A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries.

BACKGROUND: To date, there is no literature on orchiectomy as a stand-alone procedure in the transgender surgical context. AIM: To propose a simple guide to aid health-care professionals caring for transgender and gender nonconforming individuals seeking bilateral simple orchiectomy. METHODS: We use expert opinion to provide a novel guide for simple orchiectomy in the transition-related context for health-care professionals caring for transgender and gender nonconforming individuals. A review of relevant literature was also performed focusing on simple orchiectomy and vaginoplasty surgeries for transgender and gender nonconforming individuals. MAIN OUTCOME MEASURE: We describe the indications, surgical approach, preoperative and postoperative assessment, and the risks and benefits of bilateral simple orchiectomy in the context of gender surgery. RESULTS: This article is the first, to our knowledge, to describe a structured guide to bilateral simple orchiectomy in the context of gender surgery for health-care professionals caring for transgender and gender nonconforming individuals. CLINICAL IMPLICATIONS: Bilateral scrotal orchiectomy is a simple surgical procedure that has a defined role in the surgical management of many transgender individuals. STRENGTHS AND LIMITATIONS: This article provides an approach to simple orchiectomy in the context of gender surgery for health-care professionals. Only guidelines written in English were included. The quality of the included guidelines was not evaluated, but this was beyond the scope of this review. CONCLUSION: We present a novel guide for health-care professionals caring for transgender and gender nonconforming individuals seeking bilateral simple orchiectomy in the context of gender surgery. Francis C, Grober E, Potter E, et al. A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries. Sex Med Rev 2020;8:492-496.

Initial clinical experience with simple orchiectomy procedures in the context of transition-related surgeries.

Background : One of the more common procedures conducted through the transition-related surgeries (TRSs) program is simple orchiectomy. Due to the relative novelty of TRS in Canada, national perioperative guidelines for simple orchiectomy in the context of TRS are yet to be developed. Furthermore, there is a void in the literature describing the indications and outcomes of simple orchiectomy among transgender individuals. Aims : This study is the first descriptive case series in Canada highlighting our experience with simple orchiectomy in the context of TRS. Methods : This study retrospectively assessed data from electronic patient medical records of 16 patients who had simple orchiectomy procedures at Women's College Hospital in Toronto, Canada from August 2018 to April 2019. Data were collected using a standardized data collection form which includes patient baseline demographic data, and objective and subjective clinical outcomes. Results : Mean age at surgery was 32.6 ± 10.4 years and mean time to surgery following the initial approval of referral was 9.9 ± 8.5 weeks. A majority of referrals (n = 13, 81.3%) were from urban areas with specialized TRS services. The average time on hormones was 3.1 ± 1.9 years. In terms of post-surgical complications at the 30-day day follow-up visit, there was a single post-operative sperm granuloma reported. There were no other complications identified post-surgery in our patient case series. Discussion : In Ontario, the growing recognition of the benefits of TRS has led to the development of a publicly funded pathway to TRS surgery. This study is the first assessment of simple orchiectomy performed for TRS in Canada, and it has shown that the procedure is safe and reproducible. Due to its benefits, coordinating safe and efficient access of care for this procedure should be an important action item for health systems. This study is limited by its low sample size.