Why do people get their testicles removed?
As you can tell, this is an extremely important question.
One that I'm sure you've thought about many times but it poses other questions like, what
happens after removal?
Is it a big deal?
Does it change a person's physiology?
Well, in today's video, we're going to answer those questions by going over five reasons
why someone might have to remove their testicles.
Some of those reasons might actually surprise you and we'll also talk about the procedure
or how they are removed and yes, discuss the aftermath about what some could expect about
their lifestyle, their physiology wants one or more what many males consider their prized
possessions are removed.
Some important stuff in here, so hopefully we don't drop the ball.
Let's do this.
So, let's get right into this anatomy that's relevant to removing a testicle.
So, you probably guess that we're going to have to take a look at the groin region.
So, we're going to take a look at this right side of the groin.
You can see specifically here is the right scrotum suc or right scrotum and inside, yes,
everybody take a deep breath, is the right testicle or testes that you can see right
underneath my probe here.
And I do just want to mention, testis and testicle, same thing, we can use those interchangeably
so I will throughout the video.
Very similar to like the plural versions testes is the same thing as testicles but this right
testes you can see, if I flip it over you can see we kept the connective tissue on this
side but removed it on this side so you could actually differentiate between the actual
testes and the C shape structure called the epididymis.
This epididymis essentially stores sperm cells that were produced by the testes and this
other structure we need to mention too, the Spermatic Cord is really important to some
reasons why we might remove a testes.
So, I'm going to mention inside there are blood vessels like veins and arteries even
nerve endings and a really cool tube we've actually insected out called the Vast Deferens
and the vast defrins transports sperm cells outside of the testes but again, part of that
spermatic cord.
Now, when we're talking about the removal of a testicle or a testis, there's an actual
procedure and a name for it called Orchiectomy.
Now, the first half of that word, the Orc or Orchi or orchid word root actually means
testis or testicle.
Actomy refers to surgical removal of.
So, you can see how that word translates but there are two types of orchiectomies in going
to mention.
One is called a simple orchiectomy and that's where they just make an incision in the srotal
sack and remove that testes in the epididymis alone.
A radical orchiectomy, they remove those two structures that I mentioned as well as the
spermatic cord and that incision would be up higher.
You could even see in this canal, this canal that I'm sticking the probe in where the spermatic
cords emerging from, this canal is called the Inguinal Canal and so that incision would
be up closer because they'd have to get into this canal to remove the actual spermatic
cord.
Now, you might wonder, why would you do a simple versus a radical?
Well, again, that depends on the condition you're treating or the reason for the testicle
being removed and so, let's jump into some of these reasons to remove the actual testis
or testicle.
Now, the first item on our list that I want to mention is the testicular torsion.
Now, if the testicular torsion sounds bad to you, that's because it is.
I mean, this is not a fun thing to have happen.
What's going on here the testicle and the sprematic cord are twisting within the scrotal
sac.
That doesn't look like it feels very good and believe me, when I was in the emergency
department during clinical rotations during medical training, saw a few patients with
this and they were not happy.
They were in a lot of pain.
Now, people will always ask, "Well, what causes this to happen?"
Well, it can be caused just spontaneously.
We don't know why it happens - just randomly out of nowhere.
It can also happen with straining or physical activity and also happen due to trauma.
Now, we also know that there are people who are more increased at risk for this is when
the testicle or testis isn't fixed as firmly to the actual scrotal sac.
Now, during the developmental process, it should be pulled fully down into the scrotal
sac and attached firmly but in some people, it doesn't fully get as strong of attachment
and can increase their risk of a testicular torsion.
So, what is the treatment here?
The initial treatment we're not looking for is let's remove the testicle, we're trying
to preserve the testicle.
So, The reason why it can happen in some cases is because of the blood vessels that are in
here being twisted and compressed.
If blood can't go in and out of the testicle as effectively, the testicular tissue could
die off which if we get necrotic testicular tissue, then, we would remove it in that case
but initially, the first line treatment is let's get this twist out, preserve the testicle,
fix it to the scrotal sac firmly so it doesn't happen again and hopefully that's all we have
to do but you could see, as that time line increases, the longer somebody waits to get
treatment and the longer the testis don't have the blood supply, the greater risk for
having to remove it due to a testicular torsion.
So, if you think you ever have a testicular torsion, one, it's not very subtle because
it hurts pretty bad.
Don't wait.
Just go get it checked out.
Make sure so you can preserve that testicle of yours.
And the next item on the list we want to mention is cryptorchidism.
Crypt in medical terminology means hidden.
We already know orchid refers to testis or testicle.
So, we have a hidden testicle on our hands.
Now most of us know cryptorchidism as something that's commonly referred to as an Undescended
Testicle.
Now normally the testis should descend while you're developing inside mom and just prior
to birth, they should make it through this ingunol canal that I mentioned earlier and
push into the scrotal suc.
Now, if that doesn't occur, even people who are born with an undescended testicle often
clinicians will wait about three to four months to see if it'll still come down spontaneously
on its own.
But after that 4 months period, we're into interventions.
Now, some of you may be thinking, "Whoa, whoa, whoa, whoa.
You're telling me cryptorchidism or an undescended testicle means I'm going to get a testicle
removed?"
