What is an orchiectomy?

Indications and Procedures

Orchiectomy is usually performed for benign or malignant conditions. For metastatic carcinoma of the prostate, bilateral orchiectomy (removal of both testicles) is often utilized. For primary tumors of the testes that are malignant, radical orchiectomy is performed for the best result.

During simple orchiectomy, the patient's genitalia are prepared in a sterile manner. An incision is made in the scrotum, and the testis is withdrawn from its sac. The spermatic cord is clamped during the procedure, and then cut.

When it comes to radical orchiectomy, the genitalia and the inguinal region (the upper groin and lower lateral abdominal region) are prepared in a sterile manner, and an inguinal skin incision is made. Then the spermatic cord is freed and clamped Next, the testis is pulled up from the scrotum. A radical orchiectomy would typically be necessary in the case of suspected testicular cancer. Once the tumor is verified, either by gross analysis or by a frozen section, the cord is doubly clamped and then cut.

It is important for patients undergoing an orchiectomy to have blood drawn and a urine sample collected and to stop any aspirins that they may be taking a week before the procedure. Also, all nonsteroidal anti-inflammatory drugs (NSAIDs) should be discontinued two days before the procedure.

Orchiectomy can also be a part of gender reassignment surgery
and is mostly done in clinics that specialize in it. It is considered genital reconstruction. Prior to the genital reconstruction, patients usually undergo hormone therapy for several months or as long as a year before going through the surgery. The patient must be sure that he wants to live life as a woman with real-life experiences as a female with all the social implications.

Uses and Complications

Orchiectomy can be used to treat testicular cancer


. Seminoma is a type of testicular cancer that, if the tumors are localized, in 98 percent of the patients is curable with orchiectomy and low doses of adjuvant radiotherapy. Advanced cancer at stage II is curable with orchiectomy and radiation therapy to the involved areas for 85 to 90 percent of patients. In metastatic diseases, stage III or localized advanced disease is primarily curable in 90 percent of the patients if combined with chemotherapy. Nonseminoma germ cell tumors (NSGCTs) seem to resist radiation therapy and are more likely to travel to the lungs, brain, bones, and liver.

Both seminoma and nonseminoma are highly curable if caught early enough, even if the cancer has spread beyond the testes to other body parts and tissues, as compared to other cancers. When it comes to relapse of the disease, the risk is lowered with retroperitoneal lymphadenectomy followed by chemotherapy, but this protocol does not improve survival. It is also possible that removing the lymph nodes may cause infertility.

Patients who have undergone orchiectomy may go to work the next day, if they desire. However, some patients may need a day or two before they feel ready. It is important to drink fluids and to abstain from alcoholic beverages. Sometimes, the patient may feel nauseated if the procedure was performed because of cancer. Some pain and swelling may develop, which is normal, and the physician may prescribe medications to counteract them.

One of the major risks of orchiectomy is a sudden hormone change, and side effects may occur, such as loss of muscle mass, brittle bones, weight gain, fatigue, erection problems, loss of sexual desire, hot flashes, enlargement and tenderness in the breasts, and sterility.

Undergoing orchiectomy for male-to-female genital reconstruction requires a diagnosis from a psychiatrist, as well as letters from mental health counselors in support of this procedure.

Perspective and Prospects

In 1941, orchiectomy was first used on a patient suffering from advanced prostate cancer. Indications from this therapy showed no apparent improvement of survival from it. In 1967, the Veterans Administration Cooperative Urological Research Group or (VACURG), presented information on more than two thousand patients who had received different types of therapies, including orchiectomy.

From 1984 through 1993, a study was performed on seventy-two patients with stage C and stage D prostate cancer whereby forty-four out of sixty-one patients had a partial response, and a good response on the tumor markers.

Bibliography

Dawson, C. “Testicular Cancer: Seek Advice Early.” Journal of Family Health Care 12 (2002): 3.

Geldart, T. R., P. D. Simmonds, and G. M. Mead. “Orchiectomy After Chemotherapy for Patients with Metastatic Testicular Germ Cell Cancer.” BJU International 90 (September, 2002): 451–455.

Incrocci, L., et al. “ Treatment Outcome, Body Image, and Sexual Functioning After Orchiectomy and Radiotherapy for Stage I-II Testicular Seminoma.” International Journal of Radiation Oncology, Biology, Physics 53 (August 1, 2002): 1165–1173.

Khatri, Vijay P., and Juan A. Asensio. Khatri: Operative Surgery Manual. Philadelphia: Saunders, 2003.

Neff, Deanna M. "Orchiectomy." Health Library, September 26, 2012.

"Testicular Cancer Treatments: The Inguinal Orchiectomy." Testicular Cancer Resource Center, December 9, 2012.