Whatis orchedectomy
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Orchiectomy (Orchidectomy)
Orchiectomy (also written as orchidectomy or colloquially "orchedectomy") is the surgical removal of one or both testicles. It is one of the most common urological procedures with several distinct types depending on the indication.
Types of Orchiectomy
1. Radical (Inguinal) Orchiectomy
This is the standard procedure when testicular malignancy is suspected. It is both diagnostic and therapeutic.
- Approach: Inguinal incision (groin), NOT scrotal - this prevents disruption of lymphatic drainage
- What is removed: The entire ipsilateral testis, epididymis, and spermatic cord up to the level of the internal inguinal ring
- Technique: A 3-5 cm transverse inguinal incision is made; the external oblique fascia is opened; the spermatic cord is clamped early (before handling the tumor) to prevent tumor cell spread; the cord is then doubly ligated and divided at the internal inguinal ring
- Key principle: Early vascular control of the spermatic cord before tumor manipulation minimizes hematogenous dissemination
- Campbell-Walsh-Wein Urology, p. 2283
2. Simple Orchiectomy
Removal of one or both testicles via a scrotal or subinguinal approach.
Indications:
- Bilateral: Achieving castrate testosterone levels in metastatic prostate cancer (surgical androgen deprivation therapy / surgical castration)
- Unilateral: Infected testicle refractory to antibiotics; non-viable testicle (testicular torsion or trauma)
- Chronic orchialgia (last resort, lacking level-1 evidence)
Approach: Single vertical midline or transverse scrotal incision; the testis is delivered and the spermatic cord divided in two bundles (vas deferens and vascular bundle), each doubly ligated with absorbable suture.
- Hinman's Atlas of Urologic Surgery, p. 1174
Prostate cancer context: Surgical castration (bilateral simple orchiectomy) has shown a lower rate of PSA rebound, better tumor-progression-free survival, and better overall survival compared to LHRH agonists in retrospective studies. It also causes less gynecomastia (9.7% vs. 24.9%) and lower cost than medical castration - Campbell-Walsh-Wein Urology, p. 934
3. Partial Orchiectomy
- Reserved for select patients where the contralateral testicle is absent or compromised
- Criteria: polar tumor, ≤2 cm in size
- Goal: preserve testicular function while removing the tumor
4. Delayed Orchiectomy
- For patients with advanced metastatic GCT who require urgent chemotherapy before surgery
- Recommended for all such patients after completing chemotherapy, regardless of response elsewhere, because the testis often responds differently (discordantly) to systemic therapy
5. Epididymis-Sparing Orchiectomy
- A variant of simple orchiectomy where the epididymis is preserved
- Maintains a palpable scrotal mass, improving body image and patient satisfaction
- Requires an operating microscope; associated with slightly higher bleeding risk
- Used mainly in bilateral orchiectomy for prostate cancer to preserve scrotal contour
Indications Summary
| Indication | Type |
|---|---|
| Suspected testicular cancer | Radical inguinal orchiectomy |
| Metastatic prostate cancer (castration) | Bilateral simple orchiectomy |
| Testicular torsion / trauma (non-viable testis) | Simple unilateral orchiectomy |
| Severe testicular infection (refractory) | Simple unilateral orchiectomy |
| Chronic orchialgia (last resort) | Simple orchiectomy (inguinal preferred) |
Post-Orchiectomy Assessment (for testicular cancer)
After radical orchiectomy, clinical staging is based on:
- Pathology of the removed specimen (histological type - seminoma vs. NSGCT)
- CT scan of abdomen/pelvis (retroperitoneal lymph nodes)
- Serum tumor markers post-operatively: AFP (alpha-fetoprotein), beta-hCG, and LDH - trends guide further management
For stage I seminoma, about 15% harbor subclinical retroperitoneal metastases and may relapse after orchiectomy alone. Options include surveillance, adjuvant carboplatin, or para-aortic radiotherapy.
Anesthesia Options
- Regional spermatic cord block
- Conscious sedation
- Spinal or general anesthesia
Sources: Hinman's Atlas of Urologic Surgery; Campbell-Walsh-Wein Urology (3-Volume Set); Bailey and Love's Short Practice of Surgery, 28th Edition
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