Orchiectomy

• Orchiectomy is the surgical removal of one or both testicles.
• It is primarily performed for testicular cancer, but also for prostate cancer, gender affirmation, and other conditions.
• The procedure involves either removing one testicle (unilateral) or both (bilateral).
• Recovery typically involves managing pain, swelling, and activity restrictions for several weeks.
• Patients should discuss potential impacts on fertility, hormone levels, and body image with their healthcare provider.

What is Orchiectomy?

Orchiectomy refers to a surgical procedure involving the removal of one or both testicles. This operation is a significant medical intervention, often performed by urologists. Depending on the specific medical indication, it can be unilateral (removal of one testicle) or bilateral (removal of both testicles). The procedure is distinct from a vasectomy, which only involves cutting and sealing the vas deferens, leaving the testicles intact. Understanding what is an orchiectomy is crucial for patients facing this medical decision, as it has implications for hormonal balance, fertility, and body image.

Reasons for Orchiectomy

There are several critical reasons for orchiectomy, primarily driven by oncological concerns but also by other health conditions. The most common indication is testicular cancer, where the removal of the affected testicle is often the primary treatment to prevent the spread of cancer cells. According to the American Cancer Society, testicular cancer is relatively rare but is the most common cancer in American males aged 15 to 35 years, making early detection and treatment like orchiectomy vital. Other reasons include:

• Prostate Cancer: Bilateral orchiectomy, also known as surgical castration, can be performed to reduce testosterone levels, which can slow the growth of hormone-sensitive prostate cancer.
• Testicular Torsion: In cases where the testicle has twisted and blood flow has been compromised for too long, leading to irreversible damage, removal may be necessary.
• Severe Testicular Trauma or Infection: Irreparable damage from injury or severe, untreatable infections can necessitate orchiectomy to prevent further complications.
• Gender Affirmation Surgery: For transgender individuals transitioning from male to female, orchiectomy is a component of gender affirmation surgery to align physical characteristics with gender identity.

Orchiectomy Procedure and Recovery

The orchiectomy procedure details vary slightly depending on the reason for the surgery. For suspected testicular cancer, an inguinal orchiectomy is typically performed, where an incision is made in the groin, and the testicle is removed through this opening. This approach helps prevent potential cancer cell spread into the scrotum. For other conditions, a scrotal orchiectomy might be performed, with an incision directly on the scrotum. The surgery is usually performed under general anesthesia and takes about 30 to 60 minutes.

Recovery after orchiectomy surgery involves a period of healing and careful management. Patients typically experience some pain, swelling, and bruising in the surgical area, which can be managed with prescribed pain medication. Most individuals can return home the same day or the day after the procedure. It is generally advised to avoid strenuous activities, heavy lifting, and sexual activity for several weeks to allow for proper healing. A jockstrap or supportive underwear may be recommended to reduce swelling and provide comfort. Follow-up appointments are essential to monitor healing, discuss pathology results (if applicable), and address any concerns regarding hormone levels or prosthetic options. For unilateral orchiectomy, the remaining testicle usually continues to produce testosterone and sperm. However, bilateral orchiectomy results in infertility and requires hormone replacement therapy to manage testosterone deficiency symptoms.