Simple Orchiectomy in Nepal

Every procedure requires the patient to stay in a certain position. For a simple orchiectomy, the patient is made to lie in a flat or in medical terms, a supine position on an operating table. The patient is prepped and draped in the usual standard sterile manner. The penis is taped against the abdomen so that the scrotum is exposed. The nurse will shave a small area to prepare the region for an incision.

It is a simple procedure that takes only 30 minutes to be performed. It is done under local or regional anesthesia or epidural anesthesia. An example of a commonly used local anesthetic (LA) is the lidocaine. Epidural anesthesia is given by injecting a needle into a small area of the back so that anesthetic can be injected into the epidural space.

After the anesthetic has been administered, the surgeon makes an incision in the midpoint of the scrotum and cuts through the underlying tissue, going through the skin, subcutaneous tissue, dartos layer, and the tunica vaginalis.

The surgeon removes the testicles, along with all the gubernacular attachments, and parts of the spermatic cord through the incision. All the bleeders are coagulated. The incision is closed with two layers of sutures and covered with a surgical dressing.

If the patient desires, a prosthetic testicle can be inserted before the incision is closed to present an aesthetic outward appearance of a pre-surgical scrotum.

Simple orchiectomy can be performed as an outpatient procedure. The typical length of time for this procedure is usually about 30 minutes. Nonetheless, you always have the option to stay a little longer at the hospital for your recovery if you choose.

It is also important that you have regular check-ups with your surgeon while you’re still in recovery. In most cases, the doctor will use stitches that dissolve on their own in about 1 to 3 weeks and do not need to be removed.

The usual recovery time can take about a month. The first two weeks can be especially painful and patients are advised to not engage in vigorous exercise or effort. The Doctor will prescribe pain medications (NSAIDS) to ease your discomfort. It is very advisable that you take 2 weeks off work after the operation to fully help the recovery.

• After the procedure has been completed, the patient can leave. However, they are advised to rest up, especially on the day of the surgery. It is common to feel giddy after receiving anesthesia, so the patient should not be worried.
• It is advised to drink plenty of fluids, about 24 to 32 ounces above the regular water intake is recommended. Carbonated drinks, tea, coffee, and alcohol do not equate to healthy fluids. These liquids happen to be diuretics, and will, in turn, cause excess urination, leading to dehydration.
• The patient is advised to wear a scrotal support for the first two days after the surgery has been performed.
• Ice or an ice pack can be used to reduce swelling in the scrotum or around the incision.
• Wash the area gently with a mild soap when you are ready to take a bath or shower.
• Keep your incision area dry and covered in gauze for the first few days to prevent any sort of risk of developing an infection.
• Patients should take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) for your pain.
• The patient should avoid lifting heavy items for some period of time (at least two weeks) after the surgery.
• The patient can apply creams or ointments according to the doctor’s instructions.
• It is advised that the patient abstains from straining during bowel movements.
• The patient can return to their regular diet as long as they keep their water intake in check. However, a high-fiber diet may be helpful to make stools softer, which, in turn, will require less strain when you are going to the toilet.
• After the procedure, the area may be sore once the anesthesia starts to wear off, over the course of which, the patient will experience some pain and discomfort. There may even be burning when urinating.
• The patient might witness blood in their urine. Do not be alarmed, this will improve in one to three days.
• According to the doctor’s advice, the patient should abstain from sexual activity for at least one week to let the area heal.

Simple orchiectomy has a high success rate where most patients leave the operating room happy with the procedure.

Following bilateral simple orchiectomy, there can be depletion in androgen levels, a relative increase in estrogen levels, metabolic changes, and other numerous consequences, including:  

• Immediate loss of fertility
• Hot flushes
• Decreased libido
• Erectile dysfunction
• Gynecomastia
• Osteoporosis
• Anemia and fatigue
• Changes in mood and cognition
• Pain or redness around the incision
• pus or bleeding from the incision
• Fever over 100°F (37.8°C)
• Inability to urinate
• Hematoma, which is blood in the scrotum and usually looks like a large purple spot
• Loss of feeling around your scrotum

Alternatives to a simple orchiectomy are observation and certain drugs, like LHRH analogs, anti-androgens, steroid anti-androgens, estrogens. Other more advanced hormonal therapy regimens and experimental chemotherapy have been reserved for later stages of cancers.