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Definition of Orchiectomy Procedure
Orchiectomy is a surgical operation to remove one testicle (unilateral orchiectomy) or both testicles (bilateral orchiectomy) in a man.
Bilateral orchiectomy is typically a treatment for advanced prostate cancer.
The testicles produce both testosterone and sperm. Many men who undergo unilateral orchiectomy retain their fertility and full sexual function. However, other treatment such as chemotherapy may affect sperm production and thus fertility.
Bilateral orchiectomy ends production of both testosterone and sperm, resulting in permanent infertility. The intent of bilateral orchiectomy is to cut the supply of testosterone that feeds prostate cancer cells, as prostate cancer is one of the hormone-driven cancers.
For unilateral orchiectomy the surgeon removes the testicle through an incision in the lower abdomen, just above the pubic hair line. The incision exposes the inguinal canal, a passage of ligaments through which the testicles originally descended into the scrotum.
The surgeon manipulates the testicle upward from the scrotum into the lower abdomen, extracting it through the incision. This procedure prevents damage to the scrotum that could allow cancer cells to escape into the lymph nodes; the testicles and the scrotum use different lymph networks so the surgeon does not want to disturb the scrotum or create a circumstance in which cells from the testicle can enter the lymph nodes that serve the scrotum.
For bilateral orchiectomy as prophylactic treatment for advanced prostate cancer the surgeon may make the incision in the scrotum.
Side Effects and Risks
The key risks of orchiectomy include excessive bleeding and infection. Unilateral orchiectomy sometimes lowers testosterone levels, which the doctor may treat with testosterone supplementation. Long-term complications that occur with bilateral orchiectomy include loss of bone density and increased risk for osteoporosis, gynecomastia (enlarged breasts), and erectile dysfunction.
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