Orchiectomy is the removal of the testicle. This can take the form of a “simple” orchiectomy which is performed for benign disease such as testicular torsion or infection or pain or mass, or it can be as a “radical” orchiectomy for suspected testicular cancer.  Testicular masses are generally asymptomatic, and thus can grow to pretty large sizes before they are detected.  Simple orchiectomy is performed similar to the description here.

Radical orchiectomy for testicular cancer is performed in a slightly different manner.  An incision in the groin area is performed and the spermatic cord is isolated in the inguinal canal.  the testicle is then brought up through the inguinal canal in the groin and out the incision by inverting the scrotum.  The gubernacular attachments are tied off and cut, and then the spermatic cord is pedicled, and ligated in sections and cut.  The ligaments which form the inguinal canal are then reconstructed, and the fascia and skin closed overtop.  The reason that the incision in this case is made in the groin as opposed to in the scrotum is that the testicle has lymphatic drainage which travels along the spermatic cord and into the abdomen and pelvis, but if an incision is made in the scrotal skin, theoretically, cancer cells can be introduced to this entirely new lymphatic drainage territory and spread in the groin and superficial layers of the pelvis.

Pathologic diagnosis usually takes about a week to return, and you will have a followup clinic arranged for you with your Urologist to discuss the final pathologic diagnosis as well as any further treatments required based on that diagnosis.  Those treatment modalities might include radiation and/or chemotherapy.

Potential complications of this operation follow that of general scrotal surgery such as in hydrocelectomy, as well as injury to any structures in the groin area such as the ilioinguinal nerve, and the femoral artery and vein.  Hernia can also be a result of weakening of the fascia in the area of the dissection.

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