Background Information:

What are the other Names for the Procedure?

• Orchiectomy

What is Testicle Removal surgical procedure?

The Testicle Removal (Orchiectomy) procedure involves the surgical removal of one or both the testicles.

What part of the Body does the Procedure involve?

A Testicle Removal procedure involves the scrotum, the testicle(s), the spermatic cord, vas deferens, related nerves and blood vessels.

Why is the Testicle Removal surgical procedure Performed?

• The Testicle Removal procedure is performed as an aspect of a definitive treatment of testicular, prostate, or male breast cancer.
• All of these cancers are testosterone-dependent (hormone released from the testicle); the testicles are responsible for the production of testosterone
• Thus, removing the testicle(s) reduces the hormone production, thereby reducing the effects of the tumor and metastasis.
• It is also performed in cases of gender change or reassignment and testicular necrosis (due to decreased blood flow following untreated torsion testis)

What are some Alternative Choices for the Procedure?

Hormonal pills or injections could be taken as an alternative to the Testicle Removal procedure. It has a temporary effect as compared to the procedure, and all the side effects may be reversed.

What are the Recent Advances in the Procedure?

Orchiectomy (Testicle Removal) is the gold standard treatment for the conditions mentioned above.

What is the Cost of performing the Testicle Removal surgical procedure?

The cost of Orchiectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Testicle Removal surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgeryencyclopedia.com/La-Pa/Orchiectomy.html#b (accessed on May 18, 2014)

http://www.tc-cancer.com/orch.html (accessed on May 18, 2014)

Prior to Testicle Removal surgical procedure:

How is the Testicle Removal surgical procedure Performed?

There are 3 types of Orchiectomy procedure:

• Simple Orchiectomy:
  • It is performed for gender change as well as palliative treatment for advanced cancer
  • An incision is made in the mid-point of the scrotum and the surgeon cuts through the underlying tissue
  • The testicle and parts of the spermatic cord are removed through the incision, and it is closed with the help of sutures and covered with a dressing
  • A prosthetic testicle can be inserted to give the appearance of a normal scrotum
• Subcapular Orchiectomy:
  • It is performed in the treatment of prostate cancer
  • It is similar to the above method except that in this procedure the glandular tissue is removed from the lining of each testicle, rather than removing the entire testicle itself
  • This method keeps the appearance of the scrotum normal   
• Inguinal Orchiectomy:
  • It is also called Radical Orchiectomy and is performed, when testicular cancer is suspected. It can be performed on either one or both the testicles
  • An incision is made in the groin area, the testicle as well as the entire spermatic cord is removed (testicular cancer spreads to the kidneys via the spermatic cord)
  • The different layers of skin are then sutured back and the wound is covered with appropriate dressing

Where is the Procedure Performed?

The Testicle Removal procedure is generally performed in the surgical facility of a hospital.

Who Performs the Procedure?

An urologist or a general surgeon performs the Testicle Removal surgical procedure.

How long will the Procedure take?

The Testicle Removal procedure takes about 45mins to 1 hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Testicle Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Testicle Removal surgical procedure?

The following tests are required by the physician before the Testicle Removal procedure:

• X-rays
• CT scan
• Ultrasound scan
• ECG
• Routine blood tests
• Routine urine examination

The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Testicle Removal procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How many such procedures have you (the physician) performed?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Testicle Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

A local or spinal anesthesia may be injected, or a general anesthesia may be injected and inhaled with an airway tube, placed in the windpipe.

How much Blood will you lose, during the Procedure?

The blood loss during the surgery is minimal; about 5ml or less. No transfusion is required, unless any complications arise.

What are the possible Risks and Complications during the Testicle Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Inadvertent injury to other parts
• Infection
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Testicle Removal surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Testicle Removal surgical procedure:

What are the possible Risks and Complications after the Testicle Removal surgical procedure?

Post Orchiectomy (Testicle Removal) procedure, the following complications may arise:

• Surgical wound infection
• Urinary retention
• Recurrence of the cancer
• Mood swings, depression
• Weight gain
• Sterility, loss of sexual interest, erection problems
• Hot flashes
• Thin or brittle bones
• Loss of muscle mass
• Pain, discomfort
• Need for further procedures

What is the Prognosis after the Surgery?

The Testicle Removal procedure helps reduce the tumor size and reduce bone pain. However it does not cure prostate cancer, though it may prolong survival.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Any signs of infection
• Discomfort or difficult in urination
• Nausea or vomiting
• Fever or dizziness
• Headache, muscle ache, or pain
• Pain, redness, or swelling

What Post-Operative Care is needed at Home after the Testicle Removal surgical procedure?

At home, the following post-operative care is recommended, after a Testicle Removal procedure:

• No vigorous activities for 6 weeks after the surgery
• Apply ice packs for the first 24 hours after surgery; use a heating pad after that to relieve pain and prevent swelling
• Wear an athletic support (jock strap) for 4-6 weeks
• Take antibiotics as prescribed by the physician and laxatives to prevent constipation
• Resume other activities, per physician’s advice

How long does it normally take to fully recover, from the Procedure?

It takes about 3-6 weeks for a complete recovery from the Testicle Removal surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Testicle Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• The urologist or general surgeon
• An anesthesiologist (if anesthesia was administered)
• A radiologist (if radiological tests were performed during the procedure)

Individuals are advised to inquire and confirm the type of billing, before the Testicle Removal (Orchiectomy) surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA