tion of both testosterone and sperm, resulting in
permanent INFERTILITY. The intent of bilateral
orchiectomy is to cut the supply of testosterone
that feeds prostate cancer cells, as prostate cancer
is one of the HORMONE-DRIVEN CANCERS. The result-
ing precipitous decline in testosterone production
often also diminishes LIBIDO(sex drive) and may
cause ERECTILE DYSFUNCTION(difficulty achieving or
sustaining an ERECTION).
For unilateral orchiectomy the surgeon
removes the testicle through an incision in the
lower abdomen, just above the pubic HAIRline.
The incision exposes the inguinal canal, a passage
of ligaments through which the testicles originally
descended into the SCROTUM. The surgeon manipu-
lates the testicle upward from the scrotum into the
lower abdomen, extracting it through the incision.
This procedure prevents damage to the scrotum
that could allow cancer cells to escape into the
LY M P Hnodes; the testicles and the scrotum use dif-
ferent lymph networks so the surgeon does not
want to disturb the scrotum or create a circum-
stance in which cells from the testicle can enter
the lymph nodes that serve the scrotum. For bilat-
eral orchiectomy as prophylactic treatment for
advanced prostate cancer the surgeon may make
the incision in the scrotum.
The key risks of orchiectomy include excessive
bleeding and INFECTION. Unilateral orchiectomy
sometimes lowers testosterone levels, which the
doctor may treat with testosterone supplementa-
tion. Long-term complications that occur with
bilateral orchiectomy include loss ofBONE DENSITY
and increased risk for OSTEOPOROSIS, GYNECOMASTIA
(enlarged breasts), and erectile dysfunction.
See also GANGRENE; OOPHORECTOMY; ORCHIOPEXY;
SURGERY BENEFIT AND RISK ASSESSMENT.
orchiopexy A surgical OPERATION to correct an
undescended testicle (CRYPTORCHIDISM). Nearly
always the operation takes place early in child-
hood, typically between ages six and 12 months.
In many situations the operation is an outpatient
procedure the surgeon can perform in an AMBULA-
TORY SURGICAL FACILITY, usually with general ANES-
THESIA.
The surgeon makes two incisions, one in the
lower abdomen and one in the SCROTUM. The
abdominal incision provides access to the unde-
scended testicle, which the surgeon manipulates
through the inguinal canal (a passageway through
the ligaments supporting the pelvic floor) and into
the scrotum. Through the incision in the scrotum
the surgeon sutures (stitches) the testicle to the
inside of the scrotum so it cannot reascend.
The primary risks of orchiopexy are excessive
bleeding and INFECTION, both of which are uncom-
mon. Recovery is typically rapid, with HEALING
complete within two weeks. When done early in
childhood, orchiopexy preserves FERTILITY. How-
ever, an increased risk for TESTICULAR CANCER
remains, making TESTICULAR SELF-EXAMINATION an
important screening procedure.
See also ORCHIECTOMY; SURGERY BENEFIT AND RISK
ASSESSMENT; TESTICLES.orchitis INFLAMMATIONof one testicle or both TES-
TICLES, often due to INFECTION. Bacterial infection
may result from SEXUALLY TRANSMITTED DISEASES
(STDS) such as GONORRHEAor SYPHILIS. MUMPS, a
viral INFECTIONthat primarily affects the SALIVARY
GLANDS, is a common cause of orchitis, particularly
when the mumps VIRUSinfects adult men.
The symptoms of orchitis are PAINand swelling
of the involved testicle. The diagnostic path
includes physical examination of the SCROTUMand
testicles and sometimes ULTRASOUND to rule out
other causes of similar symptoms such as TESTICU-
LAR TORSION, HYDROCELE, orVARICOCELE.
Treatment with ANTIBIOTIC MEDICATIONSis neces-
sary when the infection is bacterial. NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS(NSAIDS) relieve pain and
inflammation regardless of the cause. Resting in a
reclining position or wearing an athletic supporter
also provides relief. A complication of orchitis may
be testicular atrophy (reduced size of the affected
testicle), which may affect SPERMproduction and
FERTILITY. An atrophied testicle also presents an
increased risk for TESTICULAR CANCER, making rou-
tine TESTICULAR SELF-EXAMINATIONprudent.
See also BACTERIA; EPIDIDYMITIS.orgasm Intense sensation of pleasure and excite-
ment that occurs at the culmination of sexual
stimulation. Involuntary contractions of the pelvic
muscles typically accompany orgasm. In men
these contractions result in EJACULATION, propelling
SEMENfrom the urethral opening (meatus) at the308 The Reproductive System