Orchiectomy Surgery in Delhi, India

The three types of orchiectomy procedure are:

1. Simple orchiectomy

   Simple orchiectomy is performed under local anaesthesia, and the surgery is completed in 30 minutes. This treatment is usually done bilaterally by removing both testes to prevent testosterone production in prostate cancer or for sex reassignment surgery.

2. Subcapsular orchiectomy

   In this procedure, only the tissue of the testicles is removed, leaving the testes lining intact. Sometimes one side testis may be removed for treatment of torsion of testis/ small atrophic testis/ pus in testis.

3. Radical orchiectomy (High Inguinal Orchiectomy)

   This surgery removes both the testes and spermatic cord to prevent the spread of testicular cancer into regional lymph nodes and other organs in the abdomen. The surgery is done through an incision in the groin.

A doctor may suggest this surgery to a male diagnosed with breast cancer or prostate cancer to stop hormone production. A person may wish to do orchiectomy surgery to transition from male to female, as removing the testes reduces the production of testosterone.

Simple and subcapsular orchiectomy is performed if a person experiences testicular trauma or has prostate cancer.

Other conditions that need orchiectomy treatment include:

1. Cancer

   Orchiectomy treatment removes primary testicular cancer and allows the doctor to collect tissue samples for diagnosis. This treatment is also used for male breast cancer and prostate cancer. Hormones such as androgens and testosterone encourage cancer cell growth. Removing the testes reduces hormone levels.

2. Gender transition

   Transgender women may choose orchiectomy for gender transition as the procedure reduces male hormone levels in the body. This treatment can be performed as a single surgery or as part of comprehensive gender reassignment surgery.

3. Trauma

   Injuries or trauma due to sports, motorcycle accidents, or other factors can cause severe damage to testicles. In case of major damage, the doctor may recommend removing the testes.

4. Testicular Abscess (Pus in Testis)

   May also recommend orchiectomy.

The need for orchiectomy surgery depends on the underlying condition, which is diagnosed by physical examination and tests. The doctor recommends the patient undergo a routine blood and urine tests along with chest X-ray and ECG to assess general health.

Before the surgery, local or general anaesthesia is injected to numb the part.

For simple orchiectomy:

1. The penis is taped to the abdomen to get a clear excess of the testicles.
2. A cut is made in the midpoint of scrotal skin and deeper layers
3. The testes are removed through the opening of the incision.
4. The incision is closed with sutures, and a dressing is placed on the wound.
5. In a few cases, if a patient wishes, a prosthetic testicle can be inserted through the incision to maintain the normal appearance of the scrotum.

For subcapsular orchiectomy:

The procedure for subcapsular orchiectomy is similar to simple orchiectomy. However, one major difference in this procedure is that only glandular tissue is removed instead of the entire testes. This type of orchiectomy maintains the normal appearance of the scrotum.

For Radical or Inguinal orchiectomy:

1. The surgeon will cut the patient's groin area near the inguinal ligament while ensuring no damage is caused to the ilioinguinal nerve
2. Testes (one or both) along with the spermatic cord are removed through the incision.
3. The area is cleaned with saline solution, and the incision is closed with sutures. The wound is covered with a dressing.

After the surgery, the doctor may give painkillers to relieve some pain.

Preparing for surgery includes taking precautionary steps such as not taking blood-thinning medicines like aspirin for a few days before surgery. The patient must also avoid smoking and drinking for a few days before surgery to speed up the healing process. Also, the patient must inform the doctor about any medication or supplements he is taking.

The doctor may take blood samples to make sure the patient is healthy enough for the surgery and indicators of cancer.

Before the surgery, the patient must make sure he has a ride home. Get rest for a few days and plan in advance how to limit physical activity after surgery.

Orchiectomy effectively removes the tumour and can prevent cancer growth. The treatment is highly effective, but it can cause some complications. After the treatment, the patient may experience hot flashes or erection problems. Orchiectomy is a safe procedure, but a patient may experience:

1. Pain, swelling, or numbness around the scrotum
2. Erectile dysfunction
3. Infections or fever
4. Complications due to anaesthesia
5. Depression, weight gain, and mood swings
6. Bleeding and swelling in the scrotum
7. If both testicles are removed, it can make a patient infertile
8. Low muscle mass
9. A drop in hormones can lead to lower sex drive, depression, and problems with sexual function

A patient may also experience long-term effects due to less testosterone in the body, such as osteoporosis and infertility.

A patient may feel better after surgery, but the entire recovery process takes several weeks. While recovering, a patient should:

1. Avoid physical activity

   Avoid lifting heavy objects, running, or having sex. Consult the doctor before getting back to sports and other major physical activities

2. Keep the area dry and clean

   Use mild soap and clean the area gently with water. Make sure the area is dry to prevent infection and faster recovery.

