Orchiectomy

Orchiectomy, also known as orchidectomy, is a surgical procedure to remove one or both testes. A unilateral orchiectomy removes one testis and is commonly performed for suspected or confirmed testicular cancer or as part of gender-affirming care in transgender women. A bilateral orchiectomy removes both testes and results in permanent infertility and a substantial reduction in testosterone. In cancer care, the operation is typically performed via an inguinal approach with high ligation of the spermatic cord to minimize the risk of spreading tumor cells; a scrotal incision is generally avoided when malignancy is suspected.

Indications include treatment of testicular cancer, where orchiectomy provides diagnostic tissue and local control, and androgen deprivation therapy for advanced prostate cancer when medical therapy is insufficient or unsuitable. It is also used as part of gender-affirming surgery for transgender women as a permanent method of reducing masculinizing hormones.

The procedure is usually done under general or regional anesthesia. For unilateral removal, patients typically recover quickly, with a short hospital stay or outpatient procedure. Bilateral removal causes castration and necessitates lifelong management of low testosterone levels, often with hormone replacement therapy. Potential complications include infection, hematoma, seroma, wound healing problems, and chronic pain. Bilateral orchiectomy carries symptoms of hypogonadism such as fatigue, decreased libido, mood changes, osteoporosis, and hot flashes. Fertility is not preserved after bilateral removal, and fertility may be affected in unilateral cases if the remaining testis is nonfunctional.

Outcomes depend on the underlying reason for surgery. In testicular cancer, orchiectomy is usually the first step in treatment; for prostate cancer or gender-affirming care, it serves as a modality to achieve hormonal goals.