Radical orchiectomy, also known as ablatio testis, refers to the surgical removal of the testicle. This procedure is a necessary treatment for various testicular conditions, such as testicular cancer.
Further information on radical orchiectomy, the various surgical techniques, and their consequences is provided below.
In a radical orchiectomy, one or both of the paired testicles are removed.
This surgical form of castration results in permanent infertility (also known as “irreversible infertility”). However, the individual can have sperm frozen beforehand (cryopreservation). This allows him to still fulfill a future desire to have children through artificial insemination.
The germ tissue of the testicles produces the majority of the sex hormone testosterone. After a radical orchiectomy, testosterone levels therefore drop by up to 90 percent to values below 50 ng/dl in serum. In the case of a bilateral orchiectomy, the patient must therefore undergo lifelong testosterone replacement therapy.
The surgically removed testicle can be replaced with an implant if necessary.
When is an orchiectomy performed?
An orchiectomy is generally performed in the following cases:
- for testicular cancer (radical tumor surgery for testicular germ cell carcinoma),
- as hormone deprivation therapy for advanced prostate cancer (so-called androgen-deprivation therapy for advanced prostate cancer),
- in cases of irreversible, i.e., non-reversible, testicular dysfunction,
- in elderly men as a last resort for a recurrent inguinal hernia.
During an orchiectomy, the testicles are removed either completely or partially © Henrie / Fotolia
What types of orchiectomy are there?
Generally, there are three types of orchiectomy available. The doctor selects the surgical technique based on the individual case. Specifically, orchiectomy procedures differ in their surgical approach to the testicular tissue and the extent of tissue removed:
- simple orchiectomy,
- subcapsular orchiectomy, and
- inguinal orchiectomy.
Simple orchiectomy
The indications for a simple orchiectomy are
- an irreversible disease of the testis, but
- no malignant cause such as cancer.
These include, in particular,
- a significant reduction in the size of one or both testicles resulting from testicular torsion (so-called testicular atrophy due to testicular torsion),
- testicular inflammation with pus accumulation in the tissue (so-called abscessing orchitis), and
- a testicle located in the inguinal canal whose position has not normalized by adulthood (known as a persistent inguinal testicle).
In a simple orchiectomy, the surgeon makes a small incision in the center of the scrotum. He dissects through the underlying tunicae of the testis layer by layer. He then removes the testicles and part of the spermatic cord before suturing the scrotum and the incision closed.
If desired, testicular implants can be inserted during the operation. This preserves the appearance of testicles within the scrotum.
Subcapsular orchiectomy
Subcapsular orchiectomy (hormone deprivation therapy) is primarily performed in cases of prostate cancer. It serves as an alternative to medical treatment.
In almost all cases of prostate cancer, the cancer cells require male sex hormones to grow. These are so-called androgens, such as testosterone. If these sex hormones are absent due to treatment, the tumor can no longer grow as quickly. This slows the progression of the cancer.
This is achieved either
- medically, using so-called antiandrogens, or
- by removing the hormone-producing parts of the testicles during a subcapsular orchiectomy.
Subcapsular orchiectomy is similar to simple orchiectomy. However, in this procedure, not the entire testicle is removed, but only the glandular tissue surrounding each testicle. This has the advantage that
- the tunica albuginea,
- the epididymis, and
- the spermatic cord
are preserved. With this method, the appearance and texture of the testicle do not change significantly. Therefore, the patient does not require an implant.
The procedure can generally be performed on an outpatient basis. First, a small skin incision is made in the scrotum (scrotal incision), and the tunica albuginea is opened. The surgeon then carefully pushes the testicular parenchyma (germ tissue) away from the inner surface of the testicular capsule using a small swab or a finger. Next, the surgeon uses an electrocautery device to separate the germ tissue that is still attached along the midline.
Finally, careful hemostasis is performed, and the surgeon sutures the testicular capsule and scrotum.
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Removal of the testicle via an inguinal incision (inguinal orchiectomy). During this procedure, the spermatic cord is transected and the testicle is removed © Cancer Research UK / Wikimedia Commons
Inguinal orchiectomy
Inguinal orchiectomy is used to treat testicular cancer and involves the removal of the testicle via the groin (Latin: inguinal region). This approach allows for early assessment of the testicular lymphatic and blood vessels while simultaneously avoiding injury to the scrotum. A testicular prosthesis can also be inserted via the inguinal approach relatively easily and with few complications.
Testicular cancer most commonly affects young men between the ages of 20 and 40. Patients often suspect they have testicular cancer after feeling a lump in the testicle. This suspicion can be confirmed through further medical examinations, such as an ultrasound or an analysis of blood markers.
If the findings suggest cancer, the testicle is surgically exposed via the groin. Following a rapid histological evaluation, appropriate further treatment is initiated.
In this surgical technique, the surgeon first makes an incision in the groin. This exposes the blood vessels supplying the testicle and the spermatic cord, which are then ligated.
In the next step, the testicle is detached from the scrotum, and the tissue suspected of containing a tumor is removed in a way that preserves the organ. The tissue is then sent to a pathologist for a rapid histological evaluation (frozen section analysis).
If the findings indicate a benign tumor, the testicle is returned to the scrotum (repositioning of the testicle). If a malignant tumor is present, the affected testicle is surgically removed (radical orchiectomy).
