Orchiectomy is a surgical procedure to remove a testicle to treat cancer or torsion

Orchiectomy, or testicle removal surgery, is a medical procedure in which one or both testicles are surgically removed. This operation is necessary in certain cases such as testicular cancer, advanced prostate cancer, sudden testicular torsion, or severe injuries.Although the idea of removing a testicle can be frightening for many men, this procedure has clear medical indications and significant benefits. It can help prevent the spread of cancer, protect the body from complications caused by infections or serious trauma, and in some cases, improve overall quality of life.In this Dalili Medical article, we will discuss everything you need to know about orchiectomy — including its types, surgical techniques, recovery tips after the procedure, and the most important risks and benefits — so it can serve as a comprehensive guide for anyone seeking reliable information about this topic.

1. Does orchiectomy affect fertility?

If only one testicle is removed and the other is healthy, fertility usually remains normal.

If both testicles are removed, fertility is typically lost. However, in some cases, sperm can be preserved (sperm banking) before surgery for future use.

2. Will I lose testosterone after the surgery?

Removing one or both testicles reduces testosterone production.

If both testicles are removed, lifelong hormone replacement therapy is usually required to maintain overall health, energy levels, bone strength, and sexual function.

3. Is the procedure painful?

Some pain after surgery is normal. It is usually mild to moderate and gradually improves within one to two weeks.

Pain relievers, adequate rest, and proper scrotal support can significantly reduce discomfort.

4. How long does recovery take?

Most patients gradually improve within 4 to 6 weeks.

Light movement and short walks can often begin a few days after surgery, depending on the doctor’s advice.

5. Will I need follow-up visits?

Yes, follow-up appointments are essential to:

Check the surgical wound
Ensure proper healing
Adjust hormone therapy if needed

6. Are there possible complications after orchiectomy?

Possible complications may include:

Bleeding
Swelling
Infection
Chronic pain
Psychological impact

Most complications are manageable, and regular medical follow-up reduces potential risks.

7. Can I return to my normal life after surgery?

After the initial recovery period, most patients can return to their regular daily activities.

It is recommended to avoid intense exercise and heavy lifting for at least 4 to 6 weeks.

8. Does orchiectomy have psychological effects?

It is normal to feel anxiety, sadness, or emotional distress after losing a testicle, especially for younger men or in cases involving fertility loss.

Psychological support or consulting a mental health professional can help with adjustment and emotional well-being.

What Are the Benefits of Orchiectomy?

Although the idea of removing a testicle can be frightening, orchiectomy offers important medical benefits, especially in serious health conditions.

1. Eliminating Cancer and Preventing Its Spread

Removing the affected testicle is the primary treatment for testicular cancer.

It helps prevent the tumor from spreading to other organs such as the lymph nodes, lungs, or liver.

2. Treating Testicular Torsion or Severe Injuries

In cases of testicular torsion, if not treated quickly, the testicle may lose its blood supply and die.

Removing the damaged testicle protects the body from serious complications such as infection or tissue necrosis.

3. Managing Severe Infections

Certain severe infections that cause irreversible damage to the testicle may require removal.

This helps prevent the infection from spreading to other parts of the reproductive system or the body.

4. Preventive Removal in High-Risk Cases

In some situations — such as genetic mutations or congenital conditions that increase the risk of testicular cancer — preventive orchiectomy may be considered.

The procedure significantly reduces the future risk of cancer.

5. Improving Quality of Life in Some Cases

Removing a painful or diseased testicle can relieve chronic pain and improve daily comfort and mobility.

In cases of tumors or severe injury, patients often feel significant relief after removing the source of the problem.

How to Prepare for Orchiectomy

Proper preparation before orchiectomy is essential to ensure a smooth procedure and faster recovery.

1. Consult Your Doctor

Discuss with your doctor:

The reason for surgery
Potential risks
Expected outcomes

Understanding all details helps you make an informed and confident decision.

2. Complete Medical Evaluation

This may include:

Reviewing your medical history
Discussing current medications
Blood tests or imaging studies if necessary

These evaluations help assess your overall health before surgery.

3. Pre-Surgery Instructions

You are usually advised to avoid eating or drinking for at least 8 hours before surgery to reduce anesthesia risks.

4. Medication Management

Inform your doctor about all medications and supplements you are taking.

Some medications, especially blood thinners, may need to be temporarily adjusted or stopped.

5. Arrange Transportation and Post-Surgery Support

Since orchiectomy is often performed under general anesthesia, you will need an adult to drive you home.

Prepare a comfortable recovery space at home and arrange for help if needed during the first few days.

6. Discuss Anesthesia

Talk to your doctor about the type of anesthesia that will be used and the potential risks, so you can give informed consent.

7. Emotional Preparation

Feeling anxious before surgery is completely normal.

