ORCHIECTOMY SURGICAL REMOVAL OF TESTES
Category: Urology
Abstract :
orchiectomy surgical removal of testicles - diagnosis / preparation Diagnosis CANCER. The doctor may suspect that a patient has prostate cancer from feeling a mass in the prostate in the course of a rectal examination, from the results of a transrectal ultrasound (TRUS), or from elevated levels of prostate-specific antigen (PSA) in the patient’s blood. PSA is a tumor marker, or c
orchiectomy surgical removal of testicles - diagnosis / preparation
Diagnosis
CANCER.
The doctor may suspect that a patient has prostate cancer from feeling a mass in the prostate in the course of a rectal examination, from the results of a transrectal ultrasound (TRUS), or from elevated levels of prostate-specific antigen (PSA) in the patient’s blood.
PSA is a tumor marker, or chemical, in the blood that can be used to detect cancer and monitor the results of therapy. A definite diagnosis of prostate cancer, however, requires a tissue biopsy. The tissue sample can usually be obtained with the needle technique. Testicular cancer is suspected when the doctor feels a mass in the patient’s scrotum, which may or may not be painful. In order to perform a biopsy for definitive diagnosis, however, the doctor must remove the affected testicle by radical orchiectomy.
GENDER REASSIGNMENT.
Patients requesting gender reassignment surgery must undergo a lengthy process of physical and psychological evaluation before receiving approval for surgery. The Harry Benjamin International Gender Dysphoria Association (HBIGDA), which is presently the largest worldwide professional association dealing with the treatment of gender identity disorders, has published standards of care that are followed by most surgeons who perform genital surgery for gender reassignment. HBIGDA stipulates that a patient must meet the diagnostic criteria for gender identity disorders as defined by either the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) or the International Classification of Diseases–10 (ICD-10).
Preparation
All patients preparing for an orchiectomy will have standard blood and urine tests before the procedure. They are asked to discontinue aspirin-based medications for a week before surgery and all non-steroidal anti-inflammatory drugs (NSAIDs) two days before the procedure. Patients should not eat or drink anything for the eight hours before the scheduled time of surgery. Most surgeons ask patients to shower or bathe on the morning of surgery using a special antibacterial soap. They should take extra time to lather, scrub, and rinse their genitals and groin area.
Patients who are anxious or nervous before the procedure are usually given a sedative to help them relax.
CANCER.
Patients who are having an orchiectomy as treatment for testicular cancer should consider banking sperm if they plan to have children following surgery. Although it is possible to father a child if only one testicle is removed, some surgeons recommend banking sperm as a precaution in case the other testicle should develop a tumor at a later date.
GENDER REASSIGNMENT.
Most males who have requested an orchiectomy as part of male-to-female gender reassignment have been taking hormones for a period of several months to several years prior to surgery, and have had some real-life experience dressing and functioning as women. The surgery is not performed as an immediate response to the patient’s request.
Because the standards of care for gender reassignment require a psychiatric diagnosis as well as a physical examination, the surgeon who is performing the orchiectomy should receive two letters of evaluation and recommendation by mental health professionals, preferably one from a psychiatrist and one from a clinical psychologist.
Aftercare
Patients who are having an orchiectomy in an ambulatory surgery center or other outpatient facility must have a friend or family member to drive them home after the procedure. Most patients can go to work the following day, although some may need an additional day of rest at home. Even though it is normal for patients to feel nauseated after the anesthetic wears off, they should start eating regularly when they get home. Some pain and swelling is also normal; the doctor will usually prescribe a pain-killing medication to be taken for a few days.
Other recommendations for aftercare include:
• Drinking extra fluids for the next several days, except for caffeinated and alcoholic beverages.
• Avoiding sexual activity, heavy lifting, and vigorous exercise until the follow-up appointment with the doctor.
• Taking a shower rather than a tub bath for a week following surgery to minimize the risk of absorbable stitches dissolving prematurely.
• Applying an ice pack to the groin area for the first 24–48 hours.
• Wearing a jock strap or snug briefs to support the scrotum for two weeks after surgery.
Some patients may require psychological counseling following an orchiectomy as part of their long-term aftercare. Many men have very strong feelings about any procedure involving their genitals, and may feel depressed or anxious about their bodies or their relationships after genital surgery. In addition to individual psychotherapy, support groups are often helpful. There are active networks of prostate cancer support groups in Canada and the United States as well as support groups for men’s issues in general.
Long-term aftercare for patients with testicular cancer includes frequent checkups in addition to radiation treatment or chemotherapy. Patients with prostate cancer may be given various hormonal therapies or radiation treatment.
Risks
Some of the risks for an orchiectomy done under general anesthesia are the same as for other procedures. They include deep venous thrombosis, heart or breathing problems, bleeding, infection, or reaction to the anesthesia. If the patient is having epidural anesthesia, the risks include bleeding into the spinal canal, nerve damage, or a spinal headache.
Specific risks associated with an orchiectomy include:
• loss of sexual desire (This side effect can be treated with hormone injections or gel preparations.)
• impotence
• hot flashes similar to those in menopausal women, controllable by medication
• weight gain of 10–15 lb (4.5–6.8 kg)
• mood swings or depression
• enlargement and tenderness in the breasts
• fatigue
• loss of sensation in the groin or the genitals
• osteoporosis (Men who are taking hormone treatments for prostate cancer are at greater risk of osteoporosis.)
An additional risk specific to cancer patients is recurrence of the cancer.
Normal results
Cancer
Normal results depend on the location and stage of the patient’s cancer at the time of surgery. Most prostate cancer patients, however, report rapid relief from cancer symptoms after an orchiectomy. Patients with testicular cancer have a 95% survival rate five years after surgery if the cancer had not spread beyond the testicle. Metastatic testicular cancer, however, has a poorer prognosis.
Gender reassignment
Normal results following orchiectomy as part of a sex change from male to female are a drop in testosterone levels with corresponding decrease in sex drive and gradual reduction of such masculine characteristics as beard growth. The patient may choose to have further operations at a later date.
Morbidity and mortality rates
Orchiectomy by itself has a very low rate of morbidity and mortality. Patients who are having an orchiectomy as part of cancer therapy have a higher risk of dying from the cancer than from testicular surgery. The morbidity and mortality rates for persons having an orchiectomy as part of gender reassignment surgery are about the same as those for any procedure involving general or epidural anesthesia.
Alternatives
Cancer
There is no effective alternative to radical orchiectomy in the treatment of testicular cancer; radiation and chemotherapy are considered follow-up treatments rather than alternatives.
There are, however, several alternatives to orchiectomy in the treatment of prostate cancer:
• watchful waiting
• hormonal therapy (The drugs that are usually given for prostate cancer are either medications that oppose the action of male sex hormones [anti-androgens, usually flutamide or nilutamide] or medications that prevent the production of testosterone [goserelin or leuprolide acetate].)
• radiation treatment
• chemotherapy
Gender reassignment
The primary alternative to an orchiectomy for gender reassignment is hormonal therapy. Most patients seeking MTF gender reassignment begin taking female hormones (estrogens) for three to five months minimum before requesting genital surgery. Some persons postpone surgery for a longer period of time, often for financial reasons; others choose to continue on estrogen therapy indefinitely without surgery.
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