PARTIAL ORCHIECTOMY

PARTIAL ORCHIECTOMY PROCEDURE

The beginning portion of a testis-sparing surgery is identical to a radical orchiectomy. Once the testicle is “delivered,” the testis-sparing portion should begin. Intraoperative ultrasound should be used to identify the mass, rule out other masses and create a surgical plan. The outer layer of the testicle (the tunica albuginea, which houses the tubules of the testicle) is opened and the mass is removed, often with a small margin of normal testicular tissue. The mass will go to pathology for frozen analysis — an expert genitourinary pathologist should evaluate the mass when possible.

If the patient has a normal contralateral testicle and cancer is confirmed in the mass, a completion radical orchiectomy should be performed. If the patient has (or had) cancer in the contralateral testicle, the pathologist should confirm negative margins before leaving the remainder of the testicle. If there is any suspicion of residual cancer, the testicle should be removed. Once again, the standard of care is bilateral orchiectomy, and testosterone can easily be replaced.