Urologie médicale et chirurgicale
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Epididymal Sparing Bilateral Orchidectomy with Epididymoplasty for Advanced Cancer Prostate: Our Experience in Rural Setup

Vijay P Agrawal, TK Sen and Krishna Shetty MV

Rise in incidence and variable natural history of prostatic carcinoma, presents a challenge to professionals involved in its management. Cases that come for evaluation and treatment in developing countries like ours are elderly and usually present in the late stages of the disease. Perhaps the best option remain at this stage is palliative in the form of channel TURP to improve the urine flow and suppress the cancer growth by androgen deprivation treatment (ADT). Further improvement of quality of life is achieved by supportive measures like good nutrition, vitamins and calcium supplementation to prevent demineralisation of bones and analgesic for pain relief.

Bilateral Orchidectomy remains the most effective and permanent solution for ADT as it brings down serum testosterone level very rapidly to castration level of 20%. Epididymis functions only as the carrier of sperms and help in maturation during the passage. In no way it is involved in spermatogenesis or production of testosterone. Epididymal sparing bilateral orchidectomy with epididymoplasty achieves androgen deprivation to that of castration level. Left over epididymal bubbins in the scrotal sacs maintains the shape of scrotum and gives the patient a feel of scrotal sac not being empty.