Inguinal orchiectomy (also named orchidectomy) is a specific method of orchiectomy whereby one or both

testicle A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testoste ...

s and the full

spermatic cord The spermatic cord is the cord-like structure in males formed by the vas deferens (''ductus deferens'') and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an exten ...

are surgically removed through an incision in the lower lateral

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

(the "inguinal region"). The procedure is generally performed by a

urologist Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...

, typically if

testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include a ...

is suspected. 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 The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...

. Depending on whether or not a prosthetic testicle is put in place of the original one, operating times run on average from three to six hours. A 4–6 cm incision is made above the

pubic bone In vertebrates, the pubic region ( la, pubis) is the most forward-facing ( ventral and anterior) of the three main regions making up the coxal bone. The left and right pubic regions are each made up of three sections, a superior ramus, inferior ...

on the side corresponding to the testicle to be removed. This incision runs obliquely midway between the

pubic tubercle The pubic tubercle is a prominent tubercle on the superior ramus of the pubis bone of the pelvis. Structure The pubic tubercle is a prominent forward-projecting tubercle on the upper border of the medial portion of the superior ramus of the ...

and the

anterior superior iliac spine The anterior superior iliac spine ( abbreviated: ASIS) is a bony projection of the iliac bone, and an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis. It provides attachment for the i ...

. The incision is extended down through the fat until the

external oblique The abdominal external oblique muscle (also external oblique muscle, or exterior oblique) is the largest and outermost of the three flat abdominal muscles of the lateral anterior abdomen. Structure The external oblique is situated on the lateral ...

fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs ...

is encountered. It is incised along its fibres and the spermatic cord is identified and isolated. From there, the testicle is pulled into the field through the

inguinal canal The inguinal canals are the two passages in the anterior abdominal wall of humans and animals which in males convey the spermatic cords and in females the round ligament of the uterus. The inguinal canals are larger and more prominent in males. ...

. The

is clamped off in two places and cut between the clamps. Long permanent sutures, usually silk or

polypropylene Polypropylene (PP), also known as polypropene, is a thermoplastic polymer used in a wide variety of applications. It is produced via chain-growth polymerization from the monomer propylene. Polypropylene belongs to the group of polyolefins a ...

, 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 (RPLND) is a surgical procedure to remove abdominal lymph nodes. It is used to treat testicular cancer, as well as to help establish the exact stage and type of the cancer. Indications Testicular cancer met ...

(RPLND). The inguinal orchiectomy is a necessary procedure if

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 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. Other symptoms also include intermittent and chronic back pain and sudden loss of mobility in the lower back. If the orchiectomy is performed to diagnose cancer, the testicle and spermatic cord are then sent to a

pathologist Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in th ...

to determine the makeup of the

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

, and the extent of spread within the testicle and cord. The pathology report, along with pre-surgical imaging studies and tumor markers, will determine the course of treatment.

References

{{DEFAULTSORT:Inguinal orchiectomy Male genital surgery

See also

References