Self-performing orchiectomy#

First version: 2020-03-27
Last update: 2022-03-02
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Tsarina Effy
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Scrotal orchiectomy is a simple surgery of removal of testes. We provide sources for learning how to perform orchiectomy and discuss the considerations for undertaking a self-surgery.

1 Overview

Many cases of self-performed orchiectomy are recorded in the literature. However, these cases mostly reflect poorly-performed orchiectomies that require medical attention. Deficiencies of these cases include not using surgical equipments (Peter et al., 2012), complete disregard of asepsis (Mora, Drach, 1980), and failure to occlude spermatic arteries (Garofalo, 2018). Methods for self-castration other than surgical orchiectomy are reviewed in Johnson & Irwig (2014). Methods such as injection of toxins like ethyl alcohol or lactic acid and restricting blood flow using rings or clamps result in necrosis which require surgical removal. Therefore, a properly-performed surgical orchiectomy is the safest and most effective method of castration.

The risks associated with orchiectomy is minimal and in the literature there are no recorded deaths from self-castration. Any self-surgeon should utilize hemostats for clamping of the spermatic cord prior to excision of the testis. Clamping will prevent any blood loss from spermatic arteries. Even the failure of doing so will not result in life-threatening blood loss because vascular spasm will eventually stop hemorrhage (McGovern, 1995). Risk of infection should be the highest concern of orchiectomy procedures and proper aseptic technique should be utilized to prevent infections.

2 Asepsis

Open surgeries must be performed in a sterile fashion. Common methods for instrument sterilization are reviewed in Rutala & Weber (2004). Many other sources on sterilization and disinfection of medical instruments can be found in the bibliography section of WHO (2016). A simple protocol for sterile self-surgery is described in Castelán Castro (2020). Possible steps for self-performing orchiectomy in sterile fashion are listed below:

  1. Clear room from any porous surface or drape an empty area of the room with polyethylene sheets,
  2. Disinfect every surface of the operating area,
  3. Fill a clean bucket with 10 mg/L sodium hypochlorite solution (~1:5 household bleach to water),
  4. Submerge everything that will be used in the surgery in the bucket:
    • Non-sterile surgical instruments (keep hinges open to prevent rusting),
    • Sterile instruments in non-paper pouches (suture satchels, disposable scalpels, etc.),
    • Sterile saline bottles, antiseptic bottles, lidocaine ampules,
    • Three plastic trays,
    • A dishwashing glove upto its cuff,
    • A low-density polyethylene sheet,
  5. Close the lid of the bucket and wait for an hour,
  6. Open the lid and don the dishwashing glove,
  7. Using the sterilized glove take out the polyethylene sheet and rinse and air-dry it,
  8. Place the sheet on the ground, then place all the sterile trays on top of it,
  9. Put bottles on the sterile sheet and put every other submerged instrument into the first tray,
  10. Fill the second tray with sterilant solution,
  11. Remove the glove and wash hands,
  12. Empty all the sterile instruments inside paper pouches into the third tray,
  13. Open plenty of gauze packages and make sure that sterile materials do not touch outside the package or hands,
  14. Don surgical gloves and use an antiseptic solution such as hydrogen peroxide or iodine to clean the surgical site,
  15. Rinse submerged instruments with sterile saline,
  16. Sit comfortably and begin the surgery.

3 Self-surgery considerations

Comfort of the surgeon-patient is extremely important. Room should be warm to avoid heat loss of the patient. Surgery should be undertaken during daytime to prevent fatigue and sleepiness. Daylight should be utilized to not be effected from power outages. Extra surgical supplies must be present. Extra surgical gloves are especially important to continue the procedure in a sterile fashion after a potential disruption of the surgery.

4 Notes on the procedure

Scrotal raphe incision can be made upto cremaster muscle or all the way down to tunica vaginalis. Delivery of the testis with the first method will require more work, especially during the separation of tunica dartos from the testis. Latter method is a better choice overall, however attention must be given to include cremaster muscle in the ligature.

There must be no oozing of blood from the cord stumps to prevent hematoma formation. If there is oozing, extra ligatures should be added or existing ligatures should be tightened. Even when pristine hemostasis of cord stumps is achieved, there will be bleeding from the dartos layer. Compressive dressing is used to prevent hematoma formation due to bleeding from dartos layer. A technique for scrotal elevation and compression is discussed in Griffin & Canning (1996). Circumferential dressing of scrotum for bilateral orchiectomies is discussed in Haas et al. (1989). Another method would be using plenty of gauzes on scrotum, a padding on top, and a strong adhesive tape to compress and stabilize the padding. Oesterling (1990) mentions that drains are ineffective against hemorrhage from the scrotal wall, therefore proper hemostasis and compressive dressing is essential.

Plain 1% lidocaine is sufficient for all purposes of local anesthesia in orchiectomy. Lidocaine toxicity in dentistry is discussed in Mehra et al. (1998). Mixture of lidocaine and bupivacaine can be used to elminate acute postoperative pain (Shin et al., 2018). Lee et al. (2018) discusses the safety of using such mixtures in children after scrotal surgeries.

5 Sources for studying

This article should not be used as a standalone guide. Familiarity with the following resources are essential for learning and properly performing orchiectomy.

