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Orchiectomy


Medical editor Bjørn Brennhovd MD
Urologist
Oslo University Hospital

General

In cases where the diagnosis cannot be determined clinically, an open exploration of the testicle must be performed. If malignant cells are verified by frozen section, a radical orchiectomy should be performed under the same anesthesia.

The procedure may be performed under general or epidural anesthesia. It is very important that frozen sectioning service is available in the surgical theater.

Indication

  • To determine whether clinical changes in the testicle are malignant and if so, remove the testicle.

Goal

  • To diagnose and cure the patient

Equipment

  • Universal tray

Preparation

  • The patient should understand the purpose of the procedure and the possibility that an orchiectomy may be performed under the same anesthesia. 
  • The patient must be questioned in advance about prosthetics.
  • If there is a solitary testicle, the patient must be informed about infertility and homone replacement possibilities.
  • Thrombosis prophylaxis
  • Plan for biopsy of the contralateral testicle, if necessary

Implementation

  • Make a diagonal incision in the groin up to the fascia.
  • Split the fascia from the outer inguinal canal opening, up and past the inner inguinal canal opening. 
  • The spermatic cord is dissected free in the upper third.
  • The permatic cord is clamped with a vessel forceps.
  • Release the rest of the spermatic cord and the testicle can be pulled up and out of the incision.
  • Cover the incision with a compress.
  • Remove a wedge-shaped piece of the tumor for frozen sectioning. If the tumor is so small that in cannot be clinically identified, peroperative ultrasound may ensure the biopsy. 

If a malignant tumor is confirmed by frozen section, a radical orchiectomy will be performed.

  • Divide all fibers of the cremaster muscle until the testicular vein is free.
  • Push the peritoneum away from the veins.
  • Clamp and ligate the retroperitoneal vein.
  • Clamp the duct the same way.
  • Close the anterior wall of the inguinal canal and perform thorough hemostasis.  
  • Place the testicle prosthesis in the scrotum if necessary.
  • Close the incision. 

Follow-up Care

  • Postoperative bleeding and hematoma
  • Further work-up and treatment depending on the extent of the cancer

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