An orchiectomy is a surgical procedure to remove one (unilateral) or in rare cases both (bilateral) testicles from a male patient. The procedure is most commonly used in patients with either testicular cancer or prostate cancer. An orchiectomy is an invasive procedure that may cause infertility, although the chance of occurring is less likely when only one testicle is removed. It can also lower a man's sex drive due to the loss of testosterone.
The main functions of the testicles are to produce sperm and testosterone, but the male sex hormones produced by these glands can cause prostate and testicular cancer to grow. Removing the teste better ensures that the cancer cells are unable to multiply and spread.
There are three main types of orchiectomy, each of which are performed under general or epidural anesthesia and take up to an hour to complete.
This type of orchiectomy is typically used to treat advanced stage prostate cancer. Here, after the anesthetic is administered, an incision is made in the middle of the scrotum, with cuts penetrating the underlying tissue. The testicle is then pulled out through the incision and cut loose from the vas deferens tube that transports sperm from the epididymis (the coiled tube connected to the rear of each testicle) during ejaculation. If it's a bilateral orchiectomy, both testicles can be removed through the same incision, one at a time. Parts of the spermatic cord may also be extracted. Sutures are used to close the incision and surgical dressing is placed over the site.
A subcapsular orchiectomy is also used for the treatment of prostate cancer. It operates similar to a simple orchiectomy, but rather than remove the entire gland, the glandular tissue that surrounds the testicle(s) is taken. This helps keep the appearance of the scrotum.
An inguinal orchiectomy can be referred to as a radical orchiectomy. This type is performed if an onset of testicular cancer is suspected. Removing the testicle(s) prevents the cancer from spreading from the spermatic cord to the lymph nodes.
During the procedure, the surgeon makes an incision in the groin area and then pushes the testicle(s) up through the groin beneath the skin until it can be accessed at the incision site. The testicle is clamped and cut away, along with the entire spermatic cord. The layers of tissue and skin are then sutured shut and covered with sterile gauze and bandages. A piece of non-absorbable suture may be placed in the base of the spermatic cord so that future surgeries can be performed, if necessary.
Depending on the stage of cancer and whether it has spread, patients may be able to explore alternatives other than an orchiectomy. Treatment options include:
- Chemotherapy: drugs (taken by mouth, injected into a vein, or placed directly near the cancer) are used to destroy cancer cells or prevent them from multiplying.
- Hormone therapy: This type of therapy is used to reduce the amount of male hormones generated or inhibit their function. For example, female hormones (estrogen and progesterone) can be administered to keep the testicles from producing testosterone. Other drugs, such as Luteinizing hormone-releasing hormone (LHRH) agonists, can do the same; while antiandrogens can prevent the adrenal glands from making androgen hormones that are responsible for promoting male sex characteristics.
- Biologic therapy (also known as immunotherapy or biotherapy): Substances manufactured in a laboratory or by the body help the patient’s immune system fight the cancer.
- Targeted therapy: Drugs are used to find and attack certain types of cancer cells while leaving normal cells untouched.
- Radiation therapy: radiation (either high-energy x-rays, or other types) is used to kill cancer cells or keep them from growing.
There are several benefits of an orchiectomy, including:
- Effective method of removing a testicular tumor
- Might not need chemotherapy or radiation therapy afterwards
- Might cause prostate cancer to shrink
- Can relieve bone pain from cancer
Orchiectomy Risks and Complications
The orchiectomy itself carries the normal risks of a surgical procedure, such as reactions to the anesthetic, bleeding, and infection at the incision site. If a patient has both testicles removed, infertility will result. If a patient has one testicle removed, he may remain fertile since only a single testicle is needed to maintain fertility. Regardless of whether one or both testicles are removed, potential complications may arise due to a loss of testosterone. They include:
- Loss of libido
- Hot flashes
- Erectile dysfunction
- Breast enlargement
- Loss of muscle mass
It takes about seven to 10 days to get the lab results back after an orchiectomy. The tissues that were removed will be examined in a lab to determine follow up care. If the cancer has spread to other parts of the body, additional cancer treatments will be needed. Although it is rare, sometimes the lab results will come back and reveal that the patient didn't actually have cancer. If the results show that the cancer was completely removed, the patient may be required to go for regular checkups over the next several years to make sure the cancer has not returned.
Testicular cancer treatments: The inguinal orchiectomy. (2012). The Testicular Cancer Resource Center
Orchiectomy. (2011). Oxford American Handbook of Urology