5.1 Surgical basics

Basics of general surgery are covered in Jain & Stoker (2008). Surgical basics pertinent to urology are covered in Section 1 of Smith et al. (2018). Complications of scrotal surgeries are covered in Chapter 53 of Taneja & Shah (2018). Video resources are useful for suturing and knot-tying practice.

5.2 Anatomy

Surgical anatomy of scrotum is thoroughly covered in Chapter 17 of MacLennan (2012). General anatomy textbooks also cover the anatomy of testis. Chapter 4 of Agur & Dalley (2017) labels structures of abdomen. Section 3 of Smith & Turek (2011) provides excellent illustrations of scrotum and testis.

5.3 Procedure

Method for performing simple orchiectomy is described in Chapter 109 and Chapter 116 of Smith et al. (2018). Intraoperative technique for simple bilateral orchiectomies for transsex patients is described in Francis et al. (2019) and Hehemann & Walsh (2019). Special considerations for orchiectomies for transsex patients include preservation of scrotal fat and fascia for potential future vaginoplasty and circumferential incision of external spermatic fascia for complete debulking of scrotum. Dalela (2015) demonstrates the steps of simple bilateral orchiectomy in video format.

6 References

  • A. M. R. Agur, A. F. Dalley (2017) “Grant’s Atlas of Anatomy”. 14th ed. ISBN: 9781469890685.
  • M. X. Castelán Castro (2020) “Cosmetic self-surgery in the arm”. ARK: 21206/10065.
  • D. Dalela (2015) “Total orchiectomy final”. URI:
  • C. Francis, E. Grobber, E. Potter et al. (2019) “A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries”. DOI: 10.1016/j.sxmr.2019.11.004.
  • M. Garofalo, A. Colello, P. Sadini et al. (2018) “Management of self-inflicted orchiectomy in psychiatric patient. Case report and non-systematic review of the literature”. DOI: 10.4081/aiua.2018.3.220 .
  • J. H. Griffin, J. R. Canning (1996) “The scrotal hitch for hemostasis and edema prevention in scrotal surgery”. DOI: 10.1016/S0090-4295(96)00051-9.
  • G. P. Haas, M. Melser, B. J. Miles (1989) “Method of circumferential pressure dressing of scrotum following bilateral orchiectomy”. DOI: 10.1016/0090-4295(89)90043-5.
  • M. C. Hehemann, T. J. Walsh (2019) “Orchiectomy as Bridge or Alternative to Vaginoplasty”. DOI: 10.1016/j.ucl.2019.07.005.
  • S. K. Jain, D. L Stoker (2008) “Basic Surgical Skills and Techniques”. ISBN: 9788184484083.
  • T. W. Johnson, M. S. Irwig (2014) “The hidden world of self-castration and testicular self-injury”. DOI: 10.1038/nrurol.2014.84.
  • K. Lee, J. M. Chung, S. D. Lee (2018) “The safety of a mixture of bupivacaine and lidocaine in children after urologic inguinal and scrotal surgery”. DOI: 10.4111/icu.2018.59.2.141.
  • G. T. MacLennan (2012) “Hinman’s Atlas of Urosurgical Anatomy”. 2nd ed. ISBN: 9781416040897.
  • S. J. McGovern (1995) “Self-castration in a transsexual”. DOI: 10.1136/emj.12.1.57.
  • P. Mehra, A. Caiazzo, P. Maloney (1998) “Lidocaine Toxicity”. PMCID: PMC2148953.
  • W. Mora, G. W. Drach (1980) “Self-emasculation and self-castration: Immediate surgical management and ultimate psychological adjustment”. DOI: 10.1016/s0022-5347(17)55375-6.
  • J. E. Oesterling (1990) “Scrotal surgery: A reliable method for the prevention of postoperative hematoma and edema”. DOI: 10.1016/s0022-5347(17)40224-2.
  • M. S. Peter, A. Trinidad, M. S. Irwig (2012) “Self-Castration by a Transsexual Woman: Financial and Psychological Cost: A Case Report”. DOI: 10.1111/j.1743-6109.2011.02621.x.
  • W. A. Rutala, D. J. Weber (2004) “Disinfection and Sterilization in Health Care Facilities: What Clinicians Need to Know”. DOI: 10.1086/423182.
  • Y. S. Shin, A R. Doo, J. K. Park (2018) “Let’s Take Advantage of Mixtures of Bupivacaine or Ropivacaine in Urologic Inguinal and Scrotal Surgery”. DOI: 10.5534/wjmh.180009.
  • R. P. Smith, P. J. Turek (2011) “The Netter Collection of Medical Illustrations: Reproductive System”. 2nd ed. ISBN: 9781437705959.
  • J. A. Smith, S. S. Howars, G. M. Preminger et al. (2018) “Hinman’s Atlas of Urologic Surgery”. 4th ed. ISBN: 9780128016480.
  • S. S. Taneja, O. Shah (2018) “Taneja’s Complications of Urologic Surgery: Diagnosis, Prevention, and Management”. 5th ed. ISBN: 9780323392426.
  • Cited as “WHO (2016)”. World Health Organization (2016) “Decontamination and reprocessing of medical devices for health-care facilities” (version in English). ISBN: 9789241549851. Open access.