Orchidectomy Unilateral

Unilateral orchidectomy surgery

What is Unilateral Orchidectomy?

A unilateral orchidectomy is a surgery involving the removal of a single testicle.  It is generally done to treat:

• Testicular cancer
• Torsion of non-viable testis.
• Severe trauma
• Atrophy or chronic infection.
• Undescended testis (rare instances)
• In some circumstances, gender-affirming surgery (GAS)

Unilateral Orchidectomy is used for the following Indications

The procedure can be prescribed by physicians for:

• The testicle has a mass which is suspected or proven to be cancerous.
• Long-torsion has caused death of the testicle.
• The testicular injury is severe.
• Chronic pain that is non-treatable.
• Some of the conditions require hormone regulation.

Radical inguinal unilateral orchidectomy

Radical unilateral inguinal orchidectomy refers to a surgical removal of a whole gonad and the complete spermatic cord using an incision in the groin (inguinal region). It is the initial first-line therapy of the suspected or confirmed testicular cancer in the form of gold-standard. Such a solution inhibits the proliferation of cancer cells and enables an adequate staging.

Indications

Radical inguinal orchidectomy is done in case of:

• Seasonal fever with no reported acute lymphoblastic anemia or thyroid Enlargement (possibly malignant)
• Ultrasound testicular tumour confirmed.
• Suspicious intra-testicular mass.
• Massive Testicular atrophy.
• In benign though complicated lesions of the testicles, rarely.

Why Inguinal Route?

Scrotal incision is excluded due to the following reasons:

• It minimises chances of tumour seeding.
• Maintains the proper lymphatics drainage channels.
• Permits competent testis and spermatic cord excision to the inner inguinal ring.
• Such a method is necessary to phase the staging correctly and minimize repetition.

Unilateral orchidectomy procedure

Anaesthesia

• General anaesthesia is administered to the patient (the most common one).
• Spinal anaesthesia can be applied in few benign cases.

Patient Positioning

• Patient is lying in a supine position.
• Sterilization of lower abdomen, groin, and scrotum.

Surgical Incision

This incision is based on the surgical objective:

• Inguinal incision (cancer -radical orchidectomy)
• The groin (inguinal) area is cut 5-7 cm.
• Its inguinal canal is cut, and the testis and the cord of life are reached.
• Simple orchidectomy (as in benign conditions) Scrotal incision.
• An incision made oblique on the scrotal skin.
• Typically used with torsion, necrosis or infection, but not cancer.

Delivery of the Testicle

• The surgeon carefully mobilizes and moves the affected testicle to the incision.
• The structures around an area are evaluated.

Surgical Spermatic Cord Control and Ligation

To perform radical orchidectomy (cancer):

• Clamping and ligation of the spermatic cord takes place high above the internal inguinal ring.
• This avoids the spread of tumours and the tumours are removed completely.

For simple orchidectomy:

• Cord is tied downwards, around the scrotum.

Removal of Testicle (En Bloc)

• The removed part is the testicle, epididymis and the spermatic cord segment that is attached to it.
• The specimen is put in the sterile container.

Histopathology 

• Very important in determining the type of tumour, grade, stage, or pathological basis.

Repair and Closure

• Inguinal canal is sutured (in case opened).
• Tight skin with non-absorbable/absorbable sutures.
• A dressing is applied.

Duration of Surgery

• Typically 30–45 minutes.
• May add in case reconstruction or exploration was required.

Post-Operative Care

• Opioid treatment of pain.
• Ice packs for swelling
• Supportive underwear
• Do not move on to heavy lifting during 4-6 weeks.
• Dressing care and hygiene
• Follow-up for biopsy report

Unilateral Orchidectomy for Testicular Cancer

What Happens during a Unilateral Orchidectomy for testicular cancer? 

• The normal first line of treatment of testicular cancer is a unilateral radical inguinal orchidectomy.
• It consists of the excision of one testicle and the spermatic cord in an inguinal (groin) incision.

