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Andrology

An orchidectomy (also called orchiectomy) is done to help control the growth of prostate cancer. It is an operation to remove your testicles (testes). Prostate cancer needs testosterone in order to grow. Testosterone is the male sex hormone produced by the testicles. If the testicles are removed, the level of testosterone in your blood falls very quickly. And in 9 out of 10 men (90%) the prostate cancer will stop growing and start to shrink.

Orchidectomy is not used very often these days because hormone treatments are available that can reduce testosterone levels. Some men choose to have an orchidectomy. They like the fact that it is one treatment compared to the injections which you have either monthly or 3 monthly. Other men don't like the fact that the surgery is not reversible and they worry about how they will feel about themselves after having their testicles removed. It is important to talk through with your doctor the pros and cons of having an orchidectomy.

How Orchidectomy Is Done ?

Orchidectomy is a simple operation. The surgeon makes a small cut in your scrotum (the sac which holds your testicles). After removing your testicles, your surgeon may put in plastic balls (fake testicles or prostheses) so that your scrotum looks and feels the same.

You may be able to have a smaller operation to remove only the inner part of your testes. It is called subcapsular orchidectomy. With this operation you don't need a prosthesis.

Orchiopexy

Orichiopexy is an operation in which the Paediatric Surgeon moves an undescended testicle down into the base of the scrotum. An orchidopexy is indicated in those boys whose testicle has not fully descended into the scrotum by the age of 1 year of life.

Why Does The Operation Need To Be Performed?

Orchidopexy is performed to maximise fertility, to minimise the chance of trauma or torsion (twist), to ensure cosmetic symmetry in the scrotum and to make it easier for the boy, when he is older, to check himself thoroughly for cancers of the testicle.

How Is The Operation Performed?

Orchidopexy is performed as a day case procedure. Under a full general anaesthetic, a cut is made in the inguinal region of the groin as well as on the base of the scrotum. The Paediatric Surgeon identifies where the testicle is located and carefully mobilises it to a sufficient length to enable its placement within the scrotum. At the same time, the sac of a potential hernia which is present in up to 90% of cases, is also tied off and removed. Once fully mobilised, the testicle is passed down into the scrotum and placed in a pouch just below the skin. The stitches on the scrotum may be visible after the operation, however, they will dissolve of their own accord within 2-3 weeks. The stitches in the groin are under the skin and should not be visible. They also dissolve of their own accord but after 1-2 months. Whilst the child is asleep, the nerves to the scrotum and groin are anaesthetised with local anaesthetic. The operation takes approximately one hour.

What Happens After The Operation?

After the operation, the child is usually comfortable for 6-8 hours, after which time he may require regular pain relieving medication by mouth for 3-4 days. The child may shower or have a quick bath whenever he feels comfortable to do so. In most cases, the boys who undergo an orchidopexy have a week off school, but there is no necessary restriction to their activities.

What Are The Possible Problems After The Operation?

The two most common complications are bleeding/bruising and infection. Both the groin area and the scrotum may become significantly swollen and bruised following the operation, however, it is unusual that any further operations are required and this usually resolves of its own accord after 1-2 weeks. If either of the wounds become more red, more swollen and more sore rather than less so 2-3 days following the operation, then infection is almost certainly present. If infection occurs, it usually responds to a course of antibiotics. In some boys who have a particularly high testicle, the blood supply to the testicle may be damaged as a result of the operation. Parents are usually warned of this possibility before the operation. If this complication occurs, the testicle will become smaller, and may wither away to almost nothing over the subsequent weeks.

Will The Operation Be Successful?

The results of the operation are usually excellent, however, in approximately 5% of cases a further operation may be necessary to bring the testicle down into the scrotum again as it may tend to drift higher as the boy becomes taller. Because of this possibility occurring, the Paediatric Surgeon will need to review the boy on a regular basis for some years after the operation.

Penectomy:

A penectomy to remove part (partial penectomy) or all of the penis (known as a radical or total penectomy) may have to be carried out if other treatments are not appropriate or have proved ineffective. In cases of cancer of the penis the lymph nodes in the groin may also be removed. Removing lymph nodes can help prevent further spread of cancerous cells in the body.

