LESSON 3: Procedures in Genitourinary Surgery

Section v: operations on the scrotum, penis, and urethra

3-36

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3-36. ORCHIECTOMY

a. General. This operation involves the removal of the testis or testes. Removal of both testes is castration and renders the patient both sterile and deficient in male hormones. Because of the social implications, this operation, like vasectomy, requires particular attention to legal permission. Bilateral orchiectomy is usually performed to control carcinoma of the prostate. A unilateral orchiectomy may be

indicated because of cancer, trauma, or infection of the testis. In benign conditions, a prosthesis may be implanted for cosmetic or psychological reasons. Prostheses are usually made of silicone rubber.

b. Operative Procedure.

(1) The upper anterior surface of the scrotum is incised over the testicle. The incision is carried through the skin and fascial layers to expose the tunica vaginalis. Retractors are placed and bleeding vessels clamped and tied.

 

(2) The tunica vaginalis is grasped and mobilized. The spermatic cord is dissected free up to the external abdominal ring, clamped, and ligated. The testis is removed. Bleeding is controlled. A small Penrose drain may be placed in the wound. Fine sutures of plain gut number 3-0 or nylon number 4-0 are used to close the wound.

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