Rigi10™ Malleable Penile Prosthesis
Also Known As
Orchidectomy, testicle removal surgery, testicular removal
Definition
Orchiectomy is a surgical procedure involving the removal of one or both testicles (also known as testes).1 The testes are responsible for producing sperm and the male hormone testosterone.2 This procedure can be performed for various medical reasons, most commonly as a treatment for testicular cancer, where it serves as both a diagnostic and therapeutic measure to remove the tumor and prevent its spread.1,3 It is also utilized in the management of advanced prostate cancer and male breast cancer to reduce testosterone levels, which can fuel the growth of these cancers.3,4 Orchiectomy can be unilateral (removal of one testicle) or bilateral (removal of both testicles).3 There are different surgical approaches: a simple orchiectomy involves an incision in the scrotum, while a radical inguinal orchiectomy involves an incision in the groin to remove the testicle and the entire spermatic cord, which is often done for testicular cancer to prevent cancer spread.1,3 The primary purpose of orchiectomy in urology is to treat malignancies, manage hormonal influences on certain cancers, or address other testicular pathologies such as trauma, torsion, or infection when the testicle is non-viable.1
Clinical Context
Orchiectomy is indicated in several clinical scenarios. The most critical indication is for testicular cancer, where a radical inguinal orchiectomy is typically performed. This approach involves removing the testicle and the entire spermatic cord up to the internal inguinal ring to prevent tumor seeding and allow for accurate pathological staging.1 Testicular cancer commonly affects males aged 15 to 35 years, often presenting as a painless scrotal mass.1 Early diagnosis and surgical removal significantly improve cure rates.1
Another major use of orchiectomy (often bilateral simple orchiectomy) is in the management of advanced, hormone-sensitive prostate cancer. By removing the testes, the primary source of testosterone production is eliminated, leading to androgen deprivation, which can slow cancer progression and alleviate symptoms.1,3 This is considered a form of surgical castration and can be an alternative to medical androgen deprivation therapy (ADT).3
Orchiectomy may also be performed for male breast cancer, as testosterone can promote its growth.4 Other indications include severe testicular trauma where the testicle is non-salvageable, unresolving testicular infections (orchitis or epididymo-orchitis) leading to testicular necrosis, testicular torsion that has resulted in infarction, and as part of gender-affirming surgery for transgender women to remove endogenous testosterone production.2
Patient selection criteria depend on the underlying condition. For testicular cancer, any solid intratesticular mass identified on ultrasound is highly suspicious and typically warrants radical orchiectomy.1 For prostate cancer, bilateral orchiectomy is an option for patients seeking androgen deprivation, particularly those who prefer a one-time surgical procedure over ongoing medical therapy or for whom medical ADT is contraindicated or inaccessible.3
The surgical procedure varies: a radical inguinal orchiectomy is performed through a groin incision, allowing high ligation of the spermatic cord.1 A simple orchiectomy, used for benign conditions or hormonal ablation in prostate cancer, is performed through a scrotal incision.1 Epididymal-sparing techniques may be considered in simple orchiectomy to potentially reduce post-operative discomfort.3
Expected outcomes for testicular cancer are generally excellent, especially for early-stage disease, with orchiectomy being a curative procedure for many.1 For prostate cancer, orchiectomy effectively reduces testosterone to castrate levels, controlling the disease for a period, though side effects of androgen deprivation (e.g., hot flashes, loss of libido, osteoporosis) are common and need management.1,2 Recovery typically takes a few weeks, with restrictions on heavy lifting and strenuous activity.4 Pain management and wound care are important post-operative considerations.4 Psychological support may also be crucial, particularly addressing body image concerns and the hormonal/fertility implications.2