What two approaches do you know for performing an orchidectomy?

The two approaches for performing an orchidectomy are the scrotal or inguinal approaches.

Where do the lymphatics of the testis and the scrotal skin drain to respectively?

• The testis drains to the para-aortic lymph nodes at the level of L2.

• The scrotal skin drains via both the internal and external pudendal systems to the deep and superficial inguinal lymph nodes.

How does the above knowledge dictate the approach for orchidectomy for a testicular tumour?

As the scrotal skin and the testis have different blood supply and lymph drainage, an orchidectomy for a testicular tumour should be performed via an inguinal approach to avoid the possibility of tumour seeding to the deep and superficial inguinal systems.

What pre-operative measures must be taken prior to an orchidectomy?

• Informed consent (consider sperm banking)

• Clinical examination: tumour, other testis, hepatomegaly, lungs

• Tumour markers, liver and bone profile

• Chest X-ray (CXR)

• Scrotal ultrasound examining both testes

• Chest and abdominal CT scan (lungs, liver and para-aortic lymph nodes)

• Isotope bone scan

Briefly describe how you would perform an orchidectomy for testicular tumour

Position The patient is placed under a general anaesthetic and supine on the table. A routine preparation and draping of the groin is performed.

Incision and procedure A groin crease incision is made and is deepened into the inguinal canal by incising the external oblique aponeurosis (superficial inguinal ring). The spermatic cord is then identified and cross-clamped.