3. Medications

   After surgery, a patient may feel pain, swelling, discomfort, and tenderness. Taking over-the-counter medication such as non-steroidal anti-inflammatory drugs can relieve pain. Apply an ice pack to ease the discomfort.

4. Eat healthily

   Eat fibre-rich food and drink plenty of water to avoid the problem of constipation, as pushing too heavily may cause pain.

Reviewed by Dr. Gaurav Garg (Uro), Consultant - Urology, Urology on 23-Sep-2022.

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What is an orchiectomy? An orchiectomy is a surgical procedure that involves the removal of one or both testicles.

Why is an orchiectomy performed? Orchiectomies are performed for various reasons, including the treatment of testicular cancer, transgender hormone therapy, management of prostate cancer, or reducing testosterone production in certain medical conditions.

How is an orchiectomy performed? There are two main methods for performing an orchiectomy: inguinal orchiectomy and scrotal orchiectomy. In an inguinal orchiectomy, an incision is made in the groin area, while in a scrotal orchiectomy, the incision is made in the scrotum.

Is orchiectomy a major surgery? Orchiectomy is generally considered a minor surgical procedure. It can be performed under local or general anaesthesia, depending on the specific case.

What are the potential risks and complications of orchiectomy? Possible risks and complications include bleeding, infection, blood clots, damage to surrounding structures, and adverse reactions to anaesthesia. However, these risks are relatively low.

How long does it take to recover from an orchiectomy? The recovery period varies depending on individual factors and the specific type of orchiectomy performed. In general, patients can resume normal activities within a few days to a week and fully recover within a few weeks.

Will I still be able to have erections after an orchiectomy? Orchiectomy itself does not directly affect the ability to have erections. However, the removal of the testicles may impact testosterone levels, which can have secondary effects on sexual function. Discussing this with a healthcare provider is recommended.

Are there any long-term effects of orchiectomy? For individuals undergoing orchiectomy as part of transgender hormone therapy, the long-term effects can include reduced testosterone levels, changes in secondary sexual characteristics, and potential fertility loss.

Can an orchiectomy cause weight gain? Weight gain is not a direct result of orchiectomy. However, if testosterone levels decrease significantly after the procedure, it may affect body composition and metabolism, potentially leading to weight changes.

Can an orchiectomy increase the risk of osteoporosis? Removal of the testicles can reduce testosterone levels, which may contribute to bone density loss over time. However, the risk can be managed through hormone replacement therapy and lifestyle modifications.

Can an orchiectomy affect mental health? Mental health effects can vary among individuals. For transgender individuals, an orchiectomy may alleviate gender dysphoria and contribute to improved mental well-being. However, discussing any concerns with a mental health professional is advisable.

Can an orchiectomy cause hormonal imbalances? Orchiectomy can result in a reduction of testosterone levels. This reduction may require hormone replacement therapy to maintain hormonal balance and address any related symptoms.

Can an orchiectomy cure prostate cancer? Orchiectomy can be an effective treatment for advanced prostate cancer by reducing testosterone levels, which can slow the growth of cancer cells. However, it may not be curative on its own, and other treatments may be necessary.

Is an orchiectomy reversible? Orchiectomy is generally considered irreversible since it involves the removal of the testicles. However, for transgender individuals, the desired effects can be achieved through hormone therapy without the need for reversal.

Will I need hormone replacement therapy after an orchiectomy? The need for hormone replacement therapy depends on the specific circumstances. For individuals undergoing orchiectomy as part of transgender hormone therapy, hormone replacement therapy is typically required to maintain appropriate hormone levels.

Can an orchiectomy affect fertility? Yes, orchiectomy leads to permanent infertility as it involves the removal of the testicles, which produce sperm. Preserving fertility through sperm banking or other methods should be considered before the procedure if desired.

Can an orchiectomy increase the risk of heart disease? Removal of the testicles can reduce testosterone levels, which might have an impact on cardiovascular health. However, the overall risk depends on various factors, and managing hormone levels with appropriate therapy can help mitigate potential risks.

Can an orchiectomy prevent testicular cancer? Orchiectomy can be performed as a treatment for testicular cancer, particularly in cases where cancer has not spread beyond the testicles. However, regular self-examinations and screenings remain crucial for early detection.

Will an orchiectomy affect my voice? An orchiectomy does not directly affect vocal cords or vocal range. However, transgender individuals seeking voice changes typically undergo voice therapy or other interventions to achieve desired vocal characteristics.

Are there any alternatives to orchiectomy for testosterone suppression? Yes, alternatives include medications such as GnRH agonists or antagonists, which can suppress testosterone production. These options are sometimes preferred over surgery, especially for individuals who desire reversibility or have specific medical conditions.