What is removal of the testes (orchiectomy)
Removal of one or both testes, called an orchiectomy, is a surgical procedure performed for medical reasons such as testicular cancer, severe injury, chronic pain, or certain endocrine conditions. The surgery can be done on one side (unilateral) or both sides (bilateral), and it may be partial (removing only the testicle while preserving surrounding tissue) or radical (removing the testicle along with nearby structures). This overview explains why the procedure is done, how it is performed, what to expect during recovery, and the long-term impacts on fertility and hormonal health.
Medical reasons for orchiectomy
Orchiectomy is typically recommended for serious conditions affecting the testicle or nearby structures. The most common medical reasons include testicular cancer, advanced prostate cancer in which removing testosterone production is beneficial, traumatic injury that cannot be repaired, chronic infections or abscesses, uncontrollable pain, and undescended testes that cannot be repositioned. In some cases, it is done to reduce high testosterone levels in certain hormonal disorders when other treatments have failed.
Testicular cancer
Testicular cancer often presents as a painless lump or swelling. Treatment usually involves surgery to remove the affected testicle (radical inguinal orchiectomy) to both treat the cancer and allow pathologists to examine the tissue for further guidance. Removing the testicle is a common and often curative step when the cancer is localized.
Prostate cancer
In certain cases of prostate cancer, reducing testosterone can help slow tumor growth. Bilateral orchiectomy may be used to lower testosterone levels quickly, particularly when other hormone therapies are not suitable. This approach is less common today due to the availability of medication, but it remains an option in specific clinical scenarios.
Surgical methods and approaches
Orchiectomy can be performed using different techniques depending on the clinical need. The standard approach for testicular cancer is an inguinal orchiectomy, where the incision is made in the groin to access the spermatic cord and remove the testicle. Scrotal orchiectomy involves an incision in the scrotum and is typically used for non-cancerous conditions such as severe infection or chronic pain. Both procedures can be done under general or regional anesthesia, and the choice depends on the underlying condition and surgeon preference.
Radical vs. simple orchiectomy
In a radical orchiectomy for cancer, the surgeon removes the testicle, part of the spermatic cord, and sometimes nearby lymph nodes to ensure complete removal of affected tissue. For non-cancerous issues, a simple orchiectomy may be sufficient, removing only the testicle while preserving more of the surrounding structures. The surgical plan is tailored to the diagnosis and treatment goals.
Recovery and hospital stay
Recovery from orchiectomy varies based on the surgical approach and the patient's overall health. Most patients stay in the hospital for a few hours to one day, though some go home the same day. Pain, bruising, and swelling at the incision site are common and are managed with medication. Activity restrictions, including avoiding heavy lifting and strenuous exercise, are typically recommended for two to six weeks. Follow-up visits allow the care team to monitor healing and discuss next steps, such as prosthesis options or further treatment.
Long-term effects: fertility and hormones
Removing one testicle usually does not cause infertility if the remaining testicle functions normally, but removing both testes results in infertility because sperm production stops. Men who wish to preserve fertility before a bilateral orchiectomy may consider freezing sperm. Hormonal changes are more pronounced after bilateral removal, often leading to reduced testosterone production. This can cause symptoms such as fatigue, reduced libido, and changes in mood or bone density. These effects can typically be managed with hormone replacement therapy and regular medical follow-up.
Comparing types of orchiectomy and key details
| Type / Attribute | Details | Notes or Context |
|---|---|---|
| Unilateral orchiectomy | Removal of one testicle | Often used for cancer in one testis; preserves some hormonal function |
| Bilateral orchiectomy | Removal of both testicles | Causes infertility and significant hormone changes; requires hormone monitoring |
| Radical inguinal orchiectomy | Standard approach for testicular cancer | Incision in groin; may include removal of part of the spermatic cord |
| Scrotal orchiectomy | Incision in the scrotum | Used for non-cancerous conditions such as infection or pain |
| Inpatient vs. outpatient | Typically outpatient or short stay | Depends on anesthesia, surgical approach, and recovery needs |
| Fertility preservation option | Sperm banking before surgery | Recommended if future biological children are desired |
Risks and considerations
As with any surgery, orchiectomy carries risks such as bleeding, infection, reactions to anesthesia, and pain at the incision site. Long-term considerations include infertility and the need for hormone replacement after bilateral removal. Scarring and changes in scrotal appearance are also possible. Discussing these risks with a healthcare provider helps ensure realistic expectations and appropriate preparation.
Living after orchiectomy
Many men return to normal activities after recovery, with adaptations depending on their hormonal status and fertility plans. Regular follow-up visits support monitoring of hormone levels and overall health. Emotional support and education about managing changes are important parts of aftercare. With proper medical follow-up, most people maintain good health after orchiectomy.