Sharing your feelings with a trusted friend, family member, or mental health professional can help reduce stress and improve emotional readiness.

Indications for Orchiectomy

There are several medical reasons for performing an orchiectomy. The most important include:

1. Testicular Cancer

When a malignant tumor is suspected based on examinations and imaging, inguinal orchiectomy is the primary treatment option.

It helps prevent the spread of cancer through lymphatic channels or the scrotum and confirms the diagnosis through histopathological examination.

2. Advanced Prostate Cancer

In cases of metastatic or castration-sensitive prostate cancer, bilateral orchiectomy may be used as a rapid method to control testosterone levels.

This option is particularly useful for patients who cannot tolerate or do not prefer medical hormone therapy (such as LHRH analogs).

3. Testicular Torsion

This is a medical emergency in which the spermatic cord twists, cutting off blood supply to the testicle.

If not treated within 6–8 hours, the testicle may die. In such cases, removal of the affected testicle may be necessary, along with fixation of the healthy testicle to prevent recurrence.

4. Severe Trauma or Injury

Sports injuries or serious accidents may render a testicle nonviable.

If reconstruction is not possible or there is a high risk of infection, orchiectomy may be recommended to protect overall health.

5. Congenital Conditions

Certain abnormalities, such as undescended testicle (especially after puberty), increase the risk of cancer.

Removal may be advised if orchiopexy is not appropriate or if there is suspicion of malignancy.

6. Hormonal Disorders

Some conditions, such as testosterone-secreting tumors or treatment-resistant hyperandrogenism, may require orchiectomy to control symptoms.

This can help reduce excessive hair growth, severe acne, and symptoms of androgen excess.

7. Gender-Affirming Care

Orchiectomy may be performed as part of gender-affirming care for transgender women, according to WPATH Standards of Care Version 8.

The goal is to stop endogenous testosterone production and reduce the need for long-term anti-androgen therapy.

Types of Orchiectomy

1. Partial Orchiectomy

Description: Removal of only the affected portion of the testicle while preserving healthy tissue.

Used for: Small or localized tumors, or limited injuries.

Benefit: Helps preserve fertility and hormonal function to some extent.

2. Radical Orchiectomy

Description: Complete removal of the testicle along with the spermatic cord.

Used for: Testicular cancer or large masses.

Benefit: Ensures complete removal of the diseased testicle to prevent spread.

Note: Usually performed through an incision in the groin area and may affect fertility if the remaining testicle is weak.

3. Laparoscopic Orchiectomy

Description: Performed through small abdominal incisions using a camera and specialized surgical instruments.

Used for: Undescended testicles located inside the abdomen.

Benefit: Less pain, faster recovery, and smaller scars compared to open surgery.

4. Prophylactic Orchiectomy

Description: Removal of the testicle to prevent cancer in high-risk cases (such as certain genetic mutations).

Used for: Cancer prevention before it develops.

Benefit: Significantly reduces the future risk of cancer.

5. Bilateral Orchiectomy

Description: Removal of both testicles, typically using the same approach as radical orchiectomy.

Used for: Advanced cancers or certain rare conditions.

Benefit: Eliminates the primary source of disease but requires lifelong hormone replacement therapy.

Surgical Approaches for Orchiectomy

1. Partial Orchiectomy Technique

A small incision is made in the scrotum.
The diseased portion is separated and removed while preserving healthy tissue.

Advantage: Maintains as much fertility and hormonal function as possible.

2. Radical Orchiectomy Technique

An incision is made in the groin area.
The entire affected testicle and spermatic cord are removed.

Advantage: Reduces the risk of cancer spread, though it may impact fertility.

3. Laparoscopic Technique

Small incisions are made in the abdomen.
A camera and surgical tools are inserted to remove the undescended testicle.

Advantage: Less pain, quicker recovery, and minimal scarring.

4. Prophylactic Technique

Typically performed using the same method as partial or radical orchiectomy, depending on the case.

Advantage: Greatly lowers the future risk of developing cancer.

5. Bilateral Orchiectomy Technique

Both testicles are removed using the radical approach, either in one session or in staged procedures.

Advantage: Eliminates the hormonal source of disease but requires lifelong testosterone replacement.

Contraindications to Orchiectomy

Certain conditions may make orchiectomy unsuitable or require postponement:

1. Severe Cardiovascular Disease

Patients with serious heart or vascular conditions may face increased surgical risks.

Surgical stress may worsen their condition or lead to postoperative complications.

2. Active Infection

If there is an active infection—especially in the genital area—surgery is usually postponed until the infection resolves.

Operating during an infection increases complication and delayed healing risks.

3. Bleeding Disorders

Patients with clotting disorders or those taking anticoagulant medications have a higher risk of surgical bleeding.

