title: Epididymal sparing bilateral simple orchiectomy with epididymoplasty: preservation of esthetics and body image.
abstract: OBJECTIVE
  We report the surgical technique and results of epididymal sparing bilateral simple orchiectomy as an esthetic alternative to standard bilateral simple orchiectomy and luteinizing hormone releasing hormone (LH-RH) agonist injection therapy in patients with prostate cancer.
  
  
  METHODS
  The study included 91 consecutive epididymal sparing bilateral simple orchiectomy (BSO) procedures that were performed at the Atlanta Veterans Affairs Medical Center during a 25-month period. All patients had pathologically confirmed prostate cancer. A total of 52 patients (57.1%) were receiving LH-RH agonist therapy prior to the procedure and the remaining 39 (42.9%) were not. All procedures were performed in an outpatient clinic setting using spermatic cord anesthesia block as the only method of anesthesia. In the 52 patients who were on LH-RH agonist therapy prior to the procedure the overall impression/satisfaction with the procedure was evaluated using a questionnaire.
  
  
  RESULTS
  All 91 procedures were performed at the urology outpatient clinic using local anesthesia. Mean patient age was 74.2 years (range 44 to 86). Mean serum prostate specific antigen was 58.9 ng/ml. The mean time required to perform the spermatic cord anesthesia block was 3.9 minutes (range 2 to 6) and the volume of anesthetic solution was 18.9 ml per case (range 10 to 32). Despite significant difference in testicular size between patients receiving and not receiving LH/RH agonists there were no differences in anesthesia time or anesthetic volume (3.9 and 3.9 minutes, p = 0.97, and 18.6 and 19.4 ml, respectively, p = 0.47). Mean operative time for BSO excluding anesthesia time was 36.9 minutes (range 18 to 70). Mean operative time was similar in patients receiving and not receiving LH-RH agonists (36.2 and 37.8 minutes, respectively, p = 0.39). The procedure was well tolerated, as judged by the mean intraoperative pain score during BSO of 0.2 (range 0 to 3). The majority of patients (76 or 83.5%) were pain-free during the procedure. Pain scores were similar in patients who were and were not receiving LH-RH agonists during BSO (p = 0.97). There were no adverse events. Followup data were available on 26 of the 52 patients who were receiving LH-RH agonist therapy prior to the procedure. Of them 96.2% were satisfied with the results and 84.6% preferred the procedure over medical castration therapy with LH-RH agonist therapy.
  
  
  CONCLUSIONS
  Epididymal sparing bilateral simple orchiectomy is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anesthesia. Preservation of the epididymis and subsequent epididymoplasty is effective for maintaining the esthetic appearance of the scrotum and patient satisfaction. The procedure offers patients the convenience of 1-time surgical therapy over lifelong medical injection therapy at a significantly lower cost and without significantly compromising the esthetic appearance of the scrotum.
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30033, USA. issa@emory.edu
authors.forename: Muta M
authors.initials: MM
authors.lastname: Issa
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.forename: Rafael
authors.initials: R
authors.lastname: Bouet
authors.forename: Mark R
authors.initials: MR
authors.lastname: Young
authors.forename: John A
authors.initials: JA
authors.lastname: Petros
authors.forename: Fray F
authors.initials: FF
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000772:Anesthesia, Local; D001828:Body Image; D004822:Epididymis / Q000601:surgery*; D004954:Esthetics; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009407:Nerve Block; D009919:Orchiectomy / Q000379:methods* / Q000523:psychology; D017060:Patient Satisfaction; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D013085:Spermatic Cord / Q000294:innervation; D011795:Surveys and Questionnaires; D013536:Suture Techniques
chemical_list: D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen