ORCHIDECTOMY

DEF : orchidectomy can be defined as removal of one or both the testicle

Indication :
Unilateral orchidectomy:
1. Unilateral orchidectomy are the removal of one testicle is performed for unilateral testicular disease.
2. In testicular maldescent ,when orchidopexy is not possible owing to lack of cord length or where a maldeveloped testicular remanant is not

salvageable
3. For trauma in crush injuries when complete testicular disruption may necessitate the removal or non viable organ.

4. For torsion where failure to relieve torsion has resulted in total infarction, it may be necessary to remove the destroyed organ.
5. For injection – on rare occasions, in uncontrolled acute pyogenic or tuberculous infection testicular destruction with scrotal ulceration may occur and

orchidecdtomy is indicated to secure heading
6. For malignant disease – a tumour arising in the body and in the testis is by for the most common indication for orchidectomy
7. in conjuction with inguinal hernial repair

NOTE:
In all cases of unilateral orchidectomy, the patient should be reassured that the removal of one testicles will in no way affect the patency or

fertility

Bilateral orchidectomy:
Bilateral orchidectomy is indicated for the endocrine control of prostatic carcinoma. It is based on the fact the activity of the prostatic

malignant process is subject to the hormonal influence of testicular androgens. Provides a simple method for the control of malignant disease.

Patient preparation
Position : the patient can be positioned on the table either in supine position or lithotomy position’
Skin preparation:
Begin at the scrotum, extending from the umbilicus to the midthighs and down to the table at the sides.
Anaesthesia
General, spinal, epidural, or local anaesthesia can be administered

Draping:
Folded t owels under the scrotum over the abdomen and 2 laprotomy side sheets
Orchidectomy tray:
1. gown pack
2. linen pack
3. surgical gloves
4. OT guaze
5. abdominal swab
6. bowel
7. sponge holder
8. towel clips
9. mosquito straight artery forceps
10. mosquito curved artery forceps
11. medium straight artery forceps
12. medium straight artery forceps
13. long straight artery forceps
14. long straight artery forceps
15. straight scissors
16. curved scissors
17. B P handle (bard parker)
18. scalpel
19. dissecting toothed forceps
20. dissecting non tothed forceps
21. allis tissue forceps
22. needle holder
23. blade 11 & 15
24. suture material 2-0 chromic
25. suture material 2-0,3-0 free ties
procedure:
1. The skin incision, which is made 1.25 cm above and parallel to the inguinal ligament is 5cm long and extends from above the pubic tubercle to the mid

night of the inguinal element
2. fat , superficial and deep fascia are divided in this in this line to expose the aponeurosis of the external oblique muscle and the external inguinal

ring
3. the aponeurosis is now divided in the line of the fibres from the apex of the external ring to the level of the internal ring, exposing the

underlying spermatic cord. The cord is then mobilized.
4. at the internal ring, the testicular veins join to form two or three well defined vessels these are identified and dissected free and ligated flush

with the muscles at the internal ring.
5. the vas is identified next clamped and divided and finally the remaining portion of the cord cantaining the testicular artery, and the artery of the

vas is ligated and divided.
6. it is considered important to proceed in this order when dealing with malignant disease of the testicle in orded to minimize venous embolization of

malignant cells prior to manipulation of the tumour.
7. the distal portion of the cord is now mobilized from its bed the gentle traction 2is to deliver the testis from the scrotum into the lower margin of

the wound.
8. attachments of the external spermatic fascia cremaster to the scrotal wall and surrounding tissues are gently separated by blunt dissection until the

gutenacular attachment of the lower ple of the testis scrotal wall is reached.
9. this fibrous attachment is then divided between haemostats and the testis removed
10. the wound is closed in layers.

1.Supcapsular orchidecdtomy
Incision :
The scrotum is elevated and a longitudinal incision is made through and stretched skin and dartos muscle to expose both testis


2.Evagination of testis :
Each testis is evaginated from the scrotum together with its coverings the tunica vaginalis is incised vertically of the testicle and

epididymis exposed

3.Incision of tunica albuginae:
The visceral tunica is incised vertically over the globe of thetestis
4.Removal of testicular substance:
The testicular tissue is separated from the inner surface of the tunica albuginae by blunt of sharp dissection. Careful haemostasis is required

in then region of the testis at the upper pole .
5.closure of tunica:
When all visible testicular tissue has been removed, the tunica is closed with a continuous vertical 3-0 chromic plain catgut suture and the

testicle is replaced in its scrotal covering.

6.closure of scrotum:
The scrotum is closed in two layers with a continuous vertical 3-0 chromic and interrupted 3-0 nylon sutures to the transverse skin incision.

There is no need to drain the scrotum

7.testicular prosthesis:
Should a letter simulation of the testicular body be required, it is possible to insert a silastic prosthesis into the tunica albuginae at the

time of operation.