Orchiectomy

Orchiectomy (also named orchidectomy) is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:

Less frequently, orchiectomy may be performed following a trauma, or due to wasting away of one or more testicles.

A simple orchiectomy is commonly performed as part of gender-affirming surgery for transgender women and non-binary people, or as palliative treatment for advanced cases of prostate cancer. A simple orchiectomy may also be required in the event of testicular torsion.

For the procedure, the person lies flat on an operating table with the penis taped against the abdomen. The nurse shaves a small area for the incision. After anesthetic has been administered, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue. The surgeon removes the testicles and parts of the spermatic cord through the incision. The incision is closed with two layers of sutures and is covered with a surgical dressing. If desired, prosthetic testicles can be inserted before the incision is closed to present an outward appearance of a pre-surgical scrotum.

A subcapsular orchiectomy is also commonly performed for treatment of prostate cancer. The operation is similar to that of a simple orchiectomy, with the exception that the glandular tissue that surrounds each testicle is removed rather than the entire testis itself. This type of orchiectomy is performed to remove testosterone-producing glandular tissue while maintaining the appearance of an ordinary scrotum.

Inguinal orchiectomy (named from the Latin inguen for "groin", and also called radical orchiectomy) is performed when an onset of testicular cancer is suspected, in order to prevent a possible spread of cancer from the spermatic cord into the lymph nodes near the kidneys.

An inguinal orchiectomy can be either unilateral (one testicle) or bilateral (both testicles). The surgeon makes an incision in the groin area (in contrast to an incision in the scrotum, as is done in both simple and subcapsular orchiectomies). The entire spermatic cord is removed, as well as the testicle(s). A long, non-absorbable suture may be left in the stump of the spermatic cord in case later surgery is deemed necessary. After the cord and testicle(s) have been removed, the surgeon washes the area with saline solution and closes the layers of tissues and skin with sutures. The wound is then covered with sterile gauze and bandaged.

Partial orchiectomy is an option for individuals with testicular masses that want to preserve their testes and their function. During surgery, the testis is exposed in a similar way to inguinal orchiectomy. Once the testis is exposed and the spermatic cord is clamped, there is a current debate as to whether surgeons should deliver cold ischaemia which means submitting the organ, in this case the testis, into a cold/freezing environment. Whether or not it is submerged and frozen, the next step is to cut the tunica vaginalis and an ultrasound is used to find the tumor. After, the tumor is scraped away from the testis in a process called enucleation. Following enucleation, biopsies are taken of the tissues surrounding the testicle where the mass once was. Afterwards, each layer or tunica of the testis is sutured up and the testis is placed back in the scrotum. The skin layers are also closed up with sutures.