orchiectomy

Generality

Orchiectomy is the surgical procedure aimed at removing one or both testicles (or didymis).

Orchiectomy intervention.

From the site: en.wikipedia.org/wiki/Orchiectomy

In general, doctors resort to the removal of didymas in the presence of testicular, prostate or breast metastatic tumors, or in the case of congenital dysfunctions concerning testosterone and responsible for genital malformations.

The orchiectomy involves a particular preparation, such as for example, on the day of the intervention, to appear completely without food for at least 8 hours.

There are three different approaches by which the doctor can perform the removal of the testicles: simple orchiectomy, subcapsular orchiectomy and inguinal orchiectomy.

At the end of the operation, there is a hospitalization of approximately 24 hours, except for complications.

If practiced at the right time, most orchiectomy interventions guarantee excellent results.

Anatomical and functional recall on the testicles

In number of two, the testicles (or didymas ) represent the male gonads .

The gonads are the reproductive organs that produce sex cells, also known as gametes. The male gametes are spermatozoa, so the first task of the testicles is to give rise to spermatozoa ( spermatogenesis ).

The amount of spermatozoa that a healthy male's testicles releases over a lifetime is enormous.

Size and weight of the testicles in the adult male:

• 3.5-4 cm long
• 2.5 cm wide
• 3 cm anteroposterior diameter
• About 20 grams of weight

The second task of didymas - no less important than the first - is to produce male sex hormones (or androgens). The main representative of androgens is testosterone .

The latter, together with the other androgens, provides for the development of secondary sexual characteristics (growth of hair and beard, enlargement of the penis, enlargement of the shoulders, increase in muscle mass, etc.) and the control of the genital apparatus itself.

What is the orchiectomy?

Orchiectomy is the surgical procedure to remove one or both testicles.

When the removed testicle is one, the doctors speak more properly of unilateral orchiectomy, whereas when the excision concerns both testicles they define the procedure with the most appropriate term of bilateral orchiectomy .

Curiosity: in women it corresponds to ...

In women, the equivalent of the oncectomy is ovariectomy, also known as oophorectomy. This surgical procedure consists in removing the ovaries, which are the female gonads.

When you run

Doctors use oriceectomy in the presence of:

• Malignant tumors . The main malignancy that requires orchiectomy is testicular cancer; followed by prostate and male breast tumors, with metastasizing power.

  In the first case, the operation serves to remove the diseased testicle so as to prevent it from spreading metastasis elsewhere (NB: metastases are neoplastic cells that detach from the tumor mass).

  In the following cases, on the other hand, the orchiectomy serves to limit (or stop completely) the production of testosterone, which is a factor favoring the process of metastasis.

• Congenital conditions, the result of a hormonal dysfunction concerning testosterone and other androgens (male sex hormones). A classic example is Morris syndrome. Individuals with this disease are generally men with a woman's outward appearance. All this is due to a permanent insensitivity of body cells to androgens; such insensitivity that determines the development, only outside, of female sexual characteristics (vagina in place of the penis, female breast, etc.) and the presence of cryptorchidism (since the lack of an adequate male genital apparatus makes it impossible to descend the testicles)

  Situations like the ones just described, make an orchiectomy necessary, since criptorchidism (also known as the medical term "testicles retained") is an important risk factor for testicular cancer.

Alongside the two just mentioned, there is a third field of application of the orchiectomy: the cases of normal men who want to change sex and become women ( sex rearrangement ). These individuals must have their testicles and the entire male genital apparatus removed to allow the plastic surgeon to "build" an almost normal vagina for a hormonal issue (NB: without testicles there is no testosterone production and no testosterone begin to disappear some typically masculine characteristics, like for example the beard.

ORCHIECTOMIA AND TUMORS

Testicular cancer is a very rare malignancy. In fact, according to the most recent estimates, it represents about 1% of all malignant tumors affecting male individuals.

It mainly affects the young population, between 15 and 44 years old, and of white complexion (in particular the males originating from Northern European countries, such as Sweden, Norway, Germany, etc.).

In most cases it is unilateral and, in the case of early diagnosis, it can be treated with excellent results (more than 9 cases out of 10 recover completely).

There are various types of it; among these, the most widespread is seminoma.

Prostate cancer is one of the most common cancers in the male population. Every year, in Italy, between 36, 000 and 42, 000 people are affected; in the United States, about 220, 000. It usually arises after the age of 50 and has a particular preference for African-American men.

Preparation

Pysteryectomy requires special preparation. In fact it provides:

• A few days after surgery, a series of clinical tests, such as blood tests, urine tests, electrocardiograms, blood pressure measurement, clinical history analysis, etc.

  All these tests are necessary for the doctor to understand if the patient is able to face a surgical operation or not.

• The suspension of any pharmacological treatment involving the administration of anti-aggregants (for example aspirin), anticoagulants (warfarin) and NSAIDs (Non-Steroidal Anti-inflammatory Drugs).

  Regarding the timing: antiplatelet agents and anticoagulants should be suspended at least a week before the operation; NSAIDs at least two days before.

• On the day of the procedure, complete fasting presentation. In general, the patient can take his last pre-surgery meal 8 hours before going to the hospital, where the operation will take place. Therefore, if the intervention is in the morning, the dinner of the previous evening represents the last moment in which it is possible to eat.

  This recommendation is explained by the fact that orchiectomy requires local or general anesthesia.

• Careful washing with a special antibacterial soap from the genitals and the groin area. Most surgeons recommend washing just before going to the hospital for the operation.

