Keyhole Orchidectomy

Initial consultation

The initial consultation is your first step toward a keyhole orchidectomy. During this visit, your surgeon will review your medical history, current health status, and the reasons for the procedure.

Your urologist may order tests such as blood work, ultrasound, or imaging scans to confirm a diagnosis and plan your surgery. They’ll explain how the procedure works, what recovery involves, and the potential risks. If both testicles are being removed, you’ll also discuss sperm banking to preserve fertility.

This appointment is an opportunity to establish trust, clarify expectations, and ensure you’re fully informed before proceeding.

Preparing for keyhole orchidectomy

In the days leading up to surgery, you’ll undergo a brief preoperative checkup. You’ll also meet with the anaesthesia team to discuss the safest anaesthesia plan based on your health and medication history.

You’ll receive instructions on when to stop eating or drinking before surgery. You may be asked to pause certain medications, especially blood thinners, and to avoid smoking or alcohol, which can affect healing.

It’s also essential to plan for your recovery. Arrange for someone to drive you home and provide help for the first 24 hours. Most people return to normal activities within one to two weeks, but you’ll be advised to avoid heavy lifting or strenuous exercise during early healing.

Keyhole orchidectomy is typically performed under general or spinal anaesthesia. The surgeon makes a small incision in the scrotum or lower groin area, depending on the approach. If laparoscopic instruments are used, a tiny camera may be inserted to improve visibility. The testicle and part of the spermatic cord are then carefully removed.

The incision is closed with dissolvable stitches, eliminating the need for suture removal. The entire operation usually takes less than an hour. Because the incisions are small and the procedure is minimally invasive, patients often experience less pain and recover quicker than with traditional surgery.

Most people can go home the same day after spending a few hours in recovery. You’ll be advised to rest, stay hydrated, and avoid heavy lifting or strenuous activities for a few weeks. Wearing supportive underwear or a scrotal support garment can help minimise discomfort and swelling.

Pain is usually mild and manageable with over-the-counter medications. Applying ice packs for short periods during the first 24 to 48 hours can also reduce swelling. You’ll be instructed on when to shower, and you should avoid soaking in baths until the incision has healed fully.

Follow-up appointments are essential for monitoring your progress and ensuring there are no complications, such as infection or prolonged pain.

Risks and complications

As with any surgical procedure, there are some risks. These may include bleeding, infection, scarring, or reaction to anaesthesia. More rarely, patients may experience nerve injury, formation of a hernia near the incision site, or low testosterone levels if both testicles are removed (a condition known as hypogonadism).

If the surgery is performed to remove a tumour, there is also a small risk of tumour spillage if proper techniques are not followed. Your surgeon will discuss these risks with you during the consultation, allowing you to make an informed decision.

Hormone therapy post-orchidectomy

If both testicles are removed, testosterone production stops, leading to infertility and symptoms such as fatigue, hot flushes, low sex drive, and emotional changes. Hormone replacement therapy (HRT) may be necessary to manage these symptoms. For transgender women, this typically involves oestrogen therapy to support feminisation and bone health.

Psychosocial effects

Losing a testicle can affect how some people feel about themselves, particularly younger patients or those who strongly associate their testicles with identity, masculinity, or fertility. These feelings are entirely valid and worth discussing with your healthcare provider or a counsellor.

Some patients choose to have a testicular prosthesis inserted to restore the appearance of a natural scrotum. This can significantly enhance self-esteem and body image, and many individuals report an improvement in confidence after prosthetic placement.

In gender-affirming care, orchidectomy can bring significant psychological relief by reducing gender dysphoria and eliminating the need for anti-androgen medications.

Fertility considerations

If you are planning to have children in the future, it’s important to discuss fertility preservation before surgery. Sperm banking allows patients to store sperm in advance. In cases where only one testicle is removed, fertility usually remains unaffected, as the remaining testicle continues to produce sperm and hormones.

However, there is a small risk of damaging structures like the vas deferens during surgery, which could affect sperm transport. Your surgeon will take precautions to minimise this risk and will discuss any concerns during your consultation.

Long-term follow-up

After your initial recovery, long-term follow-up may be necessary, depending on the reason for the surgery. Patients treated for cancer may need periodic imaging or blood tests to check for recurrence. Those on long-term hormone therapy should undergo regular monitoring for bone density, cardiovascular health, and overall well-being.

Staying in close contact with your healthcare team ensures that you remain healthy and informed throughout your recovery.