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The removal of the testis
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The removal of the testis
Removal of testis is called “subcapsulr orchiectomy”. This means the removal of the tissues inside the testis which produce hormones. The capsule of the testis (tunica albugenia) and the spermatic structures (spermatic string an vessels) remain untouched.

The operation is indicated in cases of cancer of the prostate. This cancer is affected by the presence of the male hormone (testosterone). Testosterone is produced to 90% from the tissues of the testis. The removal of these tissues reduces the amount of testosterone in the blood to a considerable extent. This affects the cancer of the prostate dramatically. 
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Testicle before surgery
Note the volume of the testes on both sides
E = epididymis / T = testis


Exposed testicular tissue
Hormone-producing tissues are removed


Testes after surgery
Note the small volume of the remaining shell of the testis



Who qualifies for the operation?

Patients who have cancer of the prostate which can not be removed by a radical operation. This means through an open operation to remove the prostate gland and its lymph nodes completely.

How does the operation work?

This operation can be done under local anaesthesia. The scrotum is incised in its middle line. The testis is delivered outside. The coverings and capsule are incised in its long axis. The tissues of the testis are removed using a special sharp spoon. Stitches are taken at its central part to guarantee stoppage of any possible bleeding. The capsule and coverings of the testis are closed again. The testis is returned to the scrotum. The same is repeated on the other side. The scrotal incision is closed in layers.




Incision


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Frequently asked questions (FAQ):
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  1. Why is removal of the testis a good treatment for cancer of the prostate?
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    Cancer of the prostate is mainly affected by the male hormone which is mostly produced by the testis. The deprivation of this hormone dramatically affects cancer of the prostate.
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  2. Is there another method for hormonal treatment of cancer of the prostate other than removal of the testis?
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    Yes, The three monthly injection of the hormone Lutenising Hormone Releasing Hormone (LHRH) analogue (similar substance) gives the same results.
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  3. Why should I let my testis be removed when LHRH analogue do the same?
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    You must have the injections of LHRH analogue every month or three monthly. They are very expensive. They produce the same effect but must be repeated while the operation is done in 30 minutes as an outpatient procedure and the effect is then permanent. LHRH analogue are only superior in that you avoid the risk of an operation which is actually very small in such a procedure.
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  4. Are there other treatment modalities for non operable cancer of the prostate?
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    Yes, The brachytherapy. This is done only in prostates of limited volume and of limited stage of cancer. It is done through the implantation of radioactive seeds inside the prostate which stay there permanently.
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  5. What are the complications of removal of the testis?
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    Beside the risk of the limited operative procedure, Blood collection inside the testis may result. The potency is affected too. One has to take some medications before the operation to avoid the agonising tender and minimal enlargement of the breast.
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  6. Does I become feminine if the testis is removed?
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    You loos the ability of erection and there may be a minimal increase in the volume of the breast. You can live otherwise quite normal with the effect of treating the hormone dependant cancer cells of the prostate.
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  7. Can I get my erection after that?
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    Yes, through the implantation of a penile prosthesis.
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  8. Is the operation is a guarantee for cure from cancer of the prostate?
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    Removal of the testis cures the hormone dependant cell population of cancer of the prostate. It happens sometimes after a while that some other hormone independent cells grow. These could be treated by radiotherapy and by mono chemotherapy.