Radical & Simple Orchiectomy
Radical = removal of an organ and surrounding tissue (for a diagnosis of cancer)
Simple = removal of just an organ (usually for benign disease)
Orch = pertaining to the testicle
Ectomy = removal of
Orchiectomy means "removal of a testicle." In most cases, the indication will be for a presumed diagnosis of testicular cancer, and is consequently referred to as a radical orchiectomy. In this operation, we remove the testicle and the majority of the spermatic cord through an incision in the groin or "hernia" region. The spermatic cord contains the blood supply (arteries and veins), nerves, lymphatic vessels, and the vas deferens (the spaghetti-like structure that transports sperm from the testicle to the urethra). In a simple orchiectomy, the testicle and just a short segment of the spermatic cord are removed, typically through an incision in the scrotal wall. Simple orchiectomies are performed for reasons of severe infection or chronic pain. Both testicles can be removed to temporarily help in the treatment of prostate cancer.
As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery. You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if you are currently taking or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners, aspirin, anti-inflammatory medicines, etc..."). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past ten days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
We will insist that you have a good quality scrotal support (jock strap) or a good pair of jockey shorts. You will need to wear it for several days to a couple of weeks after surgery. Support helps to reduce discomfort and swelling and keep the dressing up against a scrotal incision.
To review the basics of what we discussed in the office: The procedure can take anywhere up to an hour depending on an individual's anatomy and whether there was a prior history of surgery in that area.
In a radical orchiectomy, an incision is made in the groin region. We then bring the testicle and cord out of the scrotal sac and up to the region of the incision. Next, the end of the cord structures are all sewn tight and the cord is divided. The specimen is removed and sent to the pathologists (doctors who look at tissue under a microscope) for further examination. The incision is then closed and a sterile bandage is applied. In a simple orchiectomy, an incision is made in the wall of the scrotal sac. We tie all of the cord structures with sutures and then divide the end of the cord. The specimen is removed and sent to the pathologists for further examination. The incision is then closed. In cases where a simple orchiectomy was performed for a severe infection, we may decide to leave a small drainage tube in place for a few days. The drain may be sewn to the scrotal skin with a suture. If a severe infection involves some of the skin of the scrotum, it may be necessary remove the area of infected tissue.
You will be in the recovery room for a short time
before being sent home. In cases of severe infection,
you may be admitted for observation and intravenous
antibiotics. In radical orchiectomy patients, there will
be a small bandage over the incision. Occasionally there
is small blood staining on the bandage. If the dressing
is soaked, or you see active blood oozing, please contact
us. We may recommend that you apply ice compresses as
directed. This often helps to minimize swelling and discomfort.
In patients who underwent simple orchiectomy, there may
be a scrotal support (jock strap) with some gauze underneath.
There is occasionally some blood staining on the gauze,
and this is normal. Again if the dressing becomes soaked, or
your see active blood oozing, please contact us.
You may shower the day after surgery, but no baths or swimming (unless otherwise instructed).Some surgeons may recommend warm tub baths a couple of times per day a few days after surgery. We ask that you refrain from any strenuous activity until your follow-up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant. We strongly encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24 hours, it is to your advantage to minimize activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. Some patients have almost no discomfort while others are somewhat uncomfortable for a few days; longer is rare. We may provide you with a prescription for pain medication but you certainly may take anover-the-counter medication to which you are not allergic. Upon your follow-up in the office, we will examine you.
Expectations of Outcome
Swelling from procedures involving the groin and scrotum can persist for days or weeks. Incases of infection, it can be even more dramatic.
In cases of radical orchiectomy, it may take up to a week for the pathologists to fully evaluate the specimen. There are several types of testicular cancer, and subsequent treatment may depend on the type and extent of the cancer found in the specimen. When history, physical examination, and ultrasound support the diagnosis of testicular cancer, then cancer is found in the specimen almost 95% of the time. For this reason, we rarely perform a biopsy prior to recommending radical orchiectomy.
*You should understand, then, that there is a small (perhaps 5%) chance of undergoing a radical orchiectomy and subsequently being told that there is "no" cancer in the specimen. Leaving a testicle in the body that has cancer is far more of a danger than removing a testicle that has no cancer.
Possible Complications of the Procedure
ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
- Infection: Infection is possible in any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require drainage of the wound.
- Persistence of Infection: In patients who undergo simple orchiectomy for reasons of infection, there is a chance that further surgery is required to adequately control the infection. This is more common in patients who are diabetic, long-term smokers, or have a disorder affecting the immune system.
- Hematoma: This is when a small blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. It almost always resolves over time with compresses...much like any bad bruising or swelling. If the hematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may be required.
- Chronic Pain: As with any procedure, a patient can develop chronic pain in an area that has undergone surgery. Typically, the pain disappears over time. If persistent, further evaluation would be necessary.
- Paresthesia(s): As mentioned earlier, there are small nerves that run inside or directly alongside the spermatic cord. After orchiectomy it is possible to have areas of numbness on the scrotal sac or inner thigh area. Over time, the sensation usually returns. Less commonly, the area may stay numb forever.
- Excessive Blood Loss: These procedures are usually associated with very minimal bleeding. There are very rare instances in which one of the arteries in the spermatic cord can open after the incision is closed. While the need for transfusion is unusual, blood loss can be significant and require a minimally-invasive procedure, or repeat open procedure to stop the bleeding.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.