Simple orchiectomy

• Used for castration (metastatic prostate cancer; transgender MTF)

1. Make transverse hemiscrotal incision
2. Carry incision down through tunica vaginalis
3. Deliver testicle
4. Identify and ligate vas deferens with 2-0 silk
5. Separate cremasterics from spermatic vessels and ligate each with 2-0 silk
6. Re-approximate Dartos with 4-0 Vicryl
7. Close skin with 5-0 running suture
8. Repeat on other side

Radical orchiectomy

1. Incision: from 2 cm cephalad/lateral to pubic tubercle, extend laterally along langer's line 5-7 cm
2. Divide down to external oblique
3. Sharply open external oblique from external to internal ring
4. Identify and protect ilioinguinal nerve
5. Bluntly dissect at pubic tubercle to circumscribe spermatic cord. Wrap Penrose drain around twice and clamp (as tourniquet)
6. Deliver testicle by pushing from base of hemiscrotum
7. Dissect cord proximal to internal inguinal ring (vas deferens will diverge
8. High ligation of cord - leave long tails for identification during RPLND