User:J.Miranda, Future UCSF Pharm.D./sandbox

Add a Risks/Complications section, History section, and possibly a trends section. J.Miranda, Future UCSF Pharm.D. (talk) 15:45, 27 July 2021 (UTC)

According to this article, one third of individuals with testicular cancer can be treated without orchioectomy.

Trends
Orchiectomy rate is 42% in boys with testicular torsion.

Psychological effects
The loss of a male organ from orchiectomy can have severe implications in a male's identity and self-image surrounding masculinity, such that it can lead to an individual having thoughts of hopelessness, inadequacy, and loss. As many as one third of individuals who will undergo orchiectomy are not offered the option of having a testicular prosthesis. Data shows that simply offering testicular prosthesis to individuals undergoing orchioectomy is psychologically beneficial. While some individuals do not mind losing a testicle, studies have shown that there is a change in body image in testicular cancer survivors who have underwent orchiectomy and an improvement in body image in 50-60% of individuals who undergo testicular prosthesis placement. On the other hand, there is a current debate whether pediatric patients undergoing orchiectomy should be offered testicular prosthesis to be inserted at the time of orchiectomy procedure.

In studies that have asked for quality of life of individuals who underwent orchiectomy whether singular or bilateral, there is a.... Studies have shown that pediatric patients show no difference in quality of life, until post-puberty where body confidence decreases.

Partial orchiectomy
Partial orchiectomy is an option for individuals with testicular masses that want to preserve their testis and its function. During surgery, the testis is exposed in a similar way to inguinal orchiectomy. Once the testis is exposed and the spermatic cord is clamped, there is a current debate as to whether surgeons should deliver cold ischaemia which means submitting the organ, in this case the testis, into a cold/freezing environment. Whether or not it is submerged and frozen, the next step is to cut the tunica vaginalis and an ultrasound is used to find the tumor. After, the tumor is scraped away from the testis in a process called enucleation. Following enucleation, biopsies are taken of the tissues surrounding the testicle where the mass once was. Afterwards, each layer or tunica of the testis is sutured up and the testis is placed back in the scrotum. The skin layers are also closed up.

Pre-operative considerations
Guidelines state that fertility counseling should be offered to all patients undergoing inguinal orchiectomy, as there is a risk of subfertility or infertility. Testicular germ cell tumors (TGCT) accounts for 95% of cases of testicular cancer in young men. TGCT is associated with abnormal semen parameters. As testicular cancer diagnosis occurs commonly in young, fertile men, it is important that these individuals be educated on semen cryopreservation as well as fill out a fertility assessment prior to surgery. In addition, testicular prosthesis placement counseling and education is encouraged to be given before an individual undergoes orchiectomy or before inguinal exploration with possiblity of orchiectomy. This is an elective surgery which can be done at the time of orchiectomy. Testicular prosthesic placement has known psychological benefits (see below). Although risks for complications with prosthesis is low, individuals should also be informed of the possibility of infection, rotation, and replacement of prosthesis.

Risks and Complications with Inguinal/Radical Orchiectomy
Risks and complications associated with inguinal orchiectomy must be discussed with the individual during pre-operative counseling. Risks and complications include scrotal hematoma, infection, post-operative pain (60% initially, 1.8% 1 year after), phantom testis syndrome (25%), reduced fertility, and with the more rare complications being inguinal hernia, ilioinguinal nerve injury, tumor spillage, hypogonadism.

Orchiectomy in testicular cancer
The American Urological Association (AUA) and European Association of Urology (EAU) 2019 guidelines recommend imaging with testicular ultrasound in any individual suspected of having testicular cancer following a physical examination. The ultrasound aids in differentiating diagnoses so that the inidividual may avoid the need of the surgical approach of inguinal orchiectomy. Inguinal orchiectomy is the gold standard treatment approach for those with confirmed malignancy of testicular cancer. Thus, it is imperative to diagnose the individual as having benign tumor which are masses typically outside the testicle or surrounding it (extratesticular), whereas the malignant tumors typically lie within/inside the testicle (intratesticular).

Before inguinal orchiectomy, it is also important to for the individual to obtain serum tumor markers including alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) as these tests help in diagnosing the testicular cancer.

Partial orchiectomy, also known as testis-sparing surgery, is another option which is becoming increasingly popular. This treatment option is an alternative for testicular cancer masses which are <20mm, have a high probability of being benign, and with negative serum tumor markers. Its benefits include preserving fertility and normal hormone function.

History
Orchiectomy (and castration) has been around for thousands of years with evidence from the Biblical times as well as texts from ancient China and Rome. Orchiectomy was seen as a way to get rid of aggression and was used as a sort of punishment. A common noble man in ancient times were the eunuchs who were male servants for the royal court. They were either had both testicles removed or testicles and penis as it was thought it would make them more loyal and reliable to the court. They are referenced in Biblical, Roman, and Chinese history. There was also the practice of orchiectomy for the treatment of inguinoscrotal hernia. It was thought that removing the testicles was the only surgical solution for some time, until surgeons began searching for other ways to treat this condition. In the late 18th century, orchioectomy for hernia came to a halt as academic surgeons of the time came forward to renounce and condemn those who continued to operate orchiectomy on individuals who did not need it all.