54520 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach

Name of the Procedure:

Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach.

Summary

An orchiectomy is a surgical procedure to remove one or both testicles. It can be done either through an incision in the scrotum (scrotal approach) or in the groin (inguinal approach). Sometimes, a testicular prosthesis is inserted to maintain the appearance of the scrotum.

Purpose

The primary purpose of an orchiectomy is to treat various medical conditions, including testicular cancer, prostate cancer, and severe trauma to the testicles. The procedure aims to remove the source of the problem, alleviate symptoms, prevent the spread of cancer, and, in some cases, restore normal appearance with a prosthesis.

Indications

• Testicular cancer.
• Advanced prostate cancer.
• Severe injury or trauma to the testicles.
• Chronic testicular pain resisting other treatments.
• Hormonal conditions, such as advanced gender transition processes.

Preparation

• Fasting for at least 8 hours before surgery.
• Adjustments to medications as advised by the healthcare provider.
• Pre-operative assessment including blood tests and imaging studies.
• Patient counseling about the procedure and post-operative care.

Procedure Description

1. The patient is put under general or regional anesthesia.
2. The surgeon makes an incision either in the scrotum or the inguinal area.
3. The testicle and spermatic cord are isolated and removed.
4. If a prosthesis is being placed, it is inserted into the scrotum.
5. The incision is closed with sutures.
   • Tools used might include scalpels, clamps, and prosthesis materials if opted for.

Duration

Typically, the procedure takes about 30 minutes to 1 hour.

Setting

Orchiectomy is usually performed in a hospital or a surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common risks include:

• Infection at the incision site.
• Bleeding or hematoma formation.
• Pain or swelling.
• Adverse reactions to anesthesia.

Rare complications:

• Chronic pain.
• Scarring.
• Changes in hormone levels.
• Psychological impacts.

Benefits

• Alleviation of pain or discomfort.
• Removal of cancerous tissue.
• Reduced risk of cancer spread.
• Restoration of scrotal appearance with a prosthesis.

Benefits are often realized immediately in terms of symptom relief, though hormonal changes might take longer to adjust.

Recovery

• Post-procedure monitoring in a recovery area.
• Pain management with medications.
• Instructions to keep the incision area clean and dry.
• Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments for incision check and removal of stitches.

Most patients can resume normal activities within a few weeks.

Alternatives

• Radiation therapy or chemotherapy for cancer.
• Hormone therapy for certain conditions.
• Non-surgical management for chronic pain.
• Each alternative comes with specific suitability, risks, and benefits that should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, some pain and swelling are common, but these can be managed with medications. Comfort measures include resting, applying ice packs, and taking prescribed pain relievers.