Orchiectomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Orchiectomy is the surgical removal of one (unilateral) or both (bilateral) testes. Radical inguinal orchiectomy — performed via an inguinal groin incision rather than a scrotal approach — is both the definitive diagnostic test and primary treatment for suspected testicular germ cell tumours. By ligating the spermatic cord at the internal inguinal ring before handling the testis, it avoids tumour seeding to scrotal lymphatics and provides an intact specimen for histopathological subtyping into seminoma or non-seminoma. Bilateral simple orchiectomy permanently eliminates testicular testosterone production and is used in hormone-sensitive prostate cancer management as an alternative to medical androgen deprivation. The procedure is performed under general or spinal anaesthesia and takes 30–60 minutes, typically as a day-case or overnight admission at most centres. Subcapsular orchiectomy — removal of seminiferous tubule contents while preserving the tunica albuginea and epididymis — is an alternative for bilateral orchidectomy in prostate cancer treatment, reducing the psychological impact of bilateral gonadal loss while achieving equivalent androgen deprivation. Simple orchiectomy for non-oncological indications (chronic orchitis, atrophic testis following torsion, gender-affirming surgery) is performed via a scrotal or inguinal approach depending on indication. Post-orchiectomy testosterone levels drop to castrate levels (<50 ng/dL) within 12 hours for bilateral procedures, with permanent implications for fertility, sexual function, and bone mineral density requiring long-term management by endocrinologists and oncologists.

Radical inguinal orchiectomy is indicated as the primary diagnostic and therapeutic procedure for any palpable or ultrasound-detected testicular mass suspicious for malignancy, including seminoma, non-seminomatous germ cell tumours (NSGCT), Leydig cell tumours, and Sertoli cell tumours. Bilateral simple orchiectomy is used in metastatic prostate cancer to achieve castrate testosterone levels (under 50 ng/dL) as surgical androgen deprivation, offering an alternative to continuous GnRH agonist injections. Other indications include non-viable testis after testicular torsion with irreversible ischaemia, extensive trauma, severe orchitis progressing to abscess, and gender-affirming surgery. In patients with a solitary testis or bilateral tumours, partial (organ-sparing) orchiectomy is considered to preserve testosterone production and fertility if technically feasible with adequate tumour-free margins. Anticoagulation management and sperm banking are discussed pre-operatively.

For testicular cancer, an inguinal approach is essential. With the patient supine, an incision is made 2–3 cm above and parallel to the inguinal ligament. The spermatic cord is identified and encircled with a tape at the internal inguinal ring before the testis is delivered into the surgical field — this prevents tumour cells being expressed into the scrotal lymphatics during manipulation. The cord is doubly clamped and ligated flush at the internal ring, and the testis and complete cord to the deep ring are excised en bloc and sent for histopathology. Frozen section examination is performed in select cases (solitary testis) to guide partial orchiectomy decisions. A testicular prosthesis of appropriate size may be inserted into the scrotum via a small scrotal incision at the same sitting if the patient wishes. The wound is closed in layers with absorbable sutures and a scrotal support is applied. The procedure takes 30–60 minutes under general or spinal anaesthesia. The testis is carefully examined intraoperatively. If the frozen section confirms malignancy, the full cord is ligated at the level of the internal ring and divided. An intraoperative prosthesis can be placed at the same procedure if the patient consented pre-operatively. Haemostasis is confirmed before wound closure. For bilateral subcapsular orchiectomy, a bilateral scrotal approach is used: the tunica albuginea is incised, all germinal epithelium scooped out, and the shell closed. Total operative time is 30–60 minutes.

Radical inguinal orchiectomy for Stage I testicular germ cell tumour achieves disease-specific survival rates exceeding 99%, making testicular cancer one of the most curable solid malignancies when detected early. Even Stage III metastatic disease achieves 70–80% cure rates with post-orchiectomy platinum-based chemotherapy (BEP: bleomycin, etoposide, cisplatin) — an outcome unmatched in most other solid cancers. Bilateral orchiectomy for prostate cancer delivers rapid, irreversible castrate testosterone levels within 24 hours, equivalent in efficacy to GnRH agonists but without testosterone flare risk and at a once-only surgical cost rather than lifelong injection costs. PSA responses occur in 80–90% of hormone-naive metastatic prostate cancer patients after androgen deprivation. Organ-sparing orchiectomy in eligible cases preserves androgen production while achieving local tumour control. For patients with prostate cancer, bilateral orchiectomy provides immediate, reliable, and permanent testosterone suppression without the need for ongoing injections, monitoring, or medication costs associated with luteinising hormone-releasing hormone (LHRH) agonists. Bilateral orchiectomy is particularly advantageous in resource-limited settings or in patients with poor compliance with injectable therapy.

Early complications after radical orchiectomy include wound haematoma (2–5%), wound infection (under 2%), and scrotal oedema. Sensory changes — numbness or dysaesthesia along the inner thigh and medial scrotum from ilioinguinal nerve handling — occur in up to 20% of patients and usually improve over 3–6 months. Unilateral orchiectomy in a man with a normal contralateral testis preserves fertility and androgen production; no hormonal replacement is required. Bilateral orchiectomy causes permanent primary hypogonadism with testosterone deficiency, leading to reduced libido, erectile dysfunction, hot flushes, muscle wasting, osteoporosis, and mood changes. Testosterone replacement therapy addresses most of these effects in men with prostate cancer where it is not contraindicated. Surgical testicular prosthesis insertion carries a small risk of infection, migration, or rupture requiring revision.

Most patients undergoing radical orchiectomy are discharged on the same day or after a single overnight admission. Scrotal support and intermittent ice packs for the first 24–48 hours reduce discomfort and oedema. Strenuous physical activity and heavy lifting are restricted for 2–3 weeks. Light desk work may resume within one week. Staging investigations — CT chest, abdomen, and pelvis, and tumour markers (AFP, beta-HCG, LDH) — are arranged 2–4 weeks post-operatively to guide further treatment decisions. Patients undergoing bilateral orchiectomy are referred to endocrinology for testosterone replacement therapy initiation. Psychological support and sperm banking should ideally be discussed before surgery in men with testicular cancer. Long-term oncological surveillance follows the oncologist's schedule — typically every 3–6 months for 5 years with cross-sectional imaging and tumour markers.