The medical procedure for the surgical removal of one or both testicles is formally known as an orchiectomy (pronounced or-kee-EK-tuh-mee). This surgery involves excising the gonad from the scrotum, and it is a procedure typically performed by a urologist. The purpose of an orchiectomy is to treat or manage various medical conditions affecting the testicles or conditions that rely on testicular hormone production. The type of orchiectomy performed is determined by the underlying reason for the surgery.
Understanding Orchiectomy and Its Indications
An orchiectomy is the surgical removal of the testicle, the organ responsible for producing both sperm and the male hormone testosterone. The word itself comes from the Greek orchis, meaning testicle, and -ectomy, meaning the surgical removal of an organ. The procedure is commonly performed for several distinct medical reasons.
Testicular cancer is the most frequent indication for this surgery, where the removal of the affected testicle serves as both diagnosis and primary treatment. Another common reason is the management of advanced, hormone-sensitive cancers, such as prostate cancer or male breast cancer. Removing the testicles eliminates the body’s primary source of testosterone, which can slow the progression of these cancers.
Other indications include severe physical damage or trauma, such as a testicular rupture. It may also be necessary following severe, unresolving infections (orchitis or epididymitis) or in cases of testicular torsion that caused extensive tissue death. Furthermore, this procedure is sometimes elected as part of gender-affirming care to significantly lower endogenous testosterone production.
Detailed Surgical Approaches
The surgical approach depends on whether cancer is suspected, which determines the incision path and the extent of tissue removed. The method used for nearly all cases of suspected testicular cancer is the Radical Inguinal Orchiectomy. This procedure requires a small incision in the groin, or inguinal, area, not the scrotum.
This approach is necessary because it allows the surgeon to remove the entire spermatic cord along with the testicle. Removing the entire spermatic cord intact prevents the spread of cancer cells into the scrotum or local lymphatics. The spermatic cord is clamped high up near the internal ring before the testicle is delivered, minimizing the risk of seeding cancer.
For non-cancerous conditions, such as trauma, severe infection, or for hormone control in prostate cancer or gender-affirming care, a Simple Orchiectomy is typically performed. This procedure involves an incision made directly on the scrotum. The simple orchiectomy removes the testicle and a short segment of the spermatic cord, making it less invasive than the radical approach.
Immediate Post-Operative Recovery
Most orchiectomy procedures are performed on an outpatient basis, allowing the patient to return home the same day. Patients should anticipate mild to moderate pain for the first few days, which is generally managed effectively with prescription or over-the-counter pain medication. Applying an ice pack to the surgical area for short periods can help reduce postoperative swelling and discomfort.
It is normal to experience some bruising and swelling in the scrotum, which should gradually diminish over two to four weeks. Wound care involves keeping the incision site clean and dry, usually with stitches that dissolve on their own within a few weeks. Patients are typically advised to avoid bathing or swimming until the incision is fully healed to minimize the risk of infection.
Physical restrictions are imposed for a few weeks to ensure proper healing. Patients must avoid strenuous activity and heavy lifting for at least two to four weeks. Light walking is encouraged to promote circulation, but driving is usually restricted until the patient is no longer taking prescription pain medication and can comfortably operate the vehicle.
Addressing Long-Term Outcomes
The long-term effects of an orchiectomy depend significantly on whether one or both testicles were removed. If only a single testicle is removed, the remaining testicle often compensates by increasing its hormone production. In most cases of unilateral orchiectomy, the remaining testicle produces enough testosterone to maintain sexual function, muscle mass, and energy levels, making Testosterone Replacement Therapy (TRT) unnecessary.
However, if both testicles are removed—a bilateral orchiectomy—the body’s natural production of testosterone will cease, leading to a condition called hypogonadism. Patients who undergo bilateral removal will require lifelong TRT to prevent symptoms such as loss of muscle mass, decreased bone density (osteoporosis), and changes in sexual desire. Bilateral removal also results in permanent infertility because the body can no longer produce sperm.
For patients concerned about fertility, especially those undergoing unilateral orchiectomy for cancer, options like sperm banking should be discussed before the surgery. Patients may address cosmetic concerns by choosing to have a testicular prosthesis (a saline-filled implant) placed into the scrotum during the procedure. Counseling regarding body image and psychological adjustment is often recommended, as changes to the body can affect self-perception.