Orchiectomy, or removal of the testicles, can be done for diagnostic as well as treatment purposes depending on the underlying cause. Orchiectomy can be Partial, or radical, meaning either one testicle is removed or both, however, partial orchiectomy is relatively new, and radical orchiectomy is the most common. Orchiectomies are mainly done in the context of cancers, trauma, and infections amongst others and the outcomes depend on the underlying cause.
Orchiectomy, the removal of testes, is a relatively common and easy procedure mainly done in the context of testicular cancers.
As the testes are removed, most men prefer to have an implant put in and the outcomes associated are excellent.
As long as appropriate testosterone therapy is provided, one should not expect any sexual dysfunction post-orchiectomy, and the most common complications are local bleeding or wound infections.
How is an orchiectomy performed?
As far as surgeries go, an orchiectomy is a relatively straightforward procedure and is typically performed as an outpatient. This surgery is performed in the operating theater, and standard equipment for abdominal surgery is utilized. After the patient is brought to the operating theater, and appropriate checklists confirm the right patient and surgery, either regional or general anesthesia is applied. The patient is then placed supine, and the skin is cleaned with antiseptic solutions from around the belly button down to the thighs. Subsequently, an oblique incision would be made parallel to the inguinal canal in the length of 2.5 inches for best cosmetic outcomes.
Afterward, the appropriate nerves, as well as testes and spermatic cord are identified, and nerves are preserved, while the spermatic cord is cut and secured with silk ligatures. After the testes are removed, they’re typically sent for pathological analysis to look at the cell structures under a microscope. The testicular prosthesis may also be inserted at this time as chosen by the patient for cosmetic outcomes, before the wound is irrigated, all bleeding is stopped and the skin is closed. Ultimately a compression dressing is applied and the patient is transferred to the Post Anesthesia Care Unit (PACU) for monitoring.
Why is an orchiectomy performed?
The most common reason for an Orchiectomy is testicular tumors. Testicular cancers are common in adolescent to middle-aged men and usually are found as painless masses in the testes. An orchiectomy can also be done for an undescended testis, that is a testis that has not descended into the scrotal sac, however, as the location of these testes is in the abdomen, the surgical approach would be different. Finally, an orchiectomy can also be performed for testicular torsion, infectious causes such as Fournier gangrene, to castrate a patient with Prostate cancer, or in patients undergoing sex changes.
Complications & outcomes of orchiectomy
As with most surgeries, the most common complications of orchiectomies are bleeding-related, and in most cases are easily managed. Damage to nerves such as the ilioinguinal nerve can also lead to numbness in parts of the upper thigh and scrotum and there can be wound infections.
With the advent of a saline-filled testicular prosthesis, patient outcomes have been good. Several studies demonstrated that almost 80% were cosmetically satisfied, with only 10% regretting such prostheses, and as such psychological or social complications from lack of testes would not be expected.
Most studies have demonstrated that in patients that have undergone orchiectomies and have been appropriately treated, the procedure is well tolerated, particularly if testicular implants are chosen, and interest in sex, satisfaction with sexual life as well as erectile functioning are not necessarily different from similar men that have not had an orchiectomy.
Recovery & aftercare
As is common with some surgeries, you’ll most likely be given an IV antibiotic to prevent any possible infections before or during an orchiectomy. It is important to ensure that the wound is kept clean & dry at least for the initial 72 hours. Surgeons usually close skin with absorbable sutures that do not necessitate removal, and dissolve within a week or two.
You’ll also most likely have scrotal swelling that’ll go down in about 2 weeks, which is recommended you can ice to minimize your comfort. It is important for you to carry out the recovery guidance of your surgeon.
The end goal of orchiectomy is to leave you with minimal scarring and with no functional defects. As with most surgeries, physical exercise is also not recommended for at least 1-2 weeks including lifting and straining for defecation. You would be expected to get back to your full exercise routine within a month or so. There’re typically no medical reasons to suggest a set time frame to abstain from sex. This means that you can start having sex again as soon as you feel up to it and your soreness has subsided usually within a week or two.
From a sexual perspective, as the testes produce sperm, unless IVF and similar assistive reproductive treatments are planned, and appropriate sperm preservation was taken before orchiectomy, a patient undergoing an orchiectomy will be sterilized. Furthermore, as the testes also produce testosterone, patients will most likely be prescribed testosterone to ensure appropriate levels of this male hormone and protect sexual functioning. So unless you’ve been prescribed testosterone in the short term, you can expect some symptoms such as hot flashes and sweating until your appropriate testosterone levels are brought back to normal. If you’ve chosen to go with implants, they may feel foreign for a while, but most men are happy with the feel and look of them after an initial adjustment period.
Finally, as with any surgery, recovery will depend on a lot of factors, so listening to your body and pain is key. Do not hesitate to take it slow for as long as you need, rest, ice, and make sure you take good care of your dressings and wound to ensure the risks of infection are minimized.