What Is Orchiectomy and How Is It Performed?

Orchiectomy is the surgical removal of the testes. It is generally performed in cases such as testicular cancer, hormonal imbalance, gender transition process, or advanced prostate cancer. This operation can be performed unilaterally (one testis) or bilaterally (two testes) depending on medical requirements.

What Is Orchiectomy?

Orchiectomy is the surgical removal of one or both testes. It is also known in medicine as 'removal of the testis.' It is generally performed as part of testicular cancer treatment, in cases of advanced testicular damage, or in situations where medically reducing hormone production is required.

From a surgical technique perspective, there are two main approaches. Radical orchiectomy via the inguinal (groin) route is the standard method preferred especially in patients with suspected or confirmed testicular cancer. Scrotal orchiectomy is an intervention that can generally be preferred in non-tumor causes (such as severe infection, trauma, or chronic pain).

The purpose of orchiectomy is to remove cancerous tissue from the body, remove a testis that has suffered irreversible damage from a life-threatening infection, or to control testosterone levels in certain diseases.

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What Are the Types of Orchiectomy?

Orchiectomy has types depending on the purpose of application and surgical technique. Which type of orchiectomy will be performed is determined based on factors such as the cause of the disease, the condition of the testis, whether there is suspicion of cancer, and the patient's general health status. The types of orchiectomy are as follows:

Bilateral Orchiectomy

This is the situation where both testes are removed at the same time. This procedure is generally performed to lower testosterone levels in hormone-dependent tumors such as advanced prostate cancer. It can also be applied in rare cases where tumors are present in both testes.

Since natural testosterone production in the body stops after this operation, hormone therapy is generally planned for patients.

Unilateral Orchiectomy

This method involves removing only one testis. It is generally applied when only one testis is affected by conditions such as testicular cancer, torsion (twisting of the testis), trauma, or infection. As long as the other testis is healthy, testosterone production and reproductive function are largely preserved.

Radical (Inguinal) Orchiectomy

It is the most common surgical method applied in patients with suspected testicular cancer. Through an incision made from the groin (inguinal) region, the testis and spermatic cord are removed together. This method eliminates the risk of cancer cells spreading to the scrotum and allows pathological examination to be performed for a definitive diagnosis.

Simple (Scrotal) Orchiectomy

This is a more superficial and limited surgical procedure performed through the scrotum. It is generally a method applied for reasons other than testicular cancer.

Subcapsular Orchiectomy

In this method, the outer capsule of the testis is preserved and only the inner part is removed. It may be preferred especially in the treatment of prostate cancer to lower testosterone levels. Because it preserves the cosmetic appearance of the scrotum, it is a psychologically more comfortable option for some patients.

Why Is Orchiectomy Surgery Performed?

Orchiectomy surgery can be applied in cancer treatment as well as in various diseases and conditions affecting the testes. The main reasons are as follows:

• Testicular cancer
• Prostate cancer
• Testicular torsion
• Serious traumas
• Severe and chronic infections and inflammatory conditions
• Chronic testicular pain (orchialgia)
• Gender transition process (transgender surgeries)

How Is Orchiectomy Surgery Performed?

The manner in which orchiectomy surgery is performed varies depending on the patient's medical condition, the reason for testis removal, and the chosen surgical technique. The operation is generally performed under general or regional anesthesia. After the procedure, a testicular prosthesis can be placed to provide a more natural appearance aesthetically and psychosocially.

Before the operation, the patient undergoes a detailed physical examination and laboratory tests. If testicular tumor is suspected, the diagnosis is supported by ultrasonography and blood tests. The type of anesthesia is determined according to the patient's general health status. Blood-thinning medications are stopped before surgery and the patient is informed about the procedure.

In radical orchiectomy, an incision of a few centimeters is made in the groin region and the testis and the vascular-nerve structure called the spermatic cord are reached through this incision. The testis is carefully removed together with the surrounding tissues. In simple orchiectomy, an incision is made at the bottom of the scrotum (testicular sac), the testis is reached directly, and after the vessels and sperm duct are ligated, the testis is removed.

After the procedure, the patient is kept under observation for a short period and is generally discharged the same day or the next day. Mild pain, bruising, or swelling during the first few days is considered normal. Keeping the surgical site clean and resting as recommended by the doctor speeds up the healing process.

What Are the Risks of Orchiectomy Surgery?

Orchiectomy is generally a safe surgical procedure with a high success rate. However, as with any surgery, orchiectomy can involve certain risks and possible complications. These risks can vary depending on the type of surgery, the patient's general health status, age, and the surgical technique applied.

In most cases, the risk of complications is low and can be completely controlled with proper care. The possible risks are as follows:

• Infection
• Bleeding
• Pain and swelling
• Delayed wound healing
• Changes in hormonal balance
• Psychological effects such as low self-confidence and depression
• Decreased sexual desire and low energy, especially seen in the removal of both testes

What Should Be Considered After Orchiectomy Surgery?

There are some points that need to be considered for the recovery process to proceed smoothly after orchiectomy surgery. The success of the surgery depends not only on the surgical procedure but also on the patient's post-operative care. Proper care reduces the risk of infection and complications. Some points to consider are as follows:

• The wound area should be kept clean and dry after surgery. Dressings should be changed regularly for the period recommended by the doctor, and direct water contact with the incision site should be avoided.
• It is normal to experience mild pain, bruising, or swelling in the first few days after surgery. Pain relievers prescribed by the doctor should be used regularly. Applying a cold compress to the area (in a way that does not come into direct contact with the skin) helps reduce edema.
• Lifting heavy objects, fast movements, and sports activities should be avoided for the first week.
• Tight underwear and tight trousers in the post-operative period can put pressure on the area. Instead, soft, breathable, and supportive underwear should be preferred.
• After unilateral orchiectomy, sexual function is generally unaffected, but after bilateral orchiectomy, changes related to low testosterone may be observed. Wound healing should be complete and the doctor's approval should be awaited before resuming sexual intercourse.
• Post-operative check-up appointments must be attended. The healing status of sutures, the wound area, hormone levels, and general health are evaluated at these check-ups. Particularly for patients who have had orchiectomy due to testicular cancer, regular check-ups are of vital importance for the early detection of possible recurrence risk.

Frequently Asked Questions About Orchiectomy

Can a Child Be Had After Orchiectomy?

When a single testis is removed, reproductive function is generally preserved, but if both testes are removed, it is not possible to have children naturally.

How Long Does Orchiectomy Surgery Take?

Orchiectomy surgery takes on average 60 minutes. However, this time may vary depending on the technique applied and the patient's condition.

When Can Daily Activities Be Resumed After Orchiectomy Surgery?

Patients can generally return to light daily activities within 1 week; full recovery may take several weeks.

Is Hormone Replacement Therapy Required After Orchiectomy?

If both testes have been removed, hormone replacement therapy is generally required because testosterone production has stopped.