And some of you know people have had that, had an undescended testicle, maybe you even
had an undescended testicle and you still got it because you're right - the first line
treatment is to actually bring it down and fixate it into the scrotal suc and make it
so it can't retract up and just stays put where it's supposed to be.
Now, that's easy for us to say and say, a first world country or somewhere where we
have easy access to medical care.
What if someone's in a developing country doesn't have access to health care?
Maybe this person made it into their teenage years or even adulthood without an - with
an undescended testicle not being detected.
And in that case, they may look into removing that testicle.
Now there are variables that they'll have to consider but in those cases the testicle
may have atrophyed.
There's also data that shows that undescended testicles increase the risk for testicular
cancer.
So, these are considerations that may cause someone to have an orchiectomy due to cryptorchidism.
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Now, the next item on this list is the condition that most people think about in regards to
removing of a testicle and that is testicular cancer.
Now, we could do a whole video just on testicular cancer and we will and even cancer in general
but let's just talk briefly about cancer starting in this testicle here.
This would be the formation of abnormal cells that would essentially be growing out of control
and they could even grow to the point where you'd feel a palpable mass even through the
scrotal skin and yes, we're concerned about the mass here and what it could do at the
local level but even more concerned about any of those cancerous cells leaving the testicle
and going to other regions of the body and you can see I'm tracing the spermatic cord
for a reason because remember, vasculature which could be a pathway for cancerous cells
to leave and this is the situation where we'd see a radical orchiectomy where we wouldn't
just remove the testicle and surrounding structures here but also that spermatic cord which would
be important for staging of the cancer and even assessing risk for those cells to spreading
to other regions of the body.
Now, one last thing I want to mention about testicle cancer and even cancer in general,
one of the most important things you can do is early detection, whether that's through
routine physical exams with your primary care provider or learning about the signs or symptoms
or risk factors for certain cancers and in this case, testicular cancer and we'll put
some information below that you guys can take a look at to kind of assess those risks and
things to look out for.
And next, we have trauma.
Now, luckily, the testicles do have some level of resiliency and so, those average kicks
to the jewels don't typically result in any long-term serious consequences but with enough
blunt force trauma, you can cause damage to the testicle and even cause rupturing in some
cases.
Even think about a penetrating trauma or a penetrating wound where it went through the
scroll tissue and into the testicle, that obviously could cause damage and even rupturing.
Now, again, a clinician's knee jerk response isn't to just yank that thing out of there.
There's going to be a full assessment of the extent of the damage and even ruptured testicles
can be repaired surgically to a certain degree and there's actually data that shows that
early intervention and early repair of a damaged testicle reduces the risk of a future need
to remove that testicle if it again, it's handled early.
Now, there are going to be cases where the damage is so extensive right from the get
go that it might just have to come out unfortunately.
And finally on to the last item of our list but I did forget to ask our video quiz question
because we're asking quiz questions in each of our videos now, so let me ask that real
quick and then we'll continue - but our quiz question is, "What muscle or muscles would
you need to engage in order to click the like button?"
I'm kidding mostly.
I say "mostly" because I would be all excited if you could answer that question but our
real question that has to do with some of the anatomy we talked about today is "Why
are males more likely to develop an inguinal hernia or a groin hernia more so than females?"
If you know the answers to any of those questions, post them in the comments below and we'll
actually pin a comment at the top that shows the correct answers to those so you can see
if you got them right.
But back on to this last item.
The item on our list is gender reassignment surgery.
Now, up to this point, we've been really talking about a case where you'd remove just one testicle
but in gender reassignment surgery, we would remove both testicles and so obviously, this
is more of a choice situation than kind of conditions that we talked about in the earlier
cases but these - all these situations should maybe pose the question to you, well, what
happens afterwards?
How well does somebody live with say one testicle versus even removing two testicles?
With one testicle, most people will do just fine and even in certain cases during the
surgery, the surgeon will ask the patient if they want a prosthetic testicle to be put
in place of the one that they removed if the patient is concerned about or for cosmetic
reasons or how the testicles will look afterwards.
And if that one left over testicle, not the prosthetic one, the one that's still there,
is functioning properly, they can still have kids because they can produce sperm cells,
even produce enough testosterone levels in cases.
Now, granted, they may want to check testosterone levels to check and see but each situation
is a little different but generally, they do just fine and lead normal lives.
Now, in the case of gender reassignment surgery, you take both testicles away.
Obviously, no sperm cells are going to be produced and then testosterone levels are
going to essentially just wipe off the map there or drained or dropped dramatically but
that's kind of the point in that situation and you could talk about other situations,
say somebody had the testicles removed, removed in a that wasn't for gender reassignment,
then we just go through well, if those testosterone levels are so low, that's going to affect
muscle mass, fat distribution, libido, energy levels - we have a whole video on testosterone
which would answer those questions.
So if you want to check those out, you can get a lot of de - excuse me, details from
that but hopefully that gives you guys a lot of different ideas on why you might remove
the testicles and it wasn't an all-inclusive list, we could always find other reasons for
testicular removal but again, like I said, hopefully that gives you the answers that
you're looking for.
If you have more questions, post them in the comments below.
Like I said, engage those skeletal muscles if you feel the need to like and subscribe
and check out our VPN link to Private Internet Access if you're interested in being a little
more hidden and getting a discount there and we'll see you in the next video.