Uncontrolled bleeding may complicate the procedure or recovery.

4. Morbid Obesity

Obesity increases the risk of surgical complications, including infection and delayed wound healing.

The surgeon evaluates the patient’s overall health before proceeding.

5. Poorly Controlled Diabetes

Uncontrolled blood sugar levels increase the risk of infection and delayed healing.

Blood glucose should be stabilized before surgery whenever possible.

6. Psychological Factors

Patients with severe psychological distress or those not emotionally prepared for the consequences of losing a testicle may require psychological evaluation beforehand.

Ensuring informed understanding is essential before consent.

7. Widespread Advanced Cancer

If cancer is extensively metastatic, the risks of surgery may outweigh the benefits.

Comprehensive evaluation by an oncologist determines whether surgery is appropriate.

8. Patient Refusal

If the patient does not consent or does not fully understand the reason for surgery, the procedure cannot be performed.

Risks and Complications of Orchiectomy

Although orchiectomy is generally considered a safe procedure, like any surgery, it carries potential risks and complications.

1. Immediate Surgical Complications

Bleeding:
A small amount of bleeding during or after surgery is possible. In rare cases, medical intervention may be required to stop it.

Surgical Site Infection:
Infection may occur at the incision site or within the scrotum.

Swelling and Bruising:
Temporary swelling or bruising around the scrotum is common after surgery.

2. Complications Related to Testicular Function

Loss of Fertility:
This is especially a concern if the remaining testicle is weak or if the only testicle is removed.

Reduced Testosterone Production:
Removal of both testicles requires lifelong hormone replacement therapy.

Changes in Genital Appearance:
There may be a noticeable difference in scrotal size or appearance after removal of a testicle.

3. Nerve-Related Complications

Numbness or Tingling:
Small nerves in the incision area may be temporarily affected, causing tingling or numbness.

Chronic Pain:
In rare cases, mild persistent pain in the scrotum or upper thigh may continue after surgery.

4. Psychological and Emotional Effects

Some patients may experience anxiety or depression after losing a testicle, particularly younger men or those facing fertility loss.

There may also be an impact on self-confidence or sense of masculinity. Psychological support or counseling can be helpful.

5. Risks Related to Bilateral or Preventive Orchiectomy

Lifelong need for hormone replacement therapy
Increased risk of osteoporosis, muscle weakness, or low energy levels if testosterone is not properly replaced

Expected Recovery Timeline After Orchiectomy

First Few Days After Surgery (Day 1 – Day 3)

Symptoms:
Pain in the scrotum or groin area, swelling, bruising, and a tight sensation.

Management:

Prescribed pain medications
Cold compresses to reduce swelling
Elevating the scrotum while resting

Advice:

Complete rest
Avoid strenuous activity
Monitor for signs of bleeding or infection

First Week (Day 4 – Day 7)

Progress:
Swelling and bruising gradually decrease. Pain continues to improve.

Advice:

Gentle showering
Keep the wound clean
Continue relative rest
Wear scrotal support if recommended

Week 2 – Week 3

Progress:
Most pain resolves. Swelling becomes minimal. Normal movement improves.

Activity:
Light daily activities can usually be resumed, while avoiding heavy lifting or intense exercise.

Week 4 – Week 6

Progress:
Basic wound healing is complete. Bruising disappears. Swelling is minimal or gone.

Activity:
Return to most normal activities, while still avoiding intense physical strain if advised by your doctor.

After 6 Weeks

Progress:
Full recovery from the procedure itself. Most patients return to normal life.

Note:
If the only testicle or both testicles were removed, hormone replacement therapy is necessary to maintain proper testosterone levels.

Postoperative Care Tips After Orchiectomy

Proper aftercare is essential to reduce complications and speed up recovery.

1. Wound Care

Keep the incision clean and dry according to your doctor’s instructions.
Use antiseptic solutions or sterile dressings if recommended.
Avoid rubbing or scratching the incision site.
Seek medical attention if you notice redness, severe swelling, discharge, or foul odor.

2. Pain and Swelling Control

Take only prescribed pain medications.
Use cold compresses during the first 2–3 days to reduce swelling.
Slight elevation of the scrotum while resting helps minimize discomfort.

3. Physical Activity

Begin light walking one to two days after surgery.
Avoid heavy lifting and intense exercise for 4–6 weeks, depending on medical advice.
Gradual return to normal activities is better than sudden overexertion.

4. Clothing and Support

Wear loose clothing or a scrotal support (suspensory) to reduce discomfort and friction.
Avoid tight garments or belts that put pressure on the surgical area.

5. Diet and Hydration

Drink plenty of water to prevent constipation, which can increase pressure on the surgical site.
Eat protein-rich and vitamin-rich foods to support faster wound healing.