Radical Orchydectomy

Why is it done?

• For testis cancer.
• For lesions highly suspicious of testis cancer.

Pre-requirements

• An informed consent is required from the patient and a pre-admission clinic appointment will be arranged.
• Patients may not eat or drink from midnight the previous evening.
• Patients are to refrain from smoking before the procedure.
• In the the event of a single testis or an abnormal contralateral testis, sperm banking may be required prior to the procedure.
• Young, single men will be given the option of sperm banking.
• A prosthesis may be ordered preoperatively, and placed at the end of the procedure, should the patient want this option.
• Patients allergic to IODINE / CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr Schoeman.
• Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery.
• Patients with cardiac illnesses require a cardiologist/physician’s report.
• A chest X-ray is required for patients with lung disease.
• Pre-op blood tests are required 4 days prior to surgery.
• The inguinal area (area from navel to pubic bone, hip bone to midline, on affected side) will be shaved in hospital.
• Please ensure that the admission and theatre staff as well as Dr Schoeman are made aware of the correct side on which the procedure is to be done.
• Be prepared for an overnight stay.and a indwelling catheter.

How is it done?

• This is done under general anaesthetic.
• A single incision is made in the groin. The underlying muscle layers are split for good oncological control.
• The affected testis and spermatic cord is then surgically removed through this incision.
• A metal clip may be left right at the internal inguinal ring, as a future marker, should radiotherapy be required.
• Subcutaneous sutures (which need not be removed) are used, unless stated otherwise by Dr Schoeman.
• A dressing is then applied, which should be removed after 72 hours.
• A local anaesthetic is injected into the wound, thus giving post-operative pain relief for the next 4-6 hours.
• A drain may also be left for 24-48 hours to prevent the collection of serous fluids.

NB! Regular self-examination highly recommended.

What to expect after the procedure

• Any anaesthetic has its risks and the anaesthetist will explain such risks.
• Bleeding is a common complication. If concerned call the hospital.
• A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible.
• An infection of the wound may occur and requires immediate attention.
• Owing to the nature of the surgery and the soft skin of the scrotum, bruising may appear much worse than it is and is no cause for alarm.
• DANGER SIGNS: A scrotum that swells immediately to the size of a football, fever, or puss. Contact Dr Schoeman or the hospital immediately as this occurs in up to 15 % of all cases.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery.
• The dressing should then be removed in a bath. It should be soaked until it comes off with ease.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• On discharge a prescription may be issued for the patient to collect.
• Patients should schedule a follow-up appointment with Dr Schoeman within 2 weeks to review pathology and arrange subsequent management.
• There will be signs of bruising for at least 10 days.
• The suture-line will be hard and indurated for at least 8-10 weeks.
• Sick leave will be granted for 14 days.
• Please don’t hesitate to direct any further queries to Dr Schoeman’s rooms.
• PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

NB! You are required to bring 2 pairs of tight new undies for post-operative scrotal support.

Download Information Sheet

Orchidectomy Radical