Orchiectomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Orchiectomy is the surgical removal of one (unilateral) or both (bilateral) testes. Radical inguinal orchiectomy is the gold-standard diagnostic and therapeutic procedure for suspected testicular cancer. Bilateral orchiectomy eliminates testosterone production and is used in prostate cancer management.

Indications include testicular cancer (seminoma or non-seminoma), advanced prostate cancer requiring androgen deprivation, testicular torsion with non-viable testis, severe trauma, infection (Fournier's gangrene), and gender-affirming surgery (bilateral simple orchiectomy).

For cancer, a radical inguinal approach is used to avoid disrupting lymphatic drainage. The spermatic cord is ligated at the internal inguinal ring before testis delivery. The testis and cord to the deep ring are excised. A testicular prosthesis may be inserted at the same sitting if desired.

Most patients go home the same day or after one night. Scrotal support and ice reduce swelling. Avoid strenuous activity for 2–3 weeks. Bilateral orchiectomy causes hypogonadism; testosterone replacement therapy is discussed based on indication and individual circumstances.

Risks include haematoma, wound infection, sensory changes along the inner thigh (ilioinguinal nerve), and cosmetic concerns without prosthesis. Bilateral orchiectomy causes permanent infertility and testosterone deficiency requiring long-term hormonal management.

Radical orchiectomy for Stage I testicular germ cell tumour achieves over 99% disease-specific survival. Even Stage III disease has 70–80% cure rates with post-orchiectomy chemotherapy. Prostate cancer outcomes with bilateral orchiectomy are equivalent to GnRH agonist therapy.