinic, or hospital surgery department. General anesthesia is most frequently used in which the patient is not awake. Epidural anesthesia may be used, in which the patient is awake but does not feel anything from the waist down.

Before surgery, the patient receives standard blood and urine tests. The patient is advised not to take blood-thinning medications in the week before the surgery and should not eat or drink for six to eight hours before the procedure. The patient uses a special antibacterial soap to wash his genitals and groin before surgery. Orchiectomy takes about forty-five minutes to an hour per testicle.

Steps of the procedure: The patient lies on his back on the surgical table. The patient is anesthetized, and vital signs are monitored throughout the surgery. In a radical orchiectomy, the surgeon makes a two- to three-inch incision in the lower abdomen and then moves the testicles up through the inguinal canal and out through the incision. In a simple orchiectomy, the surgeon makes an incision in the scrotum and removes the testicles through that incision. After removal of the testicles and spermatic cord is complete, the area is closed with sutures and bandaged.

Minimally invasive approaches to orchiectomy have come into common practice and include subinguinal orchiectomy in which a smaller incision is employed and partial orchiectomy, often referred to as testes-sparing orchiectomy, which preserves some testes tissue and hormonal function. Partial orchiectomy is often used in pediatric cases. Clamp ablation of the testes is an entirely incision-less procedure, although it may not be suitable for most patients. 

After the procedure: The patient is observed in a recovery area until he is alert. He may stay overnight in the hospital or have another person drive him home. The patient receives medication for mild to moderate pain. Bed rest is recommended for a day.

The patient should wear a jock support or support briefs continuously for two to three days and should not participate in strenuous activities for two to four weeks. Pain may be experienced in the abdomen or scrotum for several weeks. The patient should contact his doctor if he experiences increased pain, bleeding, or signs of infection.

Risks: Orchiectomy is considered a low-risk procedure. The risks include infection, bleeding, formation, nerve injury, bladder damage, and the general risks associated with anesthesia. Removing both testicles causes changes in testosterone levels that increase the risk of hot flashes, erectile dysfunction, loss of sexual interest, loss of muscle mass, gynecomastia (enlarged breasts), and osteoporosis.

Results: Removing a cancerous testicle cures the cancer in the testicle. In the case of prostate cancer, removing the testicles prevents the cancer cells from using testosterone and slows the growth of the cancer while reducing symptoms.

Bibliography

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