Orchiectomy (also named orchidectomy, and sometimes shortened as orchi) is a surgical procedure in which one or both testicles are removed. The removal of both testicles (bilateral orchiectomy) is the surgical form of castration.
Diagram of the incisions in an orchiectomy
There are three main types of orchiectomy: simple, subcapsular, and inguinal. The first two types are usually done under local or epidural anesthesia, and take about 30 minutes to perform. An inguinal orchiectomy is sometimes done under general anesthesia, and takes from 30 minutes to an hour to complete.
A simple orchiectomy is commonly performed as part of sex reassignment surgery (SRS) for transgender women, or as palliative treatment for advanced cases of prostate cancer. Orchiectomy may be required in the event of a testicular torsion as well. The patient lies flat on an operating table with the penis taped against the abdomen. The nurse will shave a small area for the incision. After anesthetic has been administered, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue. The surgeon removes the testicles and parts of the spermatic cord through the incision. The incision is closed with two layers of sutures and covered with a surgical dressing. If the patient desires, a prosthetic testicle can be inserted before the incision is closed to present an outward appearance of a pre-surgical scrotum.
A subcapsular orchiectomy is also commonly performed for treatment of prostate cancer. The operation is similar to that of a simple orchiectomy, with the exception that the glandular tissue that surrounds each testicle is removed rather than the entire gland itself. This type of orchiectomy is done primarily to keep the appearance of an ordinary scrotum.
Inguinal orchiectomy (named from the Latin inguen for "groin," and also called radical orchiectomy), is performed when an onset of testicular cancer is suspected, in order to prevent a possible spread of cancer from the spermatic cord into the lymph nodes near the kidneys.
An inguinal orchiectomy can be either unilateral or bilateral. The surgeon makes an incision in the patient's groin area (in contrast to an incision in the scrotum, as is done in both simple and subcapsular orchiectomies). The entire spermatic cord is removed, as well as the testicle(s). A long, non-absorbable suture may be left in the stump of the spermatic cord in case later surgery is deemed necessary.
After the cord and testicle(s) have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged.
Orchiectomy has adverse effects such as sterility, hypoandrogenism and hypoestrogenism, associated symptoms such as hot flashes, osteoporosis, demasculinization, sexual dysfunction, and depression, as well as gynecomastia (1 to 14%).[additional citation(s) needed]
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