Orchiectomy

Overview

An orchiectomy, or orchidectomy, is a surgical procedure that involves the removal of one or both testicles. These small glands, located in the scrotum beneath the penis, are responsible for producing sperm and the male hormone testosterone. The procedure is used to treat or prevent conditions such as prostate cancer, male breast cancer, and testicular cancer. Additionally, transgender women may choose to undergo an orchiectomy as part of their transition. The surgery is usually performed on an outpatient basis, allowing patients to return home the same day.

Reasons for undergoing the procedure

Your healthcare providers may utilize orchiectomy for the following reasons:

• Treatment of cancer: Orchiectomy serves both as a diagnostic tool and a treatment for testicular cancer. By removing tissues that could be cancerous, the surgery enables pathologists to accurately diagnose the presence of cancer. 

Additionally, orchiectomy is used to treat male breast cancer and prostate cancer. Since androgens, such as testosterone, can stimulate the growth of certain cancer cells, the procedure helps reduce hormone levels by removing the testicles. This reduction in hormones can lead to the shrinkage of some cancerous tumors by eliminating the hormonal support they need to grow and spread.

• Transition of transgender: Many transgender women (or trans women) choose to have an orchiectomy as a part of their transition. Healthcare providers may choose to perform this treatment alone or in conjunction with a more comprehensive gender affirmation procedure that can involve scrotoplasty or vaginoplasty. Along with the physical transformation, removing both testicles significantly lowers male hormone levels in the body.
• Damaged testicles removal: Trauma such as motorbike accidents, sports injuries, and other incidents can seriously harm your testicles. A healthcare provider may remove the testicle and seal the surrounding tissues if they are unable to repair it. An undescended testicle may need to be removed in some rare cases. Similarly, after a testicular torsion, a testicle may need to be removed, although this is not common.

Risks

An orchiectomy has risks such as bleeding and infection, much like any other surgery. Pain and edema are possible side effects as well.  The potential complications and side effects can vary depending on the specific type of orchiectomy performed.

Hormone levels are reduced following an orchiectomy, particularly if both testicles are removed. This can lead to certain side effects. A reduction in testosterone and other male hormones, however rare, can cause:

• Depression.
• Fatigue.
• Hot flashes.
• Low muscle mass.
• Low sex drive.
• Erectile dysfunction.
• Osteoporosis.

Individuals who undergo a bilateral orchiectomy, where both testicles are removed, will no longer be able to produce sperm, which causes infertility.

Your thoughts about sex and your sense of self-worth may be affected by an orchiectomy. Experiencing these feelings after surgery is common. Talk to your healthcare provider about any psychological affects you may be experiencing. They can give you with advice and coping mechanisms to help you adjust to these changes.

Before the procedure

Orchiectomies are generally performed in a surgical center or hospital. The procedure is typically conducted under general anesthesia, ensuring that you are completely asleep and free from pain during the operation.

During the procedure

Your healthcare provider will begin by cleaning the area and making an incision. The location of the incision depends on the technique used: it may be in your pubic area (inguinal orchiectomy) or directly in your scrotum (simple orchiectomy). Depending on your condition, the procedure may involve the removal of one testicle (unilateral orchiectomy) or both testicles (bilateral orchiectomy).

In cases of radical inguinal orchiectomy, the testicles and the spermatic cord are removed. The spermatic cord, which includes blood vessels and nerves, transports semen from the testicles to the penis and can also be a pathway for cancer to spread.

If you opt for a prosthetic testicle, your healthcare provider will place it inside your scrotum during the procedure. This prosthetic is typically filled with a sterile saline solution to replicate the look and feel of a natural testicle.

The procedure usually takes between 30 to 60 minutes to complete.

After the procedure

Your healthcare provider will use stitches to close the wound after the surgical procedure. You will be kept under observation in the recovery area after the procedure until you are prepared to be discharged. The majority of patients can return home the same day as their procedure.

While you will be under anesthesia and won’t feel pain during the surgery, some discomfort may occur during the recovery period. It’s important to discuss pain management options with your healthcare provider for the days and weeks following your orchiectomy.

You will need someone to drive you home following the surgery. The recovery process generally spans several weeks. It is important to schedule a follow-up appointment with your healthcare provider after the procedure. During your recovery, you should:

• Avoid physical activity: After the procedure, take it easy for a few days and dress loosely. Stay clear of running, carrying heavy things, and sexual activity for a few weeks. To find out when it’s safe to start playing sports and other activities again, speak with your healthcare provider.
• Keeping the area clean and dry: You may need to wear a special support garment for your scrotum for approximately 48 hours after the surgery to help reduce swelling. Avoid swimming or bathing until your provider approves, which is usually several weeks post-surgery. Follow your healthcare provider’s instructions for caring for your incision. Clean the area with soap and water when you shower, and keep it dry.
• Managing pain: After the procedure, you may experience some pain, discomfort, or tenderness. To manage these symptoms, you can use over-the-counter (OTC) acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and reduce swelling. For the first day or two, apply ice packs to the area for 20-minute intervals. Additionally, your healthcare provider may recommend wearing supportive underwear to help minimize swelling.
• Hydration and nutritious foods: It’s essential to avoid straining during bowel movements. To support regularity and prevent constipation, make sure to drink plenty of water and incorporate fiber-rich foods into your diet.

Outcome

Orchiectomy is an effective treatment for testicular cancer because it removes the tumor completely and allows for detailed tissue analysis to detect cancer. It is essential to lower hormone levels as part of a comprehensive treatment plan for prostate and breast cancer.

For many transgender individuals, an orchiectomy plays a crucial role in the transition process. It reduces the need for long-term feminizing hormone therapy, which typically involves taking medications to increase estrogen levels or lower androgen levels (known as androgen deprivation therapy, or ADT). Although estrogen supplements generally have minor risks, long-term use can lead to complications such as blood clots and other health issues.

After the removal of your testicles, a sudden drop in hormone levels can cause various side effects. It’s important to work with your healthcare provider to find effective strategies for managing these potential issues and maintaining your overall well-being during this adjustment period.

Before resuming any physical activities, including sexual activity, ensure that your incision has fully healed. Healthcare providers typically advise waiting three to four weeks before engaging in activities like lifting heavy objects, playing sports, or running. Following these recommendations will help support a proper recovery. Consult with your healthcare provider to determine when it’s safe to return to your regular activities.

After an orchiectomy, contact your healthcare provider immediately if you experience any of the following:

• A fever or severe pain
• Difficulty urinating
• Loss of sensation in your scrotum
• Redness around the incision or a purple spot on the scrotum, which could indicate blood pooling under the skin (hematoma)
• Presence of blood or pus coming from the incision

See a healthcare provider if you suffer from hot flashes, exhaustion, or problems with sexual desire after a decrease in hormone levels. Hormonal fluctuations may be the cause of these symptoms. Consult with a healthcare provider about the potential benefits of hormone supplements, which can help resolve these problems and enhance your general health.