Partial removal of the penis involves removing just the tip or head of the penis. The surgeon aims to save as much of the shaft of the penis as possible. This assists with urination by allowing the stream of urine to be directed away from the body. It also means that men can pass urine standing up in public washrooms and so maintain previous habits and routines.

Total (radical penectomy) removes the entire penis. This includes the parts of the penis that extend into the pelvis. Passing urine is achieved by creating a new opening for the urethra, the tube that carries urine from the bladder.

Varicocelectomy:

Varicocelectomy

Varicocelectomy is by far the most commonly performed operation for the treatment of male infertility. The goal of treatment of the varicocele is to obstruct the refluxing venous drainage to the testis while maintaining arterial inflow and lymphatic drainage.

In principle, repair of varicocele should halt any further damage to testicular function, and in a large percentage of men, results in improved spermatogenesis as well as enhanced Leydig cell function. Urologists, therefore, have a potentially important role in preventing future infertility, which underscores the importance of using a varicocelectomy technique that minimizes the risk of complications and recurrence.

A variety of surgical and nonsurgical approaches have been advocated for varicocelectomy. They include minimally invasive procedures, such as laparoscopic varicocelectomy and transvenous percutaneous embolization, and the traditional open surgical approach (retroperitoneal, inguinal and subinguinal). The current standard of care is to perform open surgical varicocele repair with microscopic assistance to minimize possible complications.

Vasectomy:

Vasectomy

Vasectomy is an effective and permanent form of contraception. The operation is quicker, easier and more effective than female sterilisation. There is a very small failure rate. Sterilisation is only for people who have decided they do not want children, or further children in the future. It is considered a permanent method of contraception, as reversal is a complicated operation which is not always successful. In addition, reversal is not usually available on the NHS.

What Is Vasectomy?

Vasectomy is a small operation to cut the vas deferens. This is the tube that takes sperm from the testes to the penis. Sperm are made in the testes. Once the vas deferens is cut, sperm can no longer get into the semen that is ejaculated (comes) during sex.

How Reliable Is Vasectomy?

Vasectomy is very reliable - but not quite 100%. Even after a successful operation about 1 in 2,000 men who have had a vasectomy will become fertile again at some point in the future. This is because, rarely, the two ends of the cut vas deferens re-unite over time. (When no contraception is used more than 80 in 100 sexually active women will become pregnant within one year.) About 1 in 1,000 operations are not successful and tests show sperm are still present in semen after the operation

How It Is Done?

Vasectomy is usually done under a local anaesthetic. Sometimes it is done under a general anaesthetic. Local anaesthetic is injected into a small area of skin on either side of the scrotum above the testes. A small cut is then made to these numbed areas of skin.

The vas deferens can be seen quite easily under the cut skin. It can be cut with a scalpel (surgical knife) or using diathermy. Diathermy is electrical current that cuts the skin and stops bleeding at the same time. This is now more common. The small cuts to the skin are then stitched or stuck back together with tape. Dissolvable stitches are used if the cut is stitched. The operation takes about 15 minutes.

There is usually some discomfort and bruising for a few days afterwards. This normally goes away quickly. The discomfort can be helped by wearing tight-fitting underpants day and night for a week or so after the operation. It is also best not to do heavy work, exercise or lifting for a week or so after the operation.

Are There Any Risks To The Operation?

Most men have no problems after a vasectomy. Problems are uncommon but include the following: 

  • As with any operation or cut to the skin, there is a small risk of a wound infection.
  • The bruising around the operation site is sometimes quite marked, but will go in a week or so.
  • Rarely, sperm may leak into the scrotum and form a swelling which may need treatment.
  • A small number of men have a dull ache in the scrotum for a few months after the operation. This usually settles over time.
  • If you have a general anaesthetic, as with any operation, there is a small risk associated with the anaesthetic.

How Do I Know It Has Been Successful?

Some sperm survive in the upstream part of the vas deferens for several weeks after vasectomy. These can get into the semen for a while after the operation. About eight weeks after the operation you will need to produce two semen tests about 3-6 weeks apart. These are looked at under the microscope to check for sperm. If these have no sperm in them, you will be given the all clear.