Simple vs Radical Orchiectomy

9
u/[deleted]
Tue Mar 2 19:11:07 2021 UTC
*
(13 comments)

The way my surgeon explained it to me is that with a simple orchiectomy, he tries to severe the chord as far up as he can, but a radical will have 2 incision in the lower abdomen to remove the entire chord. Obviously higher risk.

Can anyone who has had either give a little bit of feedback? If you got radical, why? and was it worth it? The only difference is that with simple orchi apparently sometimes you can sort of feel the chord in your inguinal area, and was wondering if anyone who has experienced this sensation could shed any information. Is it just weird, or painful and alarming and does it ever trigger post op dysphoria? (I am prepping for GCS as well I've had my consultation already)

all 13 comments


10
u/SecretlyHiddenSelf
Tue Mar 2 19:21:48 2021 UTC
(1 child)

Radical would be typically to remove high risk tissue for testicular cancer. Not really necessary for transitioning.

1
Tue Mar 2 20:31:13 2021 UTC
(0 children)

OK yeah, that makes sense. Thanks.

10
u/ZestyChinchilla
Wed Mar 3 06:22:47 2021 UTC
(0 children)

It's not very common for doctors to perform radical (inguinal) orchies for trans women anymore. As long as a simple orchi has an incision vertically down the middle (raphe) line, it won't put a scar in usable tissue for future GRS. The raphe line is removed during GRS anyway. Simple orchies are only a problem if they put the incisions off to the sides somewhere, but most surgeons know to avoid this for trans patients now.

Radical orchies are generally reserved for cancer patients these days, because they're more invasive, having a longer recovery time, and cost a fair bit more.

Prior to GRS I had a simple orchi with a midline incision, and it caused zero problems with GRS.

4
u/Femboi2020
Tue Mar 2 22:48:15 2021 UTC
(1 child)

From what I've read the best method of orchiectomy with future gcs in mind is a vertical incision down the midline, it's more work for the doctor to do it that way. But if any scarring does occur it can be easily trimmed by the surgeon doing the gcs. Radical orchiectomy is how testicle cancer is removed so more doctors are familiar with that method but really is excessive for transition purposes.

2
Wed Mar 3 00:44:58 2021 UTC
(0 children)

We already agreed on a vertical incision. I was mainly asking about post op chord sensation in the pubic bone canal areas.

3
u/[deleted]
Tue Mar 2 20:21:09 2021 UTC
(3 children)

Since you are planning on GCS later, *everything* I've read says do the simple orchi. Make DAMN sure the Dr knows you are retaining the scrotal tissue for later GCS and that the incision is going to be a vertical line on the scrotum.

There is no reason for the more invasive procedure, the cords will retract enough that they will no longer be an issue.

2
Tue Mar 2 20:27:36 2021 UTC
(2 children)

My orchi surgeon was a resident at UW with my GCS surgeon for about a month a few years ago. We talked about it briefly and he knows about her robotic technique. He said he thinks it shouldn't matter if there gcs later "it's all going to be reconstructed anyway" but he agreed to do vertical and aslo referenced future GCS in my after visit summary.

I plan on doing simple but he offered me the choice so I thought I would look into it.

2
Tue Mar 2 20:38:47 2021 UTC
(1 child)

He said he thinks it shouldn't matter if there gcs later

Preserving the scrotal tissue with minimal scaring is vital, as that is what will be used to make the external tissue. If he removes it you will have to get skin grafts, which are completely unnecessary if the scrotal tissue is saved.

Getting it "reconstructed anyway" still requires something to reconstruct with.

2
Tue Mar 2 20:51:42 2021 UTC
(0 children)

Yeah I know. He didn't put a lot of thought into that when he said it it. He does maybe one orchi consult/surgury per month I'm sure he's a different field of urology than my gcs reconstructive. I'm not worried he didn't push or anything, he seems reasonable open minded and friendly enough and all 5 star reviews. And respects my gcs doctor enough not to mess with her future work too I think so I got that going for me too, also that it's her request.

4
u/cyba-teknik
Tue Mar 2 22:44:48 2021 UTC
(3 children)

I got a radical orchiectomy. I have two scars on my mons pubis. I got it because I was unsure if I wanted SRS at the time and didn't want scars on my scotum so that it could be used for SRS. If you are getting SRS I wouldn't even get a simple orchiectomy. Why go through that pain, risk, and scarring? You'd be damaging the scrotal donor tissue that'll be used for your vagina.

I am glad I had an orchiectomy but in retrospect I should have just gotten full SRS.

2
Tue Mar 2 23:04:35 2021 UTC
*
(2 children)

Oh because I don't want to be on spiro anymore and surgury is a year out.

3
Wed Mar 3 01:47:35 2021 UTC
(0 children)

I got a simple orchiectomy in December. I can still find the ends of the cords in my inguinal canals, just under my mons, but only because I know exactly where they are. They don't bother me at all.

2
Wed Mar 3 10:11:14 2021 UTC
(0 children)

I would tough it out for a year if I were you, but I don't really know your situation