This surgery is able to achieve two things:

• Definitive treatment- eliminates the initial tumour.
• Staging tool- this offers tissue to the pathology to direct further treatment.

Indications

Unilateral orchidectomy Planned when:

• On ultrasound, a solid intratesticular mass is observed.
• Tumour markers (AFP, 8 -hCG, LDH) are increased.
• There is a high level of suspicion of cancer.
• The biopsy is not advised before removal (to prevent tumour diffusion).

Why the Inguinal Approach?

The removal of the testicle is done via the groin rather than the scrotum due to the following reasons:

• Prevents tumour cell spread
• Has healthy lymphatic drainage.
• Makes the testis and spermatic cord absolutely removed (high ligation)
• It is the method of adequate treatment of cancer.

Best hospital for unilateral orchidectomy India

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

Recovery after unilateral orchidectomy

Hospital Stay:

• Usually same-day discharge
• Overnight observation may be done once in a case where the surgery was late or where the patient has cancer and needs to be monitored.

Pain & Swelling:

• Aches ranging from mild to moderate, typically lasting for 2-3 days and can be treated just by taking some painkillers.
• Scrotal bruising or swelling can last for 1-2 weeks.
• Ice packs wrapped in a cloth: Apply 10-15 minutes 2 to 3 times per day. 

Wound Care:

• Maintain a clean and dry groin incision.
• Do not keep the wound wet in 48 hours.
• Thereafter, normal shower (no 2 weeks in tubs)
• Wear tight supportive underwear to minimize scrotal motion.

Activity & Restrictions:

First 48 hours

• Rest, short walks indoors
• Standing: do not remain all the time.

1 week

• Light household work
• No heavy work or stooping.
• Do not use stairs several times.

2–3 weeks

• Is able to resume work in the office or other non-strenuous jobs.
• Light physical activity such as slow walking.

4–6 weeks

• Restart physical exercise.
• Sports, gym, running and cycling with medical clearance.

Sexual activity:

• These should be resumed after 3-4 weeks, or once the pain has subsided.
• With a single, healthy testicle, erection, libido and sexual functioning are normal.

Driving:

You can drive once:

• ou are on hard pain killers.
• Movement of the leg is easy and fast response.
• Usually 5–7 days after surgery

Diet:

• Normal diet unless otherwise.
• Constipation is prevented by high-fiber and well-watered diet (this is important postoperatively) 

Follow-up Appointments:

• Initial follow-up: 5-7 days post-op. Review of pathology report and tumour markers: 1-2 weeks.

For cancer cases:

• CT scans
• Tumour marker check-up after every few months.

Conclusion

Unilateral orchidectomy is a safe, effective and widely done surgery which is employed to treat diseases of one testicle, particularly when there is testicular cancer, testicular torsion, testicular trauma, or severe testicular atrophy. The procedure offers certain treatment, as well as, exact diagnosis in the event of cancer suspicion, and great long-term results. The recovery is normally easy, even the majority of patients are back to regular activities in 46 weeks and have no serious hormonal and sexual dysfunction. Fertility and testosterone are normally held with one healthy testicle.

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FAQ

Will I need to worry about losing sexual function after surgery?

• No. Most men have normal libido, erections and sexual function with only one good testicle.

Can I have children after surgery?

• Yes. Fertility is preserved.
• Sperm banking is advised preoperatively in case you want children, particularly for malignancy.

Do I need to get a testicular implant?

• Optional prosthetic testicle may also be inserted at a later date.
• It gives a cosmetic look of completeness in the scrotum.

Do I need hormone replacement?

• Rare, because the other testicle typically makes enough testosterone
• Elsewhere in the body, hormone replacement therapy may be necessary if the other testis is non-functional.

Can cancer come back in the other testis?

• Your risk is low, but regular self-examination and follow-up still matter
• Early detection allows for early treatment, should it develop.