Experts estimate that 8,000 to 10,000 men will experience testicular cancer annually.
The odds of developing this cancer are 1 in 270.
Despite its high prevalence, the condition has a remarkable cure rate, over 95%.
One of the go-to choices for testicle treatment is radical orchiectomy, depending on how severe the malignancy is.
If you want to know the details about the procedure, you’ve come to the right place.
Here, you can get a full picture of exactly what to expect.
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Orchiectomy Surgery – Covering the Basics
Orchiectomy (also known as orchidectomy or orchi) is a surgery to remove the affected testicle due to infection, torsion, or trauma.
When a physician suspects cancer, they will do an ultrasound to assess the reproductive organ, rather than performing a biopsy, which could make the cancer spread.
According to data from 291 cases of orchiectomy, the primary causes of getting the surgery for patients younger than 25 were:
- Testicular torsion (45.8%)
- Undescended testicle (32.5%)
- Testicular tumor (16.9%)
Prostate cancer was the leading cause in 51-75 year old patients with 77.6%.
Although the causes for surgery vary, the need for castration has drastically reduced.
In the last couple of years, prostate cancer patients have avoided surgical castration.
This may have a lot to do with the advancements of comprehensive health care.
Who Might Need an Orchiectomy?
Orchiectomy may be an option for treatment of the following:
- Testicular cancer
- Prostate cancer
- Severe trauma to both or one testicle
- Sexual reassignment surgery
Types of Orchiectomy
The procedure is divided into various types, each with its own impact. Here is how they look.
Simple Orchiectomy
Through the course of the procedure, the surgeon will make an incision in the scrotum.
They will then take out both or one testicle, including a segment of the spermatic cord.
Before they close the incision, the surgeon can add a prosthetic testicle if necessary.
This method can manage locally advanced prostate cancer and hormonal manipulation.
Doctors may recommend the surgery if the testicle has suffered from an infection, torsion, or trauma.
Subcapsular Orchiectomy
Subcapsular orchiectomy spares the testis since it only removes the tissue around the testicle.
The operation is quite like that of simple orchiectomy, except for glandular tissue removal instead of the entire gland.
A patient may choose this type of incision to maintain the appearance of a typical scrotum.
Bilateral Orchiectomy
Known as surgical castration, the surgery takes out both testes.
Its goal is to stop androgen production from metastatic and locally advanced prostate cancer.
During operation, the surgeon creates an incision in the front of the scrotum under local anesthesia.
Radical Inguinal Orchiectomy
Radical inguinal orchiectomy is a doctor’s first line of treatment in almost every testicular cancer case.
The goal is to prevent cancer from spreading to the rest of the organs in the human body.
This procedure is capable of removing a cancerous testicle.
With radical orchidectomy, the surgeon makes an incision over the pubic area.
Then, they take out the affected testicle.
For the patient to achieve the desired result, the surgeon must remove the complete testicular germ cell tumors with the spermatic cord and testicle.
Although radical orchiectomy is crucial for testicular cancer, partial orchiectomy has become a more viable approach for sparing the organ.
Doctors often recommend this in patients with benign testicular growth before they’ve reached puberty.
How Can Patients Prepare for Surgery?
Below are tips on how to prepare if you decide to have this surgery.
- Get familiar with the benefits and risks of this type of treatment for prostate carcinoma and other health issues.
- Provide your doctor with a copy of your advance care plan. This will give them a clear insight into your health care preferences.
- Take a shower or a bath before coming in. But, avoid using lotions or deodorants that may irritate the skin.
- Remove any piercings or jewelry around the area.
- Don’t shave the site yourself to prevent cutting the skin.
- Have a friend or a family member take you home after treatment. Because of the pain medications and anesthesia, you will be unable to drive or travel alone.
- If you are on blood thinners, be sure to ask your healthcare provider if you need to stop taking them.
- Be open about all medications and natural products you are using. Some could interfere with the orchiectomy procedure.
What Happens During the Procedure?
The surgeon starts by lifting and taping the penis to the abdomen.
Depending on the type of treatment you chose, they will do an incision on the spot above the pubic bone or scrotum.
After administering either local or general anesthesia, the doctor treats the affected area.
Surgeons rely on clamps during treatment to stop the spermatic cord from bleeding.
If the patient wants to replace the lost testicle, then the surgeon will insert a prosthetic testicle.
Based on the tumor markers, cancer stage, and germ cell tumors, doctors could take out the lymph nodes at the same time as the surgical operation or during the second procedure.
Lastly, surgeons clean the area and sew it shut.
The whole outpatient procedure can take anywhere from 30 min to 1 hour.
What Happens After the Procedure?
It depends.
If both testes were removed, then patients can experience some significant changes.
These could occur a couple of weeks after treatment due to the lack of male hormones.
Most people experience sweating and hot flashes.
Others lose their sex drive, gain weight, or have trouble with erections.
A week or so after the procedure, the doctor will take out the stitches.
Most people leave the hospital immediately after the operation.
But, they could also have to stay for a little while.
When it comes to restoring appearance, a testicular prosthesis is available to people after testicle surgery.
This can help minimize the psychological unrest, restore self-esteem and quality of life.
To maintain the natural appearance of the genitals, some opt for an artificial testicle.
The implant is also used among individuals born without testis.
It won’t function as a real testicle but will help boost the way the organ looks.
Patients also do follow-ups in approximately six weeks.
The doctor will examine the state of the reproductive organ and ask if you’ve experienced any issues.
This is when you should ask questions.
If you’ve had some discomfort or complications, further check-ups are necessary.
Your doctor will decide how often you need to book appointments.
Recovery
The recovery can feel daunting.
It is normal to experience moderate pain for a few days post-surgery.
The scrotal skin swelling typically subsides after 2 to 4 weeks.
Do have in mind that while your body recovers, you won’t be able to do strenuous activities.
The area must fully heal before you start having sex.
Most surgeons suggest people wait 3 to 4 weeks to have intercourse.
Playing sports, lifting, or running is also not a good idea.
Even if you didn’t get the operation for cancer control, you should still give your system enough time to recuperate from the testes procedure.
That way, you can achieve that much-needed relief.
Side Effects
Just like any operation out there, orchiectomy comes with a potential for adverse effects.
The most recorded ones are infection and bleeding. Swelling is also common.
But, with the drop in testosterone, other reactions can occur.
These include:
- Low sex drive
- Osteoporosis
- Drop-in muscle mass
- Exhaustion
- Depression
- Hot flashes
- Troubles with sexual function
Contact a specialist if you can’t urinate after the operation.
When it comes to long-term adverse events, loss of fertility can happen.
Having a single testis removed won’t necessarily have a drastic impact on sexual performance and reproduction.
But, when both testicles are taken out, the male body can’t make sperm.
To analyze the impact of this procedure on fertility, experts studied volunteers who had this type of surgery.
In the orchiectomy group, 83.7% of couples achieved a first successful pregnancy that culminated in a live birth.
In comparison, 91.3% of couples with orchiopexy managed to obtain a successful pregnancy.
Compared to orchiectomy, orchiopexy (surgical repositioning) provided better fertility results.
Risks & Complications
It is normal for the area to appear a little bruised or tender after surgery.
But, when a big purple spot appears, it could indicate a hematoma.
To avoid a hematoma, you shouldn’t wear tight-fitted outfits, mainly undergarments, after surgery.
Applying ice to the bruised area can speed up the natural rejuvenation process.
The cold temperature speeds up blood flow and aids the blood vessels.
If a nerve got damaged, then people can experience an Ilioinguinal nerve injury.
The complication usually dissipates. But it can take months or weeks for it to improve.
Conclusion
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