Inguinal orchiectomy
Encyclopedia
Inguinal orchiectomy is a surgical procedure
to remove a testicle
and the full spermatic cord
through an incision in the abdomen. Orchiectomy is one form of castration
. The procedure is generally performed by a urologist. Often it is performed as same-day surgery, with the patient returning home within hours of the procedure. Some patients elect to have a prosthetic testicle inserted into their scrotum
.
A 4-6 cm incision is made above the pubic bone on the side corresponding to the testicle to be removed. This incision runs obliquely midway between the pubic tubercle and the anterior superior iliac spine. The incision is extended down through the fat until the external oblique fascia is encountered. It is incised along its fibers and the spermatic cord is identified and isolated. From there, the testicle is pulled into the field through the inguinal canal
. The spermatic cord
is clamped off in two places and cut between the clamps. Long permanent sutures, usually silk or polypropylene
, are left on the stump of the spermatic cord as a marker in case it needs to be removed in the future during a retroperitoneal lymph node dissection
(RPLND).
The inguinal orchiectomy is a necessary procedure if testicular cancer
is suspected. While it is possible to remove a testicle through an incision in the scrotum, this is not done when cancer is suspected because it disrupts the natural lymphatic drainage patterns. Testicular cancer usually spreads into the lymph nodes inside the abdomen in a predictable manner. Cutting the skin in the scrotum may disrupt this and cancer may spread to the inguinal lymph nodes, making surveillance and subsequent operations more difficult.
Complications from this procedure include the usual bleeding and infection. The ilioinguinal nerve which runs anterior to the spermatic cord may be damaged during the operation and cause numbness over the inner thigh or chronic groin and scrotal pain.
If the orchiectomy is performed to diagnose cancer, the testicle and spermatic cord are then sent to a pathologist to determine the makeup of the tumor
, and the extent of spread within the testicle and cord.
The pathology report, along with pre-surgical imaging studies and tumor marker
s, will determine the course of treatment.
Glossary
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
to remove a testicle
Testicle
The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
and the full spermatic cord
Spermatic cord
The spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to each testicle.-Contents of spermatic cord:...
through an incision in the abdomen. Orchiectomy is one form of castration
Castration
Castration is any action, surgical, chemical, or otherwise, by which a male loses the functions of the testicles or a female loses the functions of the ovaries.-Humans:...
. The procedure is generally performed by a urologist. Often it is performed as same-day surgery, with the patient returning home within hours of the procedure. Some patients elect to have a prosthetic testicle inserted into their scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
.
A 4-6 cm incision is made above the pubic bone on the side corresponding to the testicle to be removed. This incision runs obliquely midway between the pubic tubercle and the anterior superior iliac spine. The incision is extended down through the fat until the external oblique fascia is encountered. It is incised along its fibers and the spermatic cord is identified and isolated. From there, the testicle is pulled into the field through the inguinal canal
Inguinal canal
The inguinal canal is a passage in the anterior abdominal wall which in men conveys the spermatic cord and in women the round ligament. The inguinal canal is larger and more prominent in men.-Site:...
. The spermatic cord
Spermatic cord
The spermatic cord is the name given to the cord-like structure in males formed by the ductus deferens and surrounding tissue that run from the abdomen down to each testicle.-Contents of spermatic cord:...
is clamped off in two places and cut between the clamps. Long permanent sutures, usually silk or polypropylene
Polypropylene
Polypropylene , also known as polypropene, is a thermoplastic polymer used in a wide variety of applications including packaging, textiles , stationery, plastic parts and reusable containers of various types, laboratory equipment, loudspeakers, automotive components, and polymer banknotes...
, are left on the stump of the spermatic cord as a marker in case it needs to be removed in the future during a retroperitoneal lymph node dissection
Retroperitoneal Lymph Node Dissection
Retroperitoneal lymph node dissection, commonly referred to as RPLND, is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type. It is usually performed using an incision that extends from the sternum to several inches below the...
(RPLND).
The inguinal orchiectomy is a necessary procedure if testicular cancer
Testicular cancer
Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system.In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. In the UK, approximately 2,000 men are diagnosed each year. Over his lifetime, a man's risk of...
is suspected. While it is possible to remove a testicle through an incision in the scrotum, this is not done when cancer is suspected because it disrupts the natural lymphatic drainage patterns. Testicular cancer usually spreads into the lymph nodes inside the abdomen in a predictable manner. Cutting the skin in the scrotum may disrupt this and cancer may spread to the inguinal lymph nodes, making surveillance and subsequent operations more difficult.
Complications from this procedure include the usual bleeding and infection. The ilioinguinal nerve which runs anterior to the spermatic cord may be damaged during the operation and cause numbness over the inner thigh or chronic groin and scrotal pain.
If the orchiectomy is performed to diagnose cancer, the testicle and spermatic cord are then sent to a pathologist to determine the makeup of the tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
, and the extent of spread within the testicle and cord.
The pathology report, along with pre-surgical imaging studies and tumor marker
Tumor marker
A tumor marker is a substance found in the blood, urine, or body tissues that can be elevated in cancer, among other tissue types. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer...
s, will determine the course of treatment.
Glossary