Simple orchiectomy refers to the surgical removal of one or both testicles through a scrotal or subinguinal approach. Indications for bilateral surgery include achieving castrate levels of testosterone for patients with prostate cancer; unilateral simple orchiectomy is indicated for removal of infected testicle refractory to conservative treatment and treatment for nonviable testicle such as in testicular torsion or trauma. On rare occasions, simple orchiectomy is indicated for chronic orchialgia. Anesthetic options include regional anesthesia via spermatic cord block, conscious sedation, spinal anesthesia, or general anesthesia.
Shave and prep the scrotum. Use either a single vertical midline incision in the median raphe or a transverse scrotal incision over the cord just above the testicle ( Fig. 109.1 ). The transverse incision is made within the scrotal rugae, with caution taken to avoid any prominent scrotal blood vessels. Carry the incision down through the tunica vaginalis and deliver the testis into the wound. Provide gentle traction on the testis to expose the spermatic cord. At this point, options include ligation of spermatic cord, epididymis-sparing orchiectomy, or subcapsular orchiectomy ( Fig. 109.2 ).
Separate the cord into two bundles. Starting with the vas deferens, double clamp proximally and single distally ( Fig. 109.3, A ). Divide sharply. Place a 2-0 Vicryl tie proximally ( Fig. 109.3, B ). Release the first clamp prior to placing a 2-0 Vicryl suture ligature distally. Repeat on the remaining bundle. Ensure meticulous hemostasis. The dartos muscle is reapproximated with interrupted 3-0 Vicryl suture. Inject the wound with bupivacaine and then close the skin edges with interrupted 4-0 chromic or Monocryl sutures.