What Happens During an Orchiectomy?

When it comes to reproductive health, it can sometimes be uncomfortable to ask the questions that need to be asked. For example, it may be difficult for someone to have an open conversation with a professional when having a procedure called an orchiectomy (also called orchidectomy). This is the removal of one or both of the testicles.

While it is still very important to consult with your healthcare provider for specific details if you're having a procedure, it can help to learn the answers to common questions about the procedure as well. This way you can learn the ins and outs of the process, and you'll be able to have a starting point for a discussion with your healthcare provider.

Purpose of an Orchiectomy

An orchiectomy is performed for many different reasons including:

• Prostate cancer (procedure prevents it from spreading)
• Testicular cancer and breast cancer in men
• Testicular torsion or other medical conditions of the male reproductive organs
• Cancer prevention
• Treatment of an undescended testicle after puberty
• Severe trauma to the testicle
• Male-to-female gender reassignment surgery

An orchiectomy may be performed to treat various types of cancer, such as prostate or male breast cancer. This is because the testicles produce testosterone, which is a hormone that can cause some types of cancer to metastasize (spread) faster.

An orchiectomy is also considered a mandatory procedure for conditions that result in necrosis (death) to the tissues of the testicles, such as testicular torsion.

Furthermore, men may elect to have an orchiectomy to reduce the level of testosterone in the body when transitioning to the female gender.

Types of Surgery

An orchiectomy is typically performed on an outpatient basis, and it typically takes between 30 minutes to one hour to perform. There are several different types of orchiectomies. The type of procedure depends on the medical condition being treated and what the treatment goal is.

Simple Orchiectomy

This procedure is the standard technique to remove the testis in most cases except for testis cancer. The surgery starts off by a surgeon temporarily securing the penis to the abdomen (to keep it out of the way of the incision site). Next, a small incision is made in the scrotum and one or both testicles are removed.

Radical Inguinal Orchiectomy

This procedure is done when there is suspicion of testicular cancer (such as when a lump is discovered in the testicle). It involves an incision made in the abdomen instead of the scrotum. This method is usually chosen in lieu of a biopsy, because a tissue biopsy may cause cancer cells to spread.

Partial Orchiectomy

The primary standard of care for treating testicular cancer is radical orchidectomy. However, according to John Hopkins Medicine, there are “a couple of circumstances where testis-sparing surgery is advocated.”

These circumstances include bilateral testis cancers and situations where fertility or testosterone is of concern. In cases of fertility interest, sperm cryopreservation and consultation with male reproductive urologist should be considered prior to surgery.

The option of getting a partial orchiectomy—during which not all of the testicle(s) are removed—should be discussed with the healthcare provider.

Types of Anesthesia

The type of anesthesia that may be used during an orchiectomy include either a general type anesthesia (where the person is unconscious) or a spinal block (the person is awake, but does not have any sensation from the waist down during the procedure).

How to Prepare

There are some things that must be accomplished before having an orchiectomy. This includes undergoing a physical exam and getting blood work done to ensure good health before undergoing the procedure.

You should also inform the healthcare provider of any medications (including over-the-counter medications, vitamins, and supplements) you are taking. In addition you should inform the healthcare provider of any prior issues or current concerns with fertility or low testosterone (energy, libido).

Arrange in advance for a ride home after the procedure as you will not be able to drive or operate machinery until the effects of the anesthesia have worn off.

Recovery

After the surgery, a person can expect to go home with a few stitches in the groin and/or scrotum area. The discomfort will most likely be noticed in the groin and scrotum for a week or so, but if the pain is severe, the healthcare provider should be notified right away.

Ice will also help with any pain you are experiencing. After a few days of keeping the incision area dry, you will be able to wash it gently in the bath. Finally, your healthcare provider may prescribe you medications for pain and ointments to promote healing. Make sure to use these as directed.

Further Post-Surgical Instructions

It can take up to two months for complete recovery from orchiectomy surgery, and there are several things a person can expect as part of the aftercare plan.

You will most likely be going home just a few hours after the procedure, but you will return the next day or soon thereafter for a follow-up appointment. Expect to take a few days off of work to recuperate. You also need to limit physical activity such as exercise, sex, sports, and running for a month after the surgery (or for however long your healthcare provider advises).

