Bilateral Orchidectomy

Bilateral Orchidectomy is done for advanced prostate cancer. Prostate cancer that mostly occurs in men above 50 years of age is characterized by its slow growth. Prostate a small, walnut-shaped gland that produces the seminal fluid which transports the sperms is thus an important organ of the male reproductive system. Bilateral Orchidectomy is done to control the growth of prostate cancer.

In the following stages of Prostate Cancer, Bilaterla Orchidectomy is performed:

  • Moderate-High Grade: Cancer cells begin to spread from the lining to the muscular walls of the bladder.
  • Locally Advanced : Cancer cells advanced to nearby blood stream and blood cells
  • Advanced: Cancer in this stage may or may not have spread to other parts of the body like
  • Recurrent cancer:
  • Sometimes even after curative treatment cancers do reoccur in the kidney or any other part of the body

Safety:

As safe as traditional any other surgeries with Minimal blood loss, pain, blood transfusion may not be necessary, only overnight hospital stay.

Length of Surgery:

3- 4 hours.

When to approach your doctor?:

  • Frequent and painful urination.
  • Reduction in the stream of urine.
  • Irregularities during sexual intercourse and ejaculation.
  • Occurrence of blood in the urine or semen.
  • Aching, discomfort, stiffness in the lower back, pelvis region, etc.
  • Swelling/ inflammation of legs.
  • Aching bones.
  • Advance Prostate Cancer:
  • Extreme fatigue and constant weakness.
  • Sudden weight loss.
  • Broken bones, increased back pain.
  • Kidney failure.
  • Urinary incontinence.
  • Total erectile dysfunction.

Diagnosis Tests:

  • (PSA) prostate specific antigen test
  • Biopsy.
  • DRE test.
  • Trans-rectal Ultrasound Scan (TRUS)
  • Advance prostate cancer:
  • Isotope bone scan
  • X-ray
  • MRI scan
  • CT scan

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • The urine culture analysis should be negative.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure

Treatments:

  • Bilateral Orchiectomy basically involves removal of the testicles to curb the testosterone production in the body, because testosterone fuels the growth of prostate cancer.
  • Simple Orchiectomy: Under general anesthesia, a small incision is made in the front part of the scrotum. Both the testicles are then removed and maybe replaced with saline artificial testicular (prostheses) implants in the scrotum.
  • Subcapsular Orchiectomy: This includes the removal of only the testosterone producing tissue lining along the testicles. In this case, the scrotum is intact as normal.

Risks:

  • Sterility.
  • Lessened sexual interest
  • Difficulty in erection
  • Loss of muscle mass.
  • Thin or brittle bones (osteoporosis).
  • Hot flashes.
  • Gynecomastia – Larger breasts
  • Speedy weight gain

Follow- up:

  • 24 hour surveillance.
  • Visit doctor: for removal of cathedral after surgery.
  • Emergency Follow up:
    Chest pain/ breathing difficulty.
    Vomiting/ nausea
    Worsening pain.
    Large amounts of blood clots in the urine.
    Difficult/ painful voiding and fully emptying the bladder.
  • Hospital-stay for one to three days after radical prostatectomy.
  • During the operation, urinary catheter is inserted and few patients may be required to wear the catheter for some more days to a few weeks even after discharge from hospital.
  • Retaining catheter kept in skin after surgery should be there for some more days after discharge from hospital.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.