You are here: Urology Textbook > Urologic surgery > Simple orchiectomy

Simple Orchiectomy via a Scrotal Approach: Surgical Technique and Complications

Indications for Simple Orchiectomy

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

Contraindications of Scrotal Orchiectomy

• Bleeding disorders
• If testicular cancer is suspected, an inguinal approach is mandatory.
• The other contraindications depend on the surgical risk due to the patient's comorbidity and the surgical procedure's impact on the patient's quality of life.

Surgical Technique of Simple Orchiectomy

Preoperative Patient Preparation:

Supine positioning. Spinal or general anesthesia, Perioperative antibiotic prophylaxis if risk factors for surgical site infections are present.

Scrotal Approach:

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

Subcapsular (Bilateral) 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 testis is delivered into the wound. The tunica albuginea is incised from the upper 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 contralateral testis is reached via the same incision. The skin is closed with a fast absorbable (monofilament) suture 4-0.

Simple Orchidoepididymectomy:

Complete simple orchiectomy is indicated for infection, testicular trauma, or after missed testicular torsion. After the skin incision, mobilize the testis with the intact tunica vaginalis parietalis. Tension on the testis enables mobilization of the spermatic cord up to the superficial inguinal ring. Open the spermatic cord and transect the vas and the testicular vessels separately between overholt clamps and suture ligations. Use cautery to control the remaining bleeding. Place a Redon suction drain if orchiectomy was done for severe infection. A running or interrupted suture closes the subcutis. Close the skin with fast absorbable (monofilament) suture 4-0.

Complications of Orchiectomy

• Bleeding with hematoma
• Wound infection, wound dehiscence
• Chronic pain
• Hypogonadism depending on the contralateral testicular function

References

J. A. Smith, S. S. Howards, G. M. Preminger, and R. R. Dmochowski, Hinman’s Atlas of Urologic Surgery Revised Reprint. Elsevier, 2019.

  Deutsche Version: Skrotale Orchiektomie

Urology-Textbook.com – Choose the Ad-Free, Professional Resource

This website is designed for physicians and medical professionals. It presents diseases of the genital organs through detailed text and images. Some content may not be suitable for children or sensitive readers. Many illustrations are available exclusively to Steady members. Are you a physician and interested in supporting this project? Join Steady to unlock full access to all images and enjoy an ad-free experience. Try it free for 7 days—no obligation.