Other things to expect after the procedure include:

• Wearing a scrotal support garment for the first two days after surgery (if instructed by your healthcare provider)
• Avoiding lifting over 10 pounds for the first two weeks after surgery (or until the lifting restriction is removed by your healthcare provider)
• Avoiding straining during bowel movements

To avoid straining during bowel movements, increase fiber in your diet, drink plenty of water, and take a stool softener if necessary.

Complications

A person should notify the healthcare provider immediately if complications are noticed after surgery, these may include redness, pus, or bleeding from the incision site, severe pain or loss of feeling around the scrotum, and a fever (over 100 degrees Fahrenheit).

In addition, you may notice a hematoma (a large purple area on the scrotum which indicates there is blood in that area), or an inability to urinate. Again, be sure to contact your healthcare provider if you notice any of these complications.

Possible Side Effects

Because the testicles are the primary source of testosterone in the body, lower testosterone can occur after orchiectomy. If testosterone is low, there are several long-term side effects which may occur and these are more pronounced if both testicles are removed, or whether they are simultaneously undergoing chemotherapy. 

These potential side effects include:

• Loss of muscle strength
• Osteoporosis (a condition in which the bone tissue becomes fragile as a result of hormonal changes)
• Low level of fertility (or perhaps loss of fertility)
• Loss of sex drive and inability to get or maintain an erection
• Hot flashes
• Weight gain
• Depression or low mood
• Erectile dysfunction
• Increased risk of cardiovascular disease

Other Questions

Is there a lot of pain after the surgery?

People have been interviewed on their experiences after getting orchiectomies. Some said they did not experience very much discomfort at all, whereas others said discomfort lasted for multiple weeks after the procedure. Some also reported that the scar in the groin area was "tender for a while after surgery."

Will I still have normal fertility if I lose a testicle as a result of testicular torsion?

Having a unilateral orchiectomy (one testicle removed) does not normally affect the testosterone level in the body on a long-term basis, provided the other testicle is healthy and working properly.

Only one testicle is required to produce semen and sperm cells; however, studies have shown that after testicular torsion, one-third of men have a lower sperm count. Testicular torsion can also adversely affect how the sperm moves (which could lower fertility), but this is rare, according to the Urology Care Foundation.

When only one testicle is removed, what precautions can be taken to protect the other testicle?

Always wear protection (such as a protective cup) when playing contact sports. Seek immediate medical attention if you notice any discomfort, pain, or anything out of the ordinary with the scrotum or the other testicle. Have regular testosterone level checks to ensure the remaining testicle is producing adequate amounts of testosterone. Testosterone can be replaced or increased with medication if needed, but be certain to specify if you are seeking fertility (to have children) in the future. This is a factor in which type of medication may be selected with your healthcare provider.

After both testicles are removed, will I still be able to get and maintain an erection?

This depends on many variables. After a bilateral orchiectomy, the body will not be able to produce sperm and the testosterone level will fall to a very low level. (Some testosterone is still produced by the adrenal glands, but it is a minimal amount.)

If a normal testosterone level cannot be maintained, it could interfere with the ability to have or keep an erection. In this scenario, testosterone replacement therapy may be implemented, depending on the circumstances. 

Can a person still have sex after removal of the testicle?

Having one testicle removed does not impact a man’s ability to have an erection and have sex, provided the other testicle is working properly and a normal testosterone level can be maintained.

What if cancer is discovered after the surgery? 

If a person is diagnosed with testicular cancer, further tests and treatment will be needed. Lab tests to monitor blood will be required for several years, even if all the cancer was removed. If there is a high risk of the cancer coming back, chemotherapy and other cancer treatments may be ordered.

Is a prosthesis recommended after surgery? 

A testicular prosthesis is oftentimes used to maintain the normal look and feel of the testicle that has been removed. It’s made of silicone and filled with saline to give it a soft and natural feel.

A prosthesis will not usually be implanted until a person is fully through puberty. If a smaller one is used for a young person, it will need to be replaced with an adult-sized prosthesis when they are grown.

The decision to have a prosthetic implant is a personal one. It’s important to discuss whether to have a prosthesis with the urologist or other healthcare provider before getting an orchidectomy.