Orchiectomy
Orchiectomy is a surgical procedure involving the removal of one or both testicles and is primarily indicated for treating conditions such as testicular cancer, prostate cancer, and male breast cancer. In cases of testicular cancer, a radical or inguinal orchiectomy is typically performed, which involves an incision in the abdomen to remove the testis and spermatic cord. For prostate cancer, bilateral simple orchiectomy may be utilized, where both testicles are removed through an incision in the scrotum. This procedure can also play a role in gender reassignment surgery as part of genital reconstruction, following appropriate hormone therapy and psychological evaluations.
The procedure is generally well-tolerated, allowing many patients to return to work within a day or two, though recovery experiences may vary. Potential complications include hormonal changes that might lead to various side effects, such as changes in sexual function, weight gain, and fatigue. Orchiectomy remains a valuable option in early-stage cancers, with high curability rates for seminomas and nonseminoma germ cell tumors when detected early. As a historical treatment dating back to the 1940s, orchiectomy continues to evolve in its applications, particularly in oncology and transgender health care.
Orchiectomy
Anatomy or system affected: Reproductive system
Also known as: Testicle removal
Definition: Excision of a testicle, usually performed as part of cancer therapy
Indications and Procedures
Orchiectomy is usually performed to prevent the spread of testicular cancer or to treat prostate cancer or male breast cancer. For metastaticcarcinoma of the prostate, bilateral simple orchiectomy (removal of both testicles through an incision in the scrotum) is often utilized. For primary malignant tumors of the testes, radical or inguinal orchiectomy (removal of one or both testicles and the spermatic cord through an incision in the abdomen) is performed for the best result.
During simple orchiectomy, the patient's genitalia are prepared in a sterile manner. An incision is made in the scrotum, and the testis is withdrawn from its sac. The spermatic cord is clamped during the procedure and then cut.
In radical orchiectomy, the genitalia and the inguinal region (the upper groin and lower lateral abdominal region) are prepared in a sterile manner, and an inguinal skin incision is made. Then the spermatic cord is freed and clamped. Next, the testis is pulled up from the scrotum. A radical orchiectomy would typically be necessary in the case of suspected testicular cancer. Once the tumor is verified, either by gross analysis or by a frozen section, the cord is doubly clamped and then cut.
It is important for patients undergoing an orchiectomy to have blood drawn and a urine sample collected and to stop any aspirins that they may be taking a week before the procedure. Also, all nonsteroidal anti-inflammatory drugs (NSAIDs) should be discontinued two days before the procedure.
Orchiectomy can also be a part of gender reassignment surgery, which is mostly performed in clinics that specialize in the procedure. It is considered genital reconstruction. Prior to the genital reconstruction, patients usually undergo hormone therapy for several months or as long as a year before going through the surgery.
Uses and Complications
Orchiectomy can be used to treat testicular cancer. Seminoma is a type of testicular cancer that, if the tumors are localized, is curable with orchiectomy and low doses of adjuvant radiotherapy in 98 percent of patients. Advanced cancer at stage 2 is curable with orchiectomy and radiation therapy to the involved areas in 85–90 percent of patients. In metastatic diseases, stage 3 or localized advanced disease is primarily curable in 90 percent of the patients if combined with chemotherapy. Nonseminoma germ cell tumors (NSGCTs) seem to resist radiation therapy and are more likely to travel to the lungs, brain, bones, and liver.
Both seminoma and nonseminoma are highly curable if caught early enough, even if the cancer has spread beyond the testes to other body parts and tissues, as compared to other cancers. When it comes to relapse of the disease, the risk is lowered with retroperitoneal lymphadenectomy followed by chemotherapy, but this protocol does not improve survival. It is also possible that removing the lymph nodes may cause infertility.
Patients who have undergone orchiectomy may go to work the next day, if they desire. However, some patients may need a day or two before they feel ready. It is important to drink fluids and to abstain from alcoholic beverages. Sometimes, the patient may feel nauseated if the procedure was performed because of cancer. Some pain and swelling may develop, which is normal, and the physician may prescribe medications to counteract them.
One of the major risks of orchiectomy is a sudden hormone change, and possible side effects may include loss of muscle mass, brittle bones, weight gain, fatigue, erection problems, loss of sexual desire, hot flashes, enlargement and tenderness in the breasts, and sterility.
Undergoing orchiectomy for male-to-female genital reconstruction requires a diagnosis from a psychiatrist, as well as letters from mental health counselors in support of this procedure.
Perspective and Prospects
Orchiectomy was first used on a patient suffering from advanced prostate cancer in 1941. Indications from this therapy showed no apparent improvement in survival from it. In 1967, the Veterans Administration Cooperative Urological Research Group (VACURG) presented information on more than two thousand patients who had received different types of therapies, including orchiectomy. In the twenty-first century, the procedure continues to be a useful tool for treating and diagnosing cancer. It is also part of the transition process for transgender women, if they so choose.
Bibliography
Dawson, C. “Testicular Cancer: Seek Advice Early.” Journal of Family Health Care, vol. 12, no. 1, 2002, p. 3.
Geldart, Thomas R., et al. “Orchiectomy after Chemotherapy for Patients with Metastatic Testicular Germ Cell Cancer.” BJU International, vol. 90, no. 4, 2002, pp. 451–55, doi:10.1046/j.1464-410X.2002.02916.x.
Incrocci, Luca, et al. “Treatment Outcome, Body Image, and Sexual Functioning after Orchiectomy and Radiotherapy for Stage I–II Testicular Seminoma.” International Journal of Radiation Oncology, Biology, Physics, vol. 53, no. 1, 2002, pp. 1165–1173.
Khatri, Vijay P., and Juan A. Asensio. Operative Surgery Manual. Saunders, 2003.
Neff, Deanna M. "Orchiectomy." Health Library, EBSCO Information Services, 18 Dec. 2017, healthlibrary.epnet.com/GetContent.aspx?token=D39207C8-9100-4DC0-9027-9AC6BA11942D&chunkiid=621012. Accessed 20 July 2023.
"Testicular Cancer Treatments: The Inguinal Orchiectomy." The Testicular Cancer Resource Center, Association of Cancer Online Resources, 28 Mar. 2018, tcrc.acor.org/orch.html. Accessed 20 July 2023.