What is radical orchiectomy
Radical orchiectomy is the surgical removal of a testicle, which is most often performed on patients with testicular cancer.

Radical orchiectomy is the surgical removal of a testicle.

  • It is mostly used to treat testicular cancer.
  • It could be required if a testicle has been seriously damaged by illness, infection, or injury.
  • An orchiectomy is a treatment option in patients with prostate cancer treatment.

However, in most patients, a radical inguinal or radical orchiectomy is done to remove a cancerous testicle. This procedure involves the removal of the:

  • Testis
  • Epididymis
  • Spermatic cord

Radical orchiectomy surgery often involves the removal of malignancy from the testicular area, most commonly germ cell tumors.

What is the procedure for radical orchiectomy?

Before the procedure

  • The patient may be evaluated for fitness for anesthesia before surgery, which is also called pre-operative assessment.
  • Some blood tests, including tumor markers, blood pressure, and a chest X-ray will be performed. An electrocardiogram may be performed to rule out any cardiac conditions the patient may have.
  • The patient will be asked not to eat or drink 8 to 12 hours before surgery.
  • The patient may be asked if they want to have a prosthesis (a false testicle) fitted at this time. This could be done in the future.

Procedure

  • Radial orchiectomy may be performed as an outpatient procedure or the patient may be asked to stay for a few days in the hospital. The surgery takes about an hour and is performed under general anesthesia.
  • The testicle is carefully removed from the scrotum through a surgical incision created slightly above the pubic region.
  • The entire tumor, as well as the testicle and spermatic cord, is then removed by the surgeon.
  • The spermatic cord comprises a portion of the vas deferens, as well as blood and lymph vessels, which could serve as paths for testicular cancer to spread throughout the body.
  • To reduce the likelihood of this happening, these vessels are tied off early in the procedure.
  • After surgery, the incision is stitched or stapled. These may require removal by a doctor later.

Recovery after radical orchiectomy

  • The patient will be transferred to the recovery room and will be monitored until they are ready to go.
  • An ice pack can be applied to the surgical site. This reduces swelling.
  • In addition, the patient may be provided a jockstrap to wear. This reduces pain and swelling and prevents harm.
  • The patient is observed in the recovery area following the treatment and is discharged home the same day.
  • Generally, mild discomfort can be relieved with over-the-counter pain relievers, such as ibuprofen or Tylenol. This medication will alleviate swelling and pain.
  • Take care and follow the guidelines of the doctor.
  • During the recuperation period:
    • Continue using the cold pack for three days or until the swelling subsides.
    • Take pain relievers as indicated.
    • Take care of the incision as directed. Check the incision for symptoms of infection daily.
    • Do not engage in vigorous exercise or physical activities.
    • Most patients recover from surgery within four to six weeks after surgery.

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What are the risks and complications of radical orchiectomy?

Follow-up visits will be scheduled so that the doctor can monitor progress. Stitches or staples will need to be removed. The doctor might discuss any additional treatments one may require. Every procedure has its risks and complication.

7 risks of radical orchiectomy

  1. Bleeding (may require a blood transfusion)
  2. Infection
  3. Damage to nearby nerves, blood vessels, soft tissues, and organs
  4. Infertility (typically in bilateral orchiectomy where both testicles are removed)
  5. Changes in hormone levels
  6. Cancer comes back or it spreads
  7. Risks of anesthesia

8 complications of radical orchiectomy

  1. Gynecomastia (male breast enlargement)
  2. Decreased libido and erection problems
  3. Loss of muscle mass
  4. Osteoporosis
  5. Hot flashes
  6. Sterility
  7. Mood swings or depression
  8. Fatigue

In most cases, orchiectomy does not cause long-term sexual side effects or infertility though it may exacerbate these issues if they existed before surgery.

A man's quality of life should not suffer if they have one healthy testicle. Men who do not have one normally functioning testicle following orchiectomy will require hormone therapy to meet the body's testosterone requirements.

Some patients opt for prosthetic testicles. Artificial testicles are placed in the scrotum after orchiectomy to maintain the natural appearance of the genitals. Talk to the doctor before surgery to clarify any concerns.

When to seek help following a radical orchiectomy

Call the doctor immediately if any of the following is present:

  • Fever of 100.4°F or higher
  • Symptoms of infection at the incision site, such as redness, swelling, warmth, worsening pain, and bad smell
  • Bleeding or pus discharge from the incision site
  • Chest pain
  • Trouble breathing

What is the outcome after radical orchiectomy?

Orchiectomy has high cure rates for malignant testicular tumors.

In certain circumstances, orchiectomy is followed by additional surgery to remove disseminated cancer or other therapies, such as chemotherapy or radiation therapy. In some cases of early-stage testicular cancer, orchiectomy is the only treatment required.

  • Post-procedure, the doctor closely monitors the patient using checkups and testing but does not use medical treatment.
  • Testicular cancer is a treatable type of cancer, especially if detected and treated early. Orchiectomy is critical to the successful treatment of this condition and provides the highest possibility of cure.
  • If cancer has migrated to other organs, such as the lungs and lymph nodes in the abdomen, a course of chemotherapy or radiotherapy is suggested, and this will be discussed during the appointment.

Having a testicle removed might have an impact on self-esteem, therefore t may be beneficial to consult with a mental health professional before or after surgery.

  • A prosthetic testicle (prosthesis) can be implanted during surgery or later in some situations.
  • Having a testicle removed may interfere with fertility particularly if both testicles are removed. If the patient wishes to have children, they may store sperm before surgery as a precaution.

Discuss with the doctor regarding all advantages and disadvantages before surgery.

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Medically Reviewed on 4/5/2022
References
Image Source: iStock Images

Johns Hopkins Medicine. Radical Orchiectomy. https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/radical-orchiectomy

Papanikolaou F. Radical Orchiectomy. Medscape. https://emedicine.medscape.com/article/449033-overview

Fairview Health. Radical Orchiectomy. https://www.fairview.org/Patient-Education/Articles/English/r/a/d/i/c/Radical_Orchiectomy_41073