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In cases of radical orchiectomy, it may take up to a week for the pathologists to fully evaluate the specimen. There are several types of testicular cancer, and subsequent treatment may depend on the type and extent of the cancer found in the specimen.
For this reason, we rarely perform a biopsy prior to recommending radical orchiectomy. Leaving a testicle in the body that has cancer is far more of a danger than removing a testicle that has no cancer. ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation.
While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional.
While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions.
Please call your doctor if you have any questions. Preparation As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery.
Procedure To review the basics of what we discussed in the office: The procedure can take anywhere up to an hour depending on an individual's anatomy and whether there was a prior history of surgery in that area. Post Procedure You will be in the recovery room for a short time before being sent home.
Expectations of Outcome Swelling from procedures involving the groin and scrotum can persist for days or weeks. Possible Complications of the Procedure ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems.
Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to: Infection: Infection is possible in any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require drainage of the wound. Even for patients with Fournier gangrene, necrotizing fasciitis around the male genitalia, requiring emergent surgical debridement, the need for orchiectomy is rare due to the independent blood supply to the testis.
Simple orchiectomy may be performed for chronic orchalgia after exhaustive efforts have been made to resolve issue with nonsurgical intervention, although the preferred intervention is microsurgical denervation with transection of the branches of the genitofemoral nerve and preservation of the testis, vas, and testicular artery 7.
In cases of testicular torsion at the time of scrotal exploration, the testis is detorsed and observed; if viable orchiopexy is performed and if not viable, then simple orchiectomy to remove ischemic tissue is necessary. Malignant diseases of the testes, such as suspected germ cell tumor, should never be managed with simple orchiectomy through a transscrotal approach. Suboptimal approaches to testicular neoplasms, including scrotal orchiectomy and transscrotal biopsy, can alter the normal lymphatic drainage of the testis and increase the burden of therapy for the patient 8.
A meta-analysis of cases of scrotal violation reported a local recurrence rate of 2. Therefore, if there is any suspicion of testicular cancer, a radical orchiectomy through an inguinal incision should be performed.
The indications for surgical or chemical castration in the treatment of advanced prostate cancer are not altogether clear. Although it is clear that castration is beneficial for patients with symptomatic metastatic disease 9 and should be avoided in those with localized disease because it may result in decreased overall survival 10 , for patients who do not fit into either of these categories, the timing of initiation of castration is controversial.
Medical castration is an alternative to bilateral simple orchiectomy. Although surgical castration rapidly results in a decrease in circulating androgen 1 , medical therapies can achieve a similar result either through inhibition of androgen synthesis, blockade of the androgen receptor, or inhibition of gonadotropin-releasing hormone GnRH. The most commonly used modality of medical castration are GnRH agonist; analogues of GnRH that inhibit the pituitary gonadal axis, resulting in the downregulation of luteinizing hormone-releasing hormone receptors and subsequent decrease in gonadotropin secretion.
Importantly, these cause a temporary increase, or flare, in the available androgen and may result in exacerbation of life-threatening symptoms and coadministration to block the flare with an antiandrogen is standard practice. For patients with impending spinal cord compression, surgical castration or medical castration with ketoconazole provides the most rapid declines in circulating androgen to prevent impending impingement.
Although the psychological effects of surgical castration can be daunting for the patient, from an economic viewpoint, surgical castration is much more cost-effective than medical castration. One last consideration is that surgical castration is irreversible, whereas medical castration may be given intermittently, although to date, there is an ongoing debate whether intermittent androgen blockade has equivalent outcomes. Local anesthetic sensory blockade is obtained by infiltrating the spermatic cord in the region of the vas deferens in the high scrotum just below the pubic tubercle with a 0.
This is the most common operation performed for testis cancer worldwide. However, as our understanding of this disease and surgical technique has improved, testis-sparing surgery or partial orchiectomy has become an option for some patients.
This surgery involves removing the testicle and spermatic cord where it exits the body to identify and likely treat the majority of cancers localized to the testis. As a male fetus develops, the testes develop near the fetal kidneys. As the fetus grows, the testicles separate from the kidneys and, at about the eighth month of pregnancy, the testicles exit the body wall to rest in the scrotum this is why premature infants have a higher likelihood of having undescended testicles.
Therefore the blood supply, lymphatic drainage and nerves to the testicle originate near the kidney on that side. Once these structures exit the body through the internal inguinal ring, they fuse with muscles of the body wall to form the spermatic cord.
To correctly stage and prevent any cancer from spreading, the spermatic cord must be taken as high toward or inside the body as possible — hence the incision in the groin rather than the scrotum. For men whose cancer has spread from the testicle and who have metastatic testis cancer elsewhere in the body or in the lymph nodes of the retroperitoneum, radical orchiectomy is an important first step in the diagnosis and management of disease. Knowing the type of cancer may help guide chemotherapy or radiation treatments.
The survival rate is higher for men diagnosed with early-stage cancer and lower for men with later-stage cancer. Neomi Apprich Teacher. How long does it take to heal from testicular torsion surgery? Rest at home for several days. You may wear a scrotal support for a week after surgery. Avoid strenuous activity for 1 to 2 weeks. Slowly start doing your normal activities. Castor Antwerp Teacher. How long does it take to recover from Orchiopexy?
Iuri Nerurkar Teacher. What are the side effects of having one testicle? Is it linked to any health risks? Testicular cancer. People with an undescended testicle have an increased risk of this type of cancer. In rare cases, having one testicle can reduce your fertility. Ihssane O'Connor Teacher. What age should Orchiopexy be done? Orchiopexy should not be performed before 6 months of age , as testes may descend spontaneously during the first few months of life.
The highest quality evidence recommends orchiopexy between 6 and 12 months of age. Ask A Question. Co-authors: 5. Updated On: 25th June,
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