From the Guidelines
The procedure for orchidectomy, or surgical removal of a testicle, typically involves making an incision in the groin area, removing the affected testicle, and resecting the spermatic cord at the level of the internal inguinal ring, as recommended by the most recent and highest quality study 1. The procedure is usually performed under general or spinal anesthesia and takes around 30-60 minutes to complete. Some key points to consider include:
- The incision is made in the groin area, not the scrotum, to avoid any potential complications or contamination of the surgical site 1.
- The surgeon will remove the affected testicle and may place a prosthetic testicle if desired by the patient.
- Recovery typically requires 1-2 weeks of limited activity, with pain managed by medications like acetaminophen or prescribed opioids for the first few days.
- Patients should watch for signs of infection, including fever, increasing pain, redness, or discharge from the incision site.
- Most men can maintain normal sexual function and fertility with one remaining testicle, as it will produce sufficient testosterone and sperm 2.
- However, if both testicles are removed, testosterone replacement therapy will be necessary to prevent symptoms of low testosterone, such as fatigue, decreased libido, and loss of muscle mass.
- Follow-up care typically includes a post-operative visit 1-2 weeks after surgery and possibly additional monitoring depending on the reason for the procedure. It's also important to note that patients of reproductive age should have a baseline fertility assessment, including semen analysis, and be informed about the possibility of cryoconservation before orchiectomy 3.
From the Research
Procedure for Orchidectomy
The procedure for orchidectomy, or the surgical removal of a testicle, can vary depending on the underlying condition and the patient's overall health.
- In cases of testicular trauma, orchidectomy may be necessary when the trauma is extensive and irreparable, leading to compromised blood supply and persistent pain 4.
- For testicular cancer, a high inguinal orchiectomy is the standard approach, which involves removing the testicle through an incision in the groin area 5.
- A new laparoscopic method of radical orchiectomy has also been developed, which allows for minimally invasive removal of the testicle and elements of the spermatic cord 6.
- In some cases, surgical exploration of a testicular mass may not always require orchiectomy, and a more conservative approach may be taken to preserve the testicle 7.
- Focal surgery is also an option for testicular cancer, which allows for the preservation of fertility, endocrine function, and integrity of the genital anatomy 8.
Surgical Approaches
Different surgical approaches can be used for orchidectomy, including:
- Inguinal approach: This involves making an incision in the groin area to access the testicle 5.
- Scrotal approach: This involves making an incision in the scrotum to access the testicle 5.
- Laparoscopic approach: This involves using a minimally invasive technique to remove the testicle through small incisions in the abdomen 6.
- Focal surgery: This involves removing only the affected portion of the testicle, rather than the entire testicle 8.
Considerations
When considering orchidectomy, several factors must be taken into account, including: