Orchiectomy

Definition

Orchiectomy is a surgical procedure to remove one or both testes in men with prostate or testicular cancer .

Purpose

In men who have prostate cancer , an orchiectomy, up until the 1990s, was considered the standard treatment. By removal of the testes, the influence of testosterone , the male hormone produced by the testes, is removed. Testosterone stimulates prostate cancer growth and progression of the disease.

Orchiectomy is done in men with testicular cancer to remove one or both testes that have cancer. By removing the cancerous testes, there will then be zero chance that the cancer can recur in the testes.

Precautions

The orchiectomy operation is generally a very basic and safe operation. As in any surgery, some bleeding will be expected, so men should not be taking any medications like aspirin or ibuprofen that could decrease their blood's ability to clot.

Description

An orchiectomy usually takes place in a hospital setting, either in an outpatient surgery clinic or in the hospital itself. General presurgery procedures, such as blood work, are done a few days to a week before the procedure.

To make sure a patient having an orchiectomy doesn't suffer any pain, anesthetic will be used during the procedure. Generally, two types of anesthetic are used during an orchiectomy: general anesthesia and epidural anesthesia. General anesthesia causes the patient to go into a sleeplike state. With epidural anesthesia, the patient is awake but is totally numb from the waist down and therefore cannot feel the operation.

Once the patient is adequately anesthetized, the surgeon will make a four-inch incision through the lower abdomen. After the incision in the lower abdomen is made, the surgeon will gently push the testicles up through the inguinal canal and out through the incision.

The orchiectomy operation generally takes only 45 minutes to an hour. Patients either stay overnight in the hospital or are discharged from the hospital the same day if there appear to be no complications. Pain from the surgery is usually mild to moderate; narcotic pain medications can control the pain for most patients.

Preparation

There are no specific preparations for having an orchiectomy versus any other type of surgery. Blood will be taken before the surgery to check for infections or other contraindications to surgery. Patients are also advised not to take any medications such as aspirin or ibuprofen that may interfere with the blood's clotting ability.

Aftercare

For approximately two to four weeks or even longer, patients are advised not to participate in any strenuous physical activity. Pain in the scrotum and abdominal area may persist for days to weeks. The surgical wound site should be kept clean and dry. It should also be watched for any signs of infection, such as an increase in pain, unusual redness or swelling, or a foul-smelling discharge.

Risks

The risks of orchiectomy include general surgical risks such as pain, bleeding, and infection. In rare cases more serious complications could develop, including abscess formation and bladder damage.

Normal results

The goal of an orchiectomy is to remove the testicles without undue damage to any other organs or structures. For testicular cancer, the end result is to remove the cancerous testicle and cure the cancer. For prostate cancer, the end result is to remove the testicles to shut down the synthesis of testosterone, which is known to promote prostate cancer growth.

Abnormal results

Abnormal results of an orchiectomy can include incomplete removal of the testicles. In the case of both testicular cancer and prostate cancer, this could result in the progression of the cancer.

Books

Abeloff, Martin D., James O. Armitage, Allen S. Lichter, and John E. Niederhuber. Clinical Oncology. New York: Churchill Livingstone, 2000.

PERIODICALS

Garnick, Marc B., and Mario Eisenberger. "Hormonal Treatment of Prostate Cancer." The New England Journal of Medicine. 340 (1999): 812-4.

OTHER

The TCRC Orchiectomy Page. 17 July 2001 <http://www.acor.org/TCRC/orch.html>.

Edward R. Rosick, D.O., M.P.H.

KEY TERMS

Testes

— The male sex organs that produce sperm and male sex hormones.

Inguinal canal

— A pair of internal openings that connect the abdominal cavity with the scrotum in the male fetus, allowing for the developing testes to decend into the scrotal sac.