Inguinal Orchiectomy
An inguinal orchiectomy is the surgical removal of a testicle through an incision in the groin. There are two common reasons why an inguinal orchiectomy may be required:
- Cancer of the testicle
- Incomplete descent of the testicle into the scrotum. If the testis is very small and under-developed then removal rather than placing it into the scrotum is recommended. Undescended testicles have a higher risk of developing cancer.
Procedure
Inguinal orchiectomy is usually performed under a general anaesthetic. Beforehand the surgeon will make a pen mark on your skin over the left or right groin to confirm the correct side for surgery. The groin and scrotum are shaved. A 5cm incision is made in the skin then the spermatic cord is cut and the testicle removed from the scrotum. Surgery usually takes 45 minutes. Following removal of the testicle it is possible to immediately insert a prosthetic silicon testicle. This is up to you, it is for cosmetic reasons only & some men prefer not to have this performed. Following surgery local anaesthetic is injected around the site of the cut, this helps with comfort after surgery. Dermabond tissue glue is used to seal the skin so that an adhesive dressing is not required.
Pre-procedure
Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications.
Post-procedure
Once you are up and about, eating and drinking and you have passed urine you will be able to return home. This may be on the day of surgery or the following morning. When getting out of bed for the first time after surgery it is important that a nurse helps you. The reason for this is that your leg may be temporarily weak from the effect of the local anaesthetic.
If a prosthetic testicle has been placed then you will need to 'pull it down into the scrotum' several times per day for the first week. This prevents the prosthesis from sitting too high inside the scrotum. Your surgeon will show you how to do this.
Risks
Fertility
Providing that there is another normal testicle on the other side removal of one testicle is unlikely to significantly affect your fertility. This is particularly so if the testicle being removed is very small. If testicular cancer is suspected then semen preservation prior to surgery is recommended. This is because several of the treatments (such as chemotherapy) used to treat testicular cancer may affect your fertility.
Pain
Mild wound pain is usual and this can be easily managed with oral painkillers such as paracetamol and diclofenac. Increasing pain or swelling may indicate a haematoma (collection of blood beneath the wound) or infection. Contact Urology Care Wellington if you are concerned about these possibilities.
Nerve Injury
Several tiny nerves travel beneath the skin in the region of the groin. These can be stretched or cut during inguinal orchiectomy. This may lead to reduced feeling in a small (2cm diameter) patch of skin near the wound. This does not concern most patients.
Return to Work
You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. Most men can return to light duties one week following surgery however would need to avoid heavy lifting for six weeks.
Follow-up after Surgery
Laboratory assessment of the removed testis takes one to two weeks to perform. The next appointment is usually two weeks following surgery. If testicular cancer is suspected then you will also have a CT scan of your abdomen and chest. Once the pathology report and CT are completed then further management can be planned.