<unk>  as a gender reassignment procedure Bilateral simple<unk>  is one option for gender reassignment surgery for transgender women. It may be performed as a standalone procedure or at the same time as a vaginoplasty. Bilateral<unk>  is considered first before undergoing vaginoplasty. Vaginoplasty can still be administered after undergoing bilateral<unk> , as the<unk>  preserves the penoscrotal skin that can later be transformed into a skin flap. Additionally, it is an option for those who are unable to undergo vaginoplasty due to the risk of complications. In addition to alleviating gender dysphoria, the procedure allows trans women to stop taking testosterone-blocking medications, which may cause unwanted side effects. Some common testosterone-blocking medications that most use before undergoing<unk>  are spironolactone and cyproterone. Common side effects caused by spironolactone are drowsiness, confusion, headache, fatigue, nausea/vomiting, gastritis, polyuria, polydipsia, and electrolyte imbalance (hyperkalemia). Cyproterone can cause side effects such as fatigue, low mood, and fulminant hepatitis.<unk>  allows individuals to stop taking these medications and avoid these adverse effects. It is also an alternative for trans women who have contraindications to antiandrogens and is a minimally invasive procedure to eliminate testosterone levels. Pre-operative evaluation World Professional Association for Transgender Health (WPATH) criteria Criteria from the World Professional Association for Transgender Health (WPATH) are used as a framework to guide health care professionals in approving or denying an<unk> . When a transgender individual wants to complete an<unk> , they are in a state of gender incongruence and they must meet the criteria before having the procedure done. The criteria are as follows: "(i) persistent, documented gender dysphoria, (ii) capacity to make informed decisions and consent to treatment, (iii) well-controlled medical or mental health comorbidities, and (iv) the use of hormone therapy for 12 months." Additionally, persons wishing to go through with the procedure are required to obtain referrals from two independent qualified mental health professionals. This referral should include "the individual's demographic information, psychosocial assessment results, duration of the therapeutic relationship, type of evaluation and therapy performed, if the criteria for surgery have been met and if informed consent has been obtained from the patient." Other medical considerations An individual seeking to undergo<unk>  is evaluated by a healthcare provider to ensure that the procedure is safe. Many candidates for<unk>  are on estrogen therapy before the operation, which increases risk of intraoperative venous thromboembolism (VTE); thus, the provider must take this risk into account and determine whether prophylaxis (prevention) is necessary. Current smokers, individuals with limited mobility, individuals older than the age of 40, and individuals who have a medical history of thrombolytic disorder are at higher risk of developing VTE. For these high-risk populations, the use of sequential compression devices during the operation is recommended to prevent VTE complications.<unk>  as diagnosis and treatment for testicular cancer Testicular cancer most commonly occurs in males ages 15 to 34. In 2017, there were 8,850 new cases and 410 deaths in the United States. The American Urological Association (AUA) and European Association of Urology (EAU) 2019 guidelines recommend imaging with testicular ultrasound in any individual suspected of having testicular cancer following a physical examination. The ultrasound aids in differentiating diagnoses so that the inidividual may avoid the need of the surgical approach of inguinal<unk> . Inguinal<unk>  is the gold standard treatment approach for those with confirmed malignancy of testicular cancer. Thus, it is imperative to diagnose the individual as having benign tumor vs. malignant tumor. Benign tumors are cancerous masses typically outside the testicle or surrounding it (extratesticular), whereas the malignant tumors typically lie within/inside the testicle (intratesticular). An<unk>  is used not only as a treatment option, but also as a diagnostic tool for testicular cancer. Before an<unk>  is deemed necessary, liver function tests, tumor markers, and various blood panels are taken to confirm the presence of testicular cancer. Tumor markers that may be checked include beta human chorionic gonadotropin, lactate dehydrogenase, and alpha fetoprotein. These markers are rechecked after<unk>  to stage the testicular cancer. Imaging, including chest radiography and an abdominal/pelvic CT (computed tomography) are also performed after<unk>  to evaluate for metastasis. An inguinal<unk>  is the primary treatment for any cancerous tumor that is found in the testicles; however, in cases where tumors are small, testis- or testes-sparing surgery may be performed instead. Partial<unk> , also known as testis-sparing surgery, is another treatment option for