Open Orchidectomy

Open Orchidectomy

Removing one or both testicles can sound alarming to most people. But it is a procedure that can save many from serious consequences. The surgery to remove testicles is called Orchidectomy in medical parlance. Patients suffering from testicular cancer undergo this surgery. There are three types of orchidectomy for treating different diseases (Simple, Subcapsular & Radical)

1. It avoids the need for biopsy, which can further trigger cancer spread.
2. Orchidectomy is good for controlling hormone levels as part of a larger treatment strategy in patients with other forms of cancer.
3. Transgenders who want to become females benefit from this surgery by reducing the need for long-term hormone therapy. 
4. High success rate of 75-85%.
5. Fast Recovery as those undergoing this surgery can return to normal work within a couple of weeks.

People with the following conditions may need Orchidectomy:

1. Testicular cancer 
2. Those who have suffered severe trauma to the testes 
3. Prostate cancer 
4. Breast cancer
5. Transgenders 

If orchidectomy is delayed :-

The cancer can spread to the other parts of the body:

1. Testicular cancer patients 

2. Prostate of male breast cancer patients 

Dependency on hormonal medication increases in case of Transgenders looking for sex transformation

Before we go into the procedure details, it is good to know the types of orchidectomy that specialists perform. 

1. Simple Orchidectomy - In this procedure, specialists make a cut in the scrotum and remove the testes. The doctor may remove either or both testes depending on how much he wants to limit testosterone production. This procedure is usually done in patients with prostate or breast cancer. 
2. Subcapsular Orchidectomy - This procedure is also performed by making a cut in the scrotum. But unlike the above procedure, only the tissues around the testes are removed here. The scrotum retains its shape and shows no outward signs of removal of the testes.
3. Radical Orchidectomy - Doctors remove either or both testes through a cut in the lower part of the abdomen. This is done when the specialists have observed a lump in the scrotum and suspect testicular cancer. In this procedure, the testes and the spermatic cord are removed.

1. A urologist performs this operation in an operation theatre.
2. Assistants make the patients lie on their backs for the operation.
3. General or local anaesthesia is administered as recommended.
4. The area between the nipple line and mid-thighs is cleaned with an antiseptic solution.
5. A cloth is draped over the area to isolate it. 

Simple & Subcapsular Orchidectomy

1. The patient's penis is taped to the abdomen to access the operating area.
2. Specialists make an incision at the midpoint in the scrotal skin and cut through other layers.
3. A blunt dissection helps separate the testes from the scrotal skin.
4. The testis is removed through the incision made in the scrotum. 
5. The surgeon closes each layer with sutures and dresses the wound to prevent infection. 
6. In case it has been agreed upon earlier, a prosthetic testis is placed before closing the incisions. 

Radical Orchidectomy

1. As with the other two procedures, anaesthesia is given as recommended.
2. In this type of operation, the incision is made in the groin area.
3. All the layers below the skin are cut, taking care not to cut any nerve.
4. The testes and the spermatic cords are removed through the incision.
5. Surgeons clean the area with saline solution before closing the different layers with sutures.
6. Doctors use sterilised gauze to dress the area and bandage it. 

No surgery is performed without much planning and taking the necessary precautions. Doctors must know the patient's history and present condition before operating upon him. Depending on the reason for performing the orchidectomy, specialists advise patients to take some medicines or go on a diet. Those undergoing sex-change surgery are given hormones that they must take for a certain time period before the procedure. 

1. Blood and urine tests are conducted to assess the patient's health.
2. Doctors also prescribe chest X-rays and electrocardiogram tests before the surgery.
3. Patients taking blood-thinning medicines are asked to stop a few days before the operation to reduce the chances of bleeding. 
4. Specialists generally ask patients to reduce or stop smoking for a few days before surgery to facilitate faster recovery after the operation. 
5. The surgeon explains the procedure to the patient and also tells him what to expect after the surgery. 
6. Doctors give the option of storing their sperm for those undergoing sex-change operations if they want to father a child later. 
7. The patients are advised not to eat or drink anything from 8 to 10 hours before the operation.
8. Specialists prescribe medicines to some patients to ensure good sleep the night before. 

1. The patient and relatives must sign consent forms for the surgery.
2. Tests are conducted to ensure that the patient is ready for the operation.
3. All jewellery, dentures and other accessories are removed.
4. The area of the operation is cleaned, and hair is removed from the area.
5. Patients wear operation theatre gowns before the procedure.
6. Nurses place the patient on a stretcher and wheel him into the operation theatre.
7. Simple and subcapsular orchidectomy takes about 30 minutes to perform.
8. Radical orchidectomy takes about an hour to complete. 

1. Nurses shift the patient from the stretcher to the operating table.
2. The patient is connected to machines to monitor vital signs.
3. Anaesthetists administer general or local anaesthesia as may be the case.
4. Doctors monitor the vital signs of the patient throughout the procedure.
5. The site of the incision is cleaned and draped to prevent infection.
6. After confirming that the patient is fully anaesthetized, the doctor performs the surgery.

Recovery At Hospital

1. Patients are shifted to the recovery room.
2. If general anaesthesia is given people take some time before coming to their full senses.
3. The patient feels drowsy even if he wakes up. It is normal with general anaesthesia.
4. The patient is checked for vital signs.
5. Nurses check the dressing to see if there is any bleeding.
6. Painkillers are given to patients as they are likely to feel slight pain in the area.
7. Even if the patient feels very thirsty, only small sips of water are given. This is to prevent vomiting.
8. Patients get liquid food after they pass gas. IV fluids are administered till such time.
9. Doctors discharge the patients after ensuring there are no complications.
10. Diet and medication are advised to ensure complete recovery.

Post-Surgical Care At Home

1. Doctors advise patients to wear scrotal support for the first 48 hours after surgery or wear snug underwear for a few days to manage the swelling.
2. Keeping an ice pack or cold compress helps in containing the swelling. However, one must take care not to keep them for more than 15 minutes.
3. If the swelling is excessive, it is wise to visit the doctor. 
4. Patients may need to skip bathing till the cut heals.
5. Sutures are normally absorbed and don't need to be removed. If staples are used, doctors tell patients when to visit to remove them.
6. One must check the wound to see if there is an infection. Doctors inform patients how to do this.
7. Those who have undergone surgery must avoid hard physical work for a few weeks. They must also avoid sex during this period. 
8. Patients must strictly follow doctors' prescriptions and take medication regularly.
9. Take high-fibre food to have regular and easy bowel movements. 
10. Removal of the testes can greatly reduce sex drive due to reduction in the hormone levels.

Follow Up Visits

1. In case removal of sutures or staples is required, doctors inform when the patient must visit.
2. Those who underwent the operation for testicular cancer must regularly visit the doctor and continue the medication/treatment recommended. 
3. Patients must consult their doctor about the continuation of medicines after the prescribed medication is over.

When To Call The Doctor

1. In case of severe pain or fever. 
2. Symptoms like hot flashes, fatigue, loss of fertility or depression can be due to a drop in hormone levels. It is wise to consult the doctor with regard to taking hormone supplements. 
3. A loose feeling in the scrotum  
4. If pus or blood is found coming out of the wound
5. If there is pain or redness around the incision.
6. Inability to urinate
7. If there are purple spots or loss of feeling in the scrotum.