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Scrotal Orchiectomy

Indications for Scrotal Orchiectomy

• Bilateral orchiectomy as an anti-androgenic therapy in advanced or metastatic prostate cancer
• Testicular abscess due to infection (e.g. epididymitis)
• After testicular trauma with completely infarcted or shattered testis
• Missed testicular torsion with complete necrosis

Contraindications of Scrotal Orchiectomy

• Manifest coagulation disorders
• If testicular cancer is suspected, an inguinal approach is mandatory

Surgical Technique of Scrotal Orchiectomy

Preoperative Preparation:

Supine positioning. Spinal or general anesthesia, perioperative antibiotic prophylaxis if risk factors for wound infection are present.

Surgical Access:

Scrotal skin incision along the raphe testis, both testicles can be reached with the same incision. Alternatively, a transverse incision between scrotal vessels is possible.

Subcapsular Orchiectomy:

The subcapsular orchiectomy (Riba’s technique) is indicated for advanced prostate carcinoma and avoids the feeling of an empty scrotum after orchiectomy. After the skin incision and incision of the tunica vaginalis parietalis, the tunica albuginea is incised from the upper pole to the lower pole. The protruding testicular tissue is detached from the tunica albuginea until the parenchyma is only fixed to the hilus. The hilar vessels are secured with a clamp and the testicular tissue is dissected and removed. A figure-of-eight suture closes the hilar vessels. Careful cautery is done to control remaining bleeding. The tunica albuginea is closed with a running suture (e.g. vicryl 3-0). The next running suture adapts the tunica vaginalis parietalis and subcutis. The skin is closed with absorbable sutures (e.g. monocryl 4-0).

Skrotal Orchidoepididymectomy:

Compete orchidoepididymectomy is indicated for infection or after missed testicular torsion. After skin incision, the testis is mobilized with intact tunica vaginalis parietalis. Tension on the testis enables to mobilize the spermatic cord. The spermatic cord is opened and the vas and the testicular vessels are dissected separately between overholt clamps and suture ligations. Careful cautery is done to control remaining bleeding. A running or interrupted suture closes the subcutis. The skin is closes with absorbable sutures (e.g. monocryl 4-0).

Complications of Orchiectomy

• Bleeding with hematoma
• Wound infection
• Hypogonadism depending on the contralateral testicular function

References

  Deutsche Version: Skrotale Orchiektomie