Testicular Surgery

Definition

Testicular surgery is any surgical operation on the testicles.

Purpose

Testicular surgery is used primarily to correct developmental defects, treat infection or trauma, and treat cancer of the testes.

Precautions

Testicular surgery, a group of surgical operations performed on the testicles, is considered major surgery. In all cases, except when the testes are being removed, care must be taken not to damage any of the nerves and blood vessels supplying the testes and associated organs.

Description

Testicular surgery is commonly performed for the following reasons: to reposition undescended testes (orchiopexy); to correct testicular torsion ; to treat testicular cancer, which may involve removal of the testicles (castration) or the testes (orchiectomy); to treat traumatic injuries of the testicles; and to correct intersex states.

Undescended testes

Undescended testes are testes that have not dropped into the scrotum. During the fetal stage of development, the testes are not in the scrotum, but in the body. As male children age, the testes descend from the body to the scrotum for proper maturation and function. Undescended testes must be treated with surgery. There are two types of undescended testes, ectopic and cryptorchid. Ectopic testes are outside the normal route of descent. Cryptorchid testes are in the proper route of descent, but descent has been stopped before the testes reached the scrotum. The treatment for undescended testes is a surgical operation called orchiopexy, in which an incision allows the surgeon to reach the testes and pull them down into the scrotum. This operation is best done between the ages of one and two; otherwise, the testes are unlikely to mature normally. If the patient has one normal testis and one poorly developed testis, the undeveloped testis is usually removed.

Testicular torsion

Testicular torsion is a developmental defect in the tissues of the scrotum that allows the testes to rotate within the scrotum. This results in the blood vessels around other tubes in the scrotum to become wrapped around each other, resulting in blood supply to the testes bring cut off. Torsion disease is seen in young boys. Pain, nausea, and scrotal swelling are the main symptoms. When torsion is suspected, immediate surgery is recommended. An incision is made in the scrotum, and the blood vessels and other tissues are untangled. During surgery, the testes are examined to determine their condition. If they have received enough blood to remain viable, the testes are surgically attached to scrotal tissue to prevent twisting from recurring. If the testes do not regain a healthy pink color after the blood vessels have been untangled, then it is best to remove the testes. The lack of a pink color indicates that the testes have been without blood for too long a time period, and are dead tissue. Unless removed, they will turn necrotic and cause further harm to the body. Usually, testicular torsion occurs in only one testis. However, because the other testicle has similar anatomy, it too is subject to torsion. During surgery, the other testicle is attached to scrotal tissue to prevent torsion from occurring.

Cancer

Carcinoma of the testes is the medical term for cancer of the testicles. For males between ages 20-35, carcinoma of the testes is the second most common cancer. It accounts for 1-2% of all cancers in all males. There are many kinds of cancer that can affect the testes. A mass of tissue that is suspected to be cancer should be removed surgically. It is recommended that a biopsy not be performed, but that the physician proceed directly to surgery. Biopsies have not proven to be better at diagnosing cancer of the testicles than exploratory surgery. If the presence of cancer is confirmed during exploratory surgery, surgical excision of the cancer can be performed immediately.

The approach to the cancer during the operation depends on the location of the tissue mass. The two main approaches are through the scrotum and through the groin (inguinal region). The amount of tissue removed is variable and depends on the amount of cancerous tissue and the location. However, if a solid lesion is confirmed within a testis, a radical orchiectomy should be performed. A radical orchiectomy is a complete removal of one or both testes and associated lymphatic tissue. Other tumors allow partial removal of a testis. After surgery, the tumor is examined to determine the type of tumor for use as a guide in followup therapy.

Castration is the surgical removal of the testicles. Castration is performed as a cancer therapy, to reduce the amount of testosterone being produced, and as part of treatment for prostate cancer. In castration, an incision is made through one or both sides of the scrotum, depending on whether one or both testicles are being removed.

Trauma

Traumatic injuries to the testes may involve penetrating gunshot or knife wounds ; explosions and other industrial accidents; and athletic injuries. Dislocation of the testes is a potential complication of blunt trauma to the abdomen, which commonly occurs in automobile or motorcycle accidents. A dislocated testis can usually be identified by either ultrasound or CT scans of the patient's pelvis.

Intersex states

Intersex states are a group of developmental diseases in which the patient has parts of both male and female genitalia. In testicular feminization syndrome, the patient appears to be a female and will have female genitalia but has internal testes. The internal testes are undescended. Genetic studies show that the person was to be a male. This form of intersex is also called male pseudohermaphroditism. There are a number of different causes of this condition. These patients produce the male hormone testosterone. Treatment consists of surgical removal of the internal testes, and the administration of the hormone estrogen, which produces female characteristics. Failure to remove the testes is associated with a higher rate of cancer in these patients.

Preparation

About one hour before receiving general anesthesia, the patient will get a shot that dries up internal fluids and makes him sleepy. Presurgical counseling is often recommended for patients whose reproductive abilities will be compromised by their surgeries.

Aftercare

A patient who has had a testicle removed should visit his physician once a month for the first year and every other month for the second year, with periodic followups thereafter.

Risks

Testicular surgery, like any major surgery, can have postoperative complications. These complications include internal bleeding and wound infection, as well as adverse reactions to anesthesia. About 10-15% of patients develop fertility problems.

As of 2004, there is growing evidence that men who have had an orchiectomy followed by external beam radiation therapy have a significantly increased risk of dying from heart disease or a second cancer.

Normal results

Undescended testes are pulled down into their correct position and mature normally. In testicular torsion, the affected testis either regains its healthy pink color and is attached to the surrounding tissue with sutures, or it is removed along with any dead tissue surrounding it. (So long as only one testis is removed, sexual function and fertility will not be affected.) Successful surgery for cancer results in the removal of malignant tissue.

Resources

PERIODICALS

Fossa, S. D. "Long-Term Sequelae after Cancer Therapy—Survivorship after Treatment for Testicular Cancer." Acta Oncologica 43 (February 2004): 134-141.

Ko, S. F., S. H. Ng, Y. L. Wan, et al. "Testicular Dislocation: An Uncommon and Easily Overlooked Complication of Blunt Abdominal Trauma." Annals of Emergency Medicine 43 (March 2004): 371-375.

Shukla, A. R., C. Woodard, M. C. Carr, et al. "Experience with Testis Sparing Surgery for Testicular Teratoma." Journal of Urology 171 (January 2004): 161-163.

Zagars, G. K., M. T. Ballo, A. K. Lee, and S. S. Strom. "Mortality after Cure of Testicular Seminoma." Journal of Clinical Oncology 22 (February 18, 2004): 640-647.

ORGANIZATIONS

American Urological Association (AUA). 1000 Corporate Boulevard, Linthicum, MD 21090. (866) 746-4282 or (410) 689-3700. 〈http://www.auanet.org〉.

KEY TERMS

Biopsy— Removing tissue to test it for disease.

Lesion— An injury in the body tissue, such as a wound, sore, rash, or boil.

Orchiectomy— Surgical removal of one or both testes.

Orchiopexy— Surgical fixation of one or both testes.

Testes— The pair of male reproductive glands enclosed in the scrotum that produce the male sex hormone testosterone and the spermatozoa. The singular form is testis.

Testicles— The testes along with their enclosing structures.