As with any major surgical procedure, once the operation is completed, the patient is obliged to be taken home by a trusted person.

Therefore, it is good that he asks in time for some close relative or close friend to keep himself free on the day of the orchiectomy or when the resignation is expected.

SPECIFIC PREPARATORY MEASURES FOR PATIENTS WITH A TESTICULAR CANCER

For patients with a testicular cancer, who intend to have children after surgery, doctors advise contacting a bank for seed cryopreservation .

This is a precautionary measure, because, although today's unilateral orchiectomy interventions are quite safe, there is still a minimal risk of sterility.

SPECIFIC PREPARATORY MEASURES FOR PATIENTS WHO WANT TO CHANGE SEX

Men intending to become women must begin estrogen-based hormone therapies (female sex hormones), several months or even years before the date of surgery.

Doctors adopt this particular preparatory measure not so much to improve the results of the surgical procedure as to "accustom" the patient to the future changes that await him.

Procedure

Surgeons can perform an orchiectomy in three different ways. In fact, there are:

• The simple pathology
• The subcapsular ectectomy
• Inguinal oral cavity

The first two require epidural anesthesia and have a maximum duration of 30 minutes.

The latter requires general anesthesia and lasts between 30 and 60 minutes.

SIMPLE ORCHORECTOMY

Indicated for cases of prostate cancer and for cases of sex rearrangement, the simple orchiectomy involves an incision in the center of the scrotum and the removal of the testicle (s) and part of the spermatic funicular (s) attached to the testicles.

Once the removal is completed, the surgeon closes the incision with some stitches; after which it covers the area operated with a protective bandage.

Patients with prostate cancer may require, if they wish, replacement of the testicle or testicles removed with artificial prostheses, which have no functional capacity; they only give a normal appearance to the scrotum.

UNDERCAP ORCHAIR

Ideal for prostate cancer, the subcapsular orchiectomy is very similar, from a procedural point of view, to simple orocterectomy.

The substantial difference is that the surgeon only removes testicular cells used for testosterone production. These cells, which cover the male gonad, are known as Leydig cells.

Failure to remove the whole or the testicles in their entirety causes the scrotum to maintain, to a large extent, its normal anatomy, without the use of artificial prostheses.

INGUINAL ORCHIECTOMY

The inguinal orchiectomy is the intervention method designed for testicular cancer.

It involves an incision at the inguinal level of 7-8 centimeters, through which the operating surgeon removes, in full, the diseased testicle and the attached spermatic cord.

Total removal of the spermatic cord is indispensable, because this element could contain neoplastic cells, capable of spreading to the neighboring lymph nodes and other organs of the body (metastasization).

Once the testicle and cord are removed, the surgeon washes the area operated with a saline solution and closes the incision with sutures (absorbable or non-absorbable); then apply a protective bandage.

The bilateral inguinal oral cavity consists of a double incision (left and right) and the removal of both testicles and both spermatic funicular.

After the surgery

After the orchiectomy, the expected hospitalization is usually one day.

During this time, the medical staff monitors the patient in his vital parameters (blood pressure, cardiac activity, etc.) and explains the various stages of recovery and the most important post-operative recommendations.

To return home, remember that the presence of a trusted companion is required.

POST-OPERATIVE SENSATIONS

It is quite normal that after the orchiectomy, patients feel:

• Pain and / or swelling at the level of the operated area . Generally, they are disorders that resolve within a few days. For pain, there is the possibility of using painkillers.
• Confusion, dizziness and alteration of reflexes . These are all effects of anesthesia, especially the general one. This explains why a carer is needed.

POST-OPERATION RECOMMENDATIONS

The most important post-operative recommendations include:

• Drink plenty of fluids several times a day to help keep the drugs and anesthetics used during the operation away from the blood.
• Avoid: having sex, lifting weights and doing strenuous activities.
• For body washing, prefer the shower to the bathtub. Washing in a bathtub could lead to premature suture dissolution.
• During the first 24-48 hours, apply ice to the operated area.
• Wear comfortable underwear and / or jockstrap for at least a couple of weeks

Risks and complications

The pathosectomy is a fairly safe procedure.

However, since it is still a surgery of some importance, it presents a small risk margin and the possibility of giving complications.

Possible complications include:

• The risks associated with the practice of anesthesia. In the case of general anesthesia, the risks are: deep vein thrombosis, respiratory and / or cardiac problems, bleeding, infections and allergic reactions to anesthetics. In the case of epidural anesthesia, however, the risks are: damage to nerve structures, headaches and bleeding within the spinal cord.
• Low libido. In general, the removal of a testicle does not compromise the total production of testosterone, as the remaining testicle increases its activity and compensates for the deficiencies of the removed testicle.
• Impotence.
• Infertility. This problem is inevitable when testicular excision is bilateral (for example at the bilateral inguinal orchiectomy). Moreover, without both testicles sperm production is lost.
• Hot flashes, similar to those of the menopausal woman
• Tendency to gain weight
• Mood swings and / or depression
• Breast enlargement
• Sense of recurrent fatigue
• Loss of sensitivity in the inguinal or genital level
• Osteoporosis

Results

The results of a triageectomy, performed in the presence of a prostate neoplasm, are generally positive: in fact, the symptomatic picture improves in most patients.

The results of an inguinal osteectomy, for the treatment of a testicular tumor, depend on the stage of progress of the latter. If the removal of the diseased testicle takes place before the spread of metastases, the chances of complete recovery are high (about 95%).

Finally, in the case of a reassignment of the sex, the results of a pylonectomy are generally satisfactory, but they are appreciated only in the long term.