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Bilateral Orchidectomy
What is
Bilateral Orchidectomy?
Bilateral orchidectomy is the surgical removal
of both testicles. It is also known as
castration for the reason that the person is no
longer able to reproduce.
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Effects
of Bilateral Orchidectomy
This
procedure extensively reduces the risk for
prostate cancer leading to the reduction of the
risk of testicular cancer. As a result, this
procedure has the potential of adding 14 years
to the average male life expectancy.
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Candidates for Bilateral Orchidectomy
Ideal
candidates for orchidectomy are individuals who
have cancer of the testicle or testicles, those
who have any injury or trauma to the testicle or
testicles, or those who are suffering from
advanced prostate cancer that may have already
spread to the testes. Men who suffer from
cryptorchidism or undescended testes have a
higher risk of testicular cancer. Even after
surgery has been performed to descend the
testicles in the scrotum, the increased risk for
having testicular cancer does not change. A
prophylactic orchidectomy may be indicated to
high-risk patients such as those with a family
history of testicular cancer. Before performing
orchidectomy, it is important for the physician
to exclude inflammation of the testes which also
presents as a swelling and lump in the scrotum.
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Your Consultation
Standard blood and urine tests
are done before the procedure for patients who
will undergo orchiectomy. Aspirin-based
medications are discontinued for a week prior to
surgery and all nonsteroidal anti-inflammatory
drugs (NSAIDs) are also discontinued two days
before undergoing the procedure. Eight hours
before the scheduled time of surgery, the
patient is not allowed anymore to eat or drink
anything.
On the morning of the surgery, the doctor may
request the patient to shower or bathe using a
special antibacterial soap. Extra time should be
taken to lather, scrub, and rinse the genitals
and groin area.
A sedative may be given to patients before the
procedure who are anxious and are nervous.
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The
Bilateral Orchidectomy Procedure
This procedure is done under general anesthesia
and prior hospitalization may or may not be
necessary. Before the surgery, the lower abdomen
region and the scrotum will be shaved and
cleansed thoroughly. To ensure that pain will
not be experienced, either a general anesthesia
or a local anesthesia with spinal block will be
utilized during the orchidectomy procedure.
Through an incision made in the scrotum or groin
area, the testicles will be removed. The
incision will be sutured at the end of the
orchidectomy procedure. This procedure usually
takes between 30 minutes to an hour. A
prosthesis or a scrotal implant may be suggested
by the surgeon to be inserted or an artificial
replacement may be placed for the testes in the
scrotum in order to give the scrotum a normal
look. Removal of some of the lymph nodes found
deep in the abdomen or inguinal area may also be
done.
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Recovery
It is
important that arrangements have been made for
someone to drive a patient who is undergoing an
orchiectomy in an ambulatory surgery center or
an outpatient facility home after the
procedure. A day after the procedure, the
patient may be able to resume work although some
may require an additional day of rest at home.
Normally, nausea may be felt after the
anesthetic wears off. Even though it is normal
for patients to feel nauseated, they should
start eating regularly as soon as they get
home. Pain and swelling can also be expected
after this procedure and the doctor may
prescribe a pain killer to be taken for a few
days.
Recommendations for aftercare include the
following:
-
Apply an ice pack to the groin area for the
first 24-48 hours after the procedure
-
Drink extra fluids, except for caffeinated and
alcoholic beverages, for the next several days
-
Sexual activity, heavy lifting, and vigorous
exercise should be avoided until the follow-up
appointment with the doctor.
-
To
reduce the risk of the absorbable stitches to
dissolve prematurely, it is better to take a
shower rather than taking a tub bath for a
week post surgery.
-
Wear
snug briefs or a jock strap in order to
provide support for the scrotum two weeks
after the surgery.
Psychological counseling may be required for
some patients after undergoing an orchidectomy
as part of their long-term aftercare. This
includes regular check-ups together with
radiation treatment or chemotherapy. Hormonal
therapies or radiation treatment may be given to
patients with prostate cancer.
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Risks
The
general risks for an orchidectomy done under
general anesthesia are basically the same as for
other procedures. These are the following:
Deep venous thrombosis, heart problems,
breathing problems, bleeding, infection, and
reaction to the anesthesia. Risks such as
bleeding into the spinal canal, nerve damage, or
spinal headache are usually expected under an
epidural anesthesia.
The
specific risks related with an orchidectomy are
the following:
-
Enlargement and tenderness in the breasts
-
Fatigue
-
Hot
flashes that are comparable to those in
menopausal women which can be controlled with
medication
-
Impotence
-
Loss
of sensation in the region of the groin or the
genitals
-
Loss
of sexual desire which can be treated with
hormone injections or gel preparations
-
Mood
swings or depression
-
Osteoporosis especially to patients who are
taking hormone treatments for prostate cancer
-
Weight gain of about 10-15 pounds or 4.5 to
6.8 kilograms
Patients who have cancer are at a greater risk
for recurrence of the cancer.
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Frequently Asked Questions
Q:
What is an orchidectomy for?
A:
A bilateral orchidectomy is generally done as
one phase in male-to-female (MTF) gender
reassignment surgery. This is done to set up
the genital area for later surgeries to
construct a vagina and an external female
genitalia, as well as to lower the levels of
male hormones in the body.
Q:
What are the advantages and disadvantages of a
bilateral orchidectomy?
A:
The ease of the procedure, its immediate
response while a deep calm serenity develops,
and its low cost are some of the advantages of
this procedure. On the other hand, this
procedure is not reversible and as of yet is its
biggest disadvantage.
Q:
Who does the orchidectomy?
A:
Majority of the surgeons who perform this
procedure to treat cancer are board‑certified
urologists or general surgeons. This procedure
when done as part of cancer therapy may be
performed in the hospital setting under general
anesthesia but can also be done in a urology
clinic or a similar facility as an outpatient
procedure.
Q:
How should I prepare for an orchidectomy?
A:
A special blood test will be requested by your
physician and will consist of serum tumor
markers like alpha fetoprotein (AFP), beta-hCG,
and LDH. On your preoperative consult, routine
blood and urine analysis, CT of the abdomen, and
chest x-ray will be asked from you by your
doctor. Make sure that you inform your doctor
about any other health conditions and
medications which include prescription and
non-prescription medications, nutritional
supplements like vitamins, minerals, and herbal
products. Two weeks prior to undergoing an
orchidectomy, aspirin or ibuprofen should be
avoided. Smoking should be stopped several
weeks before the procedure in order to prevent
healing problems during the period of recovery.
At least 10 hours prior to the orchidectomy
surgery, eating and drinking anything are not
allowed.
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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