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Orchiectomy Surgery

What is Orchiectomy?

Orchiectomy is the surgical procedure to remove one or both testicles in males. It is also known as ‘Orchidectomy’. When both testicles are removed it is called as a ‘Bilateral Orchiectomy’ (castration). This renders the person unable to reproduce.

Another word for bilateral Orchiectomy is ‘emasculation’, which is also performed on women when both their ovaries are removed with a bilateral oophorectomy.

Why is Orchiectomy performed?

An orchiectomy is performed to treat various serious disorders and diseases, including cancer. Other reasons for this procedure are to lower the testosterone levels in the body, which is an essential male sex hormone. Mostly, surgical removal of testicle is required in case there is a tumor in the gland. Apart from this, an Orchiectomy is also performed to treat prostate cancer or male breast cancer. Testosterone is one of the factors that contribute to the growth of cancers in men. An Orchiectomy is useful for preventing cancer in case of an undescended testicle in a patient at an age after they have hit puberty.

A MTF (Male To Female) gender re-assignment surgical procedure requires bilateral orchiectomy. This helps to lower testosterone levels and to make the genitalia ready for future surgical procedures to make it into a vagina and external female genitalia.

Surgical castration is also used as punishment for sex offenders who choose so in certain European countries and in 4 US states (Texas, Montana, Florida and California). This is an attempt to control their sexual urges.

What is the diagnosis which needs Orchiectomy procedure as treatment?

Cancer – In case a rectal examination shows an abnormal mass in the prostate, this may be an indication of prostate cancer. The doctor may use TRUS (trans-rectal ultrasound), or a check for PSA (prostate-specific antigen) levels in the blood. This antigen can signal the growth of cancer in the prostate. However, for confirming the cancerous nature of the abnormal mass in the prostate and detailed biopsy is required.

An abnormal mass in the scrotum (painful or not) might be sufficient reason for the doctor to order a biopsy.

Gender Reassignment – A significantly lengthy physical and psychological evaluation is done for patients who are looking to undergo gender reassignment surgery. The HBIGDA (Harry Benjamin International Gender Dysphoria Association), which is currently the largest global professional association which deals with treatment of gender identity disorders in people, has also set higher standards of care that needs to be taken by medical professionals performing gender reassignment surgery. The association also affirms that the patient must meet the strict diagnostic criteria for the disorder as defined in the Diagnostic and Statistical Manual of Mental Disorder (4th Edition) or in the International Classification of Diseases – 10 (ICD-10).

How to prepare for an Orchiectomy?

The conventional blood and urine tests are required for the patient before planning the surgery. Aspirin-based medicines should be avoided from a week prior to surgery. Any NSAIDs (non-steroidal anti-inflammatory drugs) should be avoided at least 2 days from the surgery. Refrain from drinking or eating at least 8 to 10 hours before the surgery is scheduled.

It is advised to shower or bathe in the morning before the surgery using a special antibacterial soap. This should be done with intense care to remove all types of bacteria from your body.

A sedative is usually advised for patients who are anxious about the surgery to help calm them.

Cancer – Patients who wish to have an orchiectomy are advised to have their sperm saved and stored, in case the procedure is for testicular cancer. This will help them to have children even after their procedure.

Even though a single testicle is also able to play a positive reproductive role, the doctor will still advise you to store your sperm in a sperm bank, in case the other testicle also tests positive for cancer later.

Gender Reassignment – The orchiectomy procedure is preceded with months and even years of hormone-change therapy by a person considering a male-to-female gender reassignment surgery. This is a long process which leads to the person being qualified and better prepared for the big change after this procedure.

As this surgery requires intense level of care, including psychiatric diagnosis and physical examination, the surgeon performing the orchiectomy procedure should normally get two letters of evaluation by mental health professionals and one from the psychiatrist, if possible, along with one from a clinical psychologist.

What happens after an Orchiectomy procedure is completed?

The patient should normally have a friend or family member to drive them home after the outpatient procedure. Normally, the patient is able to resume work the next day, while a few may require a few days’ rest for proper recovery.

As the anesthetic effects wear off, the patient is advised to eat normally once at home. In case there is swelling or pain the doctor will usually prescribe painkillers for a few days.

Apart from this, ensure that you:

  • Drink additional liquid for the next several days (avoid caffeinated and alcoholic drinks)

  • Avoid sexual activities, rigorous workout, lifting heavy things, until the next appointment for the follow-up with the doctor

  • Choose to shower instead of bathe for a week after the surgery, which prevents risk of the absorbable stitches being dissolved before the wound heals

  • Apply ice-packs to the groin for the first 24 to 48 hours

  • Wear a jock-strap or tight briefs to support the scrotum for at least a couple of weeks following the surgery

A few patients require psychological counseling for a long-term after their surgery. Testicles are very vital for normal men and their loss may induce depression and anxiety into the patient. This may need to be treated through individual psychological sessions along with being a part of a support group. There are several of these support groups for men who have undergone an orchiectomy, in the US, Canada and in many places around the world.

For the long-term, the patient may need to undergo frequent checkups, apart from chemotherapy or radiotherapy, in case of orchiectomy for testicular cancer. In case the orchiectomy is for treatment of prostate cancer, then the patient may require hormonal therapies or radiotherapy.

Are there any risks associated with Orchiectomy?

There are several commonly seen surgical risks that are also sometimes associated with an orchiectomy. These may include breathing and heart problems, deep vein thrombosis, infection, bleeding and anesthetic allergy.

In case the patient is on an epidural anesthesia, then the risks include nerve damage, bleeding into the spinal canal or a spinal headache.
Certain specific risks associated with an orchiectomy procedure are:

  • Loss of libido – Can be effectively treated with hormone gels and injections

  • Impotence

  • Hot mood flashes

  • Weight gain

  • Mood swings/depression

  • Fatigue

  • Enlarged and tender breasts

  • Loss of sensation in the genital and general groin area

  • Osteoporosis

Cancer may recur in a few patients even after an orchiectomy procedure.

How is a successful Orchiectomy procedure?

For Cancer

Normally, the time of surgery and the stage of the cancer determine the success rate of the procedure. However, most patients recover and are successfully treated. Patients with testicular cancer have shown a survival rate of 95% in the first 5 years following the orchiectomy procedure. There is poorer prognosis for metastasized testicular cancer.

For Gender Reassignment

There is significant drop in testosterone levels in the body of patients after a male-to-female gender reassignment surgery. There is also noticeable decrease in libido and gradual decrease of masculine traits, such as facial hair.

Additional surgery is required to complete the anatomical reassignment.

What are the alternatives to an Orchiectomy procedure?

For cancer patients

Apart from radical orchiectomy there is no other treatment method as effective to treat testicular cancer and prevent it from spreading (metastasizing). Radiotherapy or chemotherapy is usually followed after this.

Other procedures that may be counted as alternatives to this procedure are:

  • Observing and waiting

  • Hormonal therapy

  • Radiotherapy

  • Chemotherapy

For Gender Reassignment patients

The initial alternative to an orchiectomy for gender reassignment is hormonal therapy. Majority of patients seeking to undergo male-to-female gender reassignment need to have hormonal therapy of estrogens for at least 3 to 5 months prior to requesting a surgical procedure.

The surgery is often delayed for longer by the patient for various personal reasons. Others may often choose hormonal therapy as the alternative and avoid genital change completely.

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