Orchidectomy Bilateral

Bilateral orchidectomy surgery

Bilateral orchidectomy is the excision of both the testicles. It is done in the case of conditions like:

• Mature cancer of the prostate (to lower testosterone)
• Two testes tumors are present.
• Trauma or sepsis 
• Gender affirming surgery (male to female).

This surgery dramatically decreases androgen (testosterone) production, and this can have far-reaching effects.

Bilateral Orchidectomy types

Simple Bilateral Orchidectomy:

• Excision of testicles through an incision in the scrotum. 
• Usually applied in the management of hormones in prostate cancer.

Subcapsular orchidectomy (SCO) Bilateral:   

• The testicular tissue is removed but the tunica albuginea is left intact for cosmetic reasons. 
• This is often used in prostate cancer to be able to retain the appearance of the scrotum.

Radical Bilateral Orchidectomy:

• Applied in cases of testicular cancer in both testes.
• Involves the removal of testicles and spermatic cords with additional tissue on some occasions.

Bilateral radical orchidectomy procedure

Preparation before Surgery

Evaluation:

• Physical examinations
• Blood tests
• Sperm banking and fertility advice available on request. 

Anaesthesia:

• Usually general anaesthesia.
• Consent and Counselling
• Potential for ongoing infertility and hormone deficiency with a need for hormone replacement. 

Surgical Steps

Positioning:

• The patient is laid on his back on the operating table.
• Scrotal region is sanitized and cleaned.

Inguinal Incision:

• An incision is made transversely and obliquely across the scrotum.
• The incision is avoided in the scrotum to minimize chances of spreading the tumor.

Exposure of Spermatic Cord:

• The spermatic cord is then ripped out.
• Cord is cut and laced high above the internal inguinal ring to eliminate any possible tumor expansion.

Removal of Testicle:

• Removal is performed together with testicle and epididymis along with spermatic cord.
• Special care is taken not to violate tunica albuginea, which will cause tumor seeding.

Specimen Handling:

• Histopathology is ordered on testicular specimen.

Hemostasis and Closure:

• Slow bleeding, stump of the cord tied.
• Incision closed in layers.
• Scrotum can be drained or loosely packed.

Repeat on Anti lateral Side:

• Same actions done to the second testicle in bilateral cases.

Postoperative Care

• Hospitalization: 1-2 hours in case of uncomplicated.
• Pain Control: Narcotics and scrotal support.
• Activity: Not to lift heavy in 2-4 weeks or 4 weeks.

Follow-up:

• Testosterone (monitoring hormones).
• Tumor markers, imaging (cancer surveillance).
• Hormone Replacement: Administration is needed in case both testes have been removed (testosterone therapy).

Bilateral orchidectomy for prostate cancer

Bilateral orchidectomy prostate cancer is the surgical deactivation of both testes to lower the levels of testosterone that contribute to the development of androgen-sensitive prostate cancer. It is a treatment of androgen deprivation therapy (ADT).

Bilateral orchidectomy indications

In bilateral orchidectomy both the testes are removed and the testosterone is permanently reduced. It is pointed out under the following conditions:

Prostate Cancer

• Prostate cancer which is sensitive to androgens and is advanced or metastatic in nature.
• Used as androgen deprivation therapy (ADT) to reduce the growth of tumor.

Indicated when:

• It is impossible to use medical hormone therapy.
• Suppression of testosterone is necessary soon.
• Patient would like to have a single surgical solution.

Testicular Cancer

• Bilateral tumors of the testes or risky tumors in the two testes.
• Radical orchidectomy is done to eliminate any occurrence by removing testes and spermatic cords.

Indicated in:

• Germ cell tumors
• Testicular cancer in both testes at an advanced stage.

Testicular Infection or Trauma of a Severe Type

Irreversible damage of testicles due to:

• Trauma (e.g., crush injury)
• Which type of headache? (e.g. severe infection e.g. necrotizing orchitis)
• If there is no possibility of testicular salvage, a bilateral orchidectomy may be required.

Gender-Affirming Surgery

• Gender-affirming surgery (MTF).
• Hysterectomy of testis to decrease testosterone levels and encourage feminizing hormone therapy. 

Hormonal Disorders

Uncommon hormone-sensitive disease necessitating testosterone suppression including:

• Extreme refractory hyperandrogenism.
• Some testosterone-influenced metastatic cancers.

Best hospital for bilateral orchidectomy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Bilateral orchidectomy recovery

The process of recovery is subject to the nature of orchidectomy (simple, subcapsular or radical) and the health condition of the patient. The average length of stay in the hospital and a slow process of resuming normal activities are to be expected by most patients.

First 0 to 48 hours after surgery

• Hospitalization: Typically same day discharge or observation 1 night.
• Pain management: Mild to moderate pain: This is often managed through the oral analgesic.

Wound care:

• Dressing of the scrotum; may be taken down after 24-48 hours.
• Tight-fitting underwear or scrotal support suggested minimizing swelling.
• Observations: Bleeding, hematoma, or infection.

First Week

• Swelling and bruising: not enlarged; can take 1-2 weeks to resolve.
• Hygiene: Clean and dry incision. The use of light showering is normally permitted 48 hours later.

Activity:

• Rest is important.
• Should avoid heavy lifting, sexual activity, or strenuous activity.
• Diet: Return to normal diet unless otherwise prescribed.

Weeks 2–4

• Healing of incisions: Sutures (when not absorbable) can be taken out at 714 days.
• Activity: Stage wise resume of everyday activity; moderate exercise may commence.
• Follow-up: Entering the first postoperative appointment to examine healing and prostate hormone levels and discuss prosthesis (where appropriate).

Long-term (Post 4 Weeks) Recovery

Hormonal effects:

Testosterone falls right after surgery; may cause:

• Fatigue
• Reduced libido
• Hot flashes
• Muscle loss
• Testosterone replacement therapy can be used as a possible symptom treatment (except in prostate cancer).
• Psychological adaptation: Body image, mood changes or sexual functionality may be addressed with the aid of counselling.
• Fertility: Infertility has a permanent effect; if one desires to have children; sperm banking is recommended prior to surgery. 

Conclusion

A bilateral orchidectomy is a total surgical procedure that removes both testicles and is most often performed because of:

• High-risk or metastatic prostate cancer (as androgen deprivation therapy) 
• Tumors of the testicles.
• Radical testicular trauma or infection.
• Gender-affirming surgery

The process is successful in lowering the level of testosterone, which slows the rate of hormone-sensitive diseases. The recovery is typically within the 2 -4 week range and most patients would resume their daily routines but recovery has lasting effects which include:

• Infertility
• Hormonal deficiency (resulting in low libido, tiredness, and loss of muscle). 
• Body image psychological impact.

Bilateral orchidectomy is a safe, effective and cost-effective intervention that can be used successfully with proper preoperative counselling, surgical management and support to patients who need prolonged testosterone suppression or malignant testes removal.

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FAQ

Is it performed in general anaesthesia?

• Yes, general or spinal anaesthesia. There can be some basic ones that can be performed under local and with sedation.

Can I get infertile due to the surgery?

• And both testes were removed, which results in permanent infertility. Sperm banking is to be viewed as a preoperative matter.

Can I have testicular implant?

• Prosthetic testicles can indeed be implanted to use as cosmetics in the course of an operation or after.

Should I have hormone therapy following surgery?

• Yes, except in prostate cancer when it is wanted that testosterone is suppressed. In other cases, hormone replacement is advised as a way of managing the symptoms.

Is this surgery reversible?

• No, both testes are removed permanently.