Orchidectomy
Figure 1: Radical Orchidectomy.
What are the indications for a radical orchidectomy?
A radical orchidectomy is indicated in the management of a suspected testicular tumour. A testicular tumour should be suspected in any patient with the physical findings of a painless, firm, and irregular mass arising from the testicle.
If you wish, a silicone prosthesis can be inserted in place of the original testicle at the time of the orchidectomy or at a later date.
What pre-operative work up is needed?
Your urologist will organise any necessary blood tests (routine blood tests as well as tumour markers) and an ultrasound scan to confirm the diagnosis at your consultation prior to your procedure. A CT scan may also be done to check for any spread of cancer to the lymph glands and other organs.
You will be offered sperm banking if you wish to have children in the future. This can then be used in the future for assisted conception (e.g. IVF). Sperm storage must be done before any treatment which may affect your fertility (e.g. chemotherapy).
Please ensure you return any admission forms given to you to be filled out back to the hospital.
What happens on the day of the procedure?
You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the general anaesthetic before you are taken to the operation theatre. You may be provided with a pair of TED stockings to wear to prevent blood clots from developing and passing into your lungs.
What does the procedure involve?
Your groin area is shaved. After a general anaesthetic, you are given some intravenous antibiotics to reduce the risk of infection. Surgery to remove a testicle with cancer is called a radical inguinal orchidectomy. An incision (cut) is made in the groin just above the pubic area, and the testicle is gently removed from the scrotum through the opening. The surgeon then removes the entire tumour along with the testicle and spermatic cord. A testicular prosthesis (implant) can be inserted at the same time, if you wish. However, it may not be appropriate to put in an implant if there has been significant bleeding or any difficulty during the operation. Local anaesthetic is injected into the wound to provide pain relief and a dressing applied. Most patients are discharged the same day, however some patients may need to stay in hospital overnight and will be discharged the next day.
Are there any risks or side‑effects?
Mild pain and swelling around the surgical site lasting a few days 40-50%
Minor infection of the incision requiring antibiotics 3-5%
Infection of the implant requiring removal 2-3%
Injury to a nerve in the groin leading to numbness and nerve pain 3-5%
Benign (non cancerous) pathology 5-10%
Dissatisfaction with final cosmetic result or position of implant 3-5%
Severe bleeding or infection needing further surgery 1-2%
What should I expect on discharge when I get home?
You will be discharged with antibiotics to take if you had a testicular prosthesis placed. You will experience some swelling and discomfort at the operative site for a couple of weeks, which should settle with time and with paracetamol and/or ibuprofen. You should wear firm supportive underwear for the first 2 weeks (avoid loose boxers). Keep the waterproof dressing on for 7 days. You can then keep the area clean during showers and pat the area dry afterwards. The sutures are self-dissolving (takes 2-4 weeks) and do not need to be removed.
If you have a testicular prosthesis placed, this can migrate upwards as healing occurs. After 1 week you should pull this prosthesis down to the bottom of the scrotum everyday.
After 2-3 days, you can begin normal activities and light duties again. You should avoid strenuous activity and driving for 2 weeks at least and resume these only when you are completely pain free and when your GP is happy with your progress. If you develop swelling, fevers or significant pain and redness at the site, you should contact your GP.
What follow-up will I need?
Your urologist will see you in the clinic in 1-2 weeks to check everything has healed well and tell you about the pathology results from the operation. If your pathology confirms cancer, you will be referred to an oncologist (medical cancer specialist) to discuss potential options of chemotherapy and for ongoing follow-up.