smaller testicular masses which is becoming widely popular in recent years. This treatment option is an alternative to remove testicular cancer masses which are <20mm, have a high probability of being benign, and with negative serum tumor markers. Its benefits include preserving fertility and normal hormone function. About half of testicular cancer germ cell tumors are seminomas. Individuals with seminomas are 80-85% likely to have a stage 1 diagnosis and the individual must undergo surveillance every 3-6 months in the first year following their<unk> , with an abdominal/pelvic CT at 3,6 and 12 months. Additional treatment such as chemotherapy may be given if they have risk factors for a relapse. Men with stage 1 seminoma after<unk>  have been shown to be free from a relapse for five years following<unk> .<unk>  as a complication of testicular torsion Among children and adolescents diagnosed with testicular torsion, the<unk>  rate is as high as 42%. Though the goal during surgery is to correct the twist of the spermatic cord,<unk>  is performed if the testicle is examined during the surgery to have dead tissue (necrosis) and suspected to no longer be a functioning testicle (no fertility). Delays in diagnosis and treatment increase the risk of<unk> , with diagnosis in the first four to eight hours of symptoms being critical to prevent permanent ischemic damage, decreased fertility, and need for<unk> .<unk>  for prostate cancer Prostate cancer, if non-metastatic, is commonly treated with radical prostatectomy or radiation therapy. Less often,<unk>  is used to treat prostate cancer. Prostate cancer grows in the presence of testosterone. When testosterone is present, " it is metabolized and converted into dihydrotestosterone (DHT) which stimulates the growth of prostate cells. This leads to normal prostate growth in adolescents but contributes to abnormal cell growth in older men." Reducing the amount of testosterone in a person is one way in which prostate cancer is treated. If the prostate cancer is in fact metastatic, then<unk>  may be used "...to abolish the stimulation of cancer cells by inhibiting testicular testosterone production and thereby reducing androgen levels in the blood: so-called androgen deprivation therapy (ADT)." Castration or<unk>  is a suitable option for androgen deprivation therapy, and it should be used if a very quick reduction in testosterone levels is needed. However in recent years,<unk>  is not commonly used since medical castration is a viable option. Medical castration means that drugs or medications are used to suppress the production of androgens such as testosterone. Some examples of medications used in medical castration include, euprolide, goserelin (Zoladex), buserelin, and triptorelin (Trelstar). Some of the side effects of these medications include but are not limited to "Reduced sexual desire and libido, Impotence, reduced size of testes and penis, hot flashes, growth of breast tissue (gynaecomastia) and pain across the breasts, thinning of the bones or osteoporosis and risk of fracture, anemia, loss of muscle mass, weight gain, fatigue and memory problems, and depression."<unk>  for pediatric testis tumors Until the mid-1980's, pediatric testis tumors were managed in accordance with adult guidelines where the standard therapy was radical inguinal<unk> . It was later discovered that this procedure was being overused in the pediatric population, particularly those in pre-puberty, because it was assumed that the tumor was malignant. It was discovered that the majority of the pediatric tumor registries over reported malignant tumors and had biased reporting. It has now been found that most tumors are benign lesions and the majority are cases of teratoma which act benign in pre-puberty pediatric individuals along with other benign tumors that have been reported such as: Sertolic cell tumor, Leydig cell tumor and juvenile granulosa cell tumors. The most malignant tumor that has been found in the pre-pubertal individuals is Pure yolk sac tumors. There is a difference in pre-pubertal, post-pubertal, and adult testis tumors in their histology and their level of malignancy with malignant tumors being rate in the pre-pubertal pediatric population.There has been a consideration to switch to testes sparing surgery (TSS) such as partial<unk>  specifically for the pre-puberty pediatric populations who lack signs of malignant tumors. Partial<unk>  allows the ability to preserve hormone function and the possibility of reproduction in the future. It has also been found to increase the quality of life. In the case that an individual is pediatric (<18 years of age) and is a post-pubertal with a malignant testes tumor, they must follow the adult recommended standard guidelines and proceed with radical inguinal<unk> . Post-pubertal populations The post-pubertal pediatric population and adults are at higher risk of malignant tumors and usually have a histology of a mixed
Orchiectomy
Orchiopexy
Vaginectomy
Hymenotomy
Spermatocelectomy
Sacrohysteropexy
Prolotherapy
Tubal ligation