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Bilateral orchiectomy


Medical editor Bjørn Brennhovd
Urologist
Oslo University Hospital
Norway

General

Prostate cells, both normal and malignant, are dependent on testosterone stimulation to grow and divide. This is exploited in palliative treatment of prostate cancer. For metastatic disease, treatment aims at halting production of testosterone. Ninety-five percent of testosterone is produced in the testicles.

Production of testosterone in the testicles is most often done chemically with an injection every three months for life. Alternatively, surgical castration of both testicles can be done operatively.

An orchiectomy can be performed through the inguinal or scrotal area.

Indications

  • Locally advanced prostate cancer (T3/T4)
  • Metastatic prostate cancer (N1/M1)

Goals

  • Palliation

  • To reduce symptoms from the disease and prevent serious complications such as spinal cord complications

 

 


Equipment

  • Surgery tray

Preparation

  • Shave the pubis and scrotum

Implementation

The procedure is performed under local anesthesia, spinal anesthesia, or general anesthesia.

Scrotal bilateral orchiectomy

  • Incise the scrotum along the medial raphe
  • Lift one testicle out of the scrotum.
  • Ligate and divide the spermatic cord.
  • Ligate and divide the testicular vessels separately.
  • Repeat on other testicle.
  • Check hemostasis.
  • Insert testicle prosthesis in scrotum if appropriate.
  • Close the incision.

Inguinal bilateral orchiectomy

  • Make a cross incision over the outer inguinal opening.
  • Lift the testicle out of the scrotum
  • Isolate the spermatic cord.
  • Ligate and divide the spermatic cord.
  • Ligate and divide the testicular vessels separately. 
  • Repeat on the other side.
  • Check hemostasis.
  • Insert testicle prosthesis in the scrotum if applicable.
  • Close the incision.

Follow-up

Complications

  • Postoperative bleeding and hematoma with subsequent infection.

Following orchiectomy

  • Loss of libido with erectile dysfunction 
  • Hot flashes
  • Fatigue
  • Osteoporosis
  • Muscular atrophy

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