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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20387
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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I am a 57 year old MTF desiring GRS Surgery. I had approval

Customer Question

I am a 57 year old MTF desiring GRS Surgery. I had approval from the government to fund my surgery in Montreal, and have done all of the necessary referral letters etc. However, upon reviewing my complete medical file, the clinic in Montreal has declined to operate claiming high surgical risk and that it needs to be done in a hospital complete with an ICU and cardiologist. I have gotten a similar response from an American surgeon who specializes in GRS surgery. Through followup, I believe the reason is because of elevated anaesthesia/surgical risk. I believe my risk factors are as follows:1) Cardiac: I have a mechanical heart valve and stent (Bentall procedure) performed 5 years ago with the newest generation artificial valves. I am on anticoagulation therapy consisting of warfarin and low dose EC-ASA, with a target INR of 2.0-3.0. I am told by all of my doctors that surgery is possible with bridging anticoagulation therapy, specifically discontinuation of warfarin and ASA and the use of LMWH.2) Complex Sleep Apnea (a mix of central and obstructive sleep apneas). My research after my rejection letter from Montreal led me to conclude that because sleep apnea can be a complicating factor in maintaining the airway during surgery, that it is really the general anesthesia that is the source of most of the risk.3) The use of epidural anesthesia when on warfarin is discouraged because of the possibility of bleeding into the spinal column (resulting in paraplegia).So with all of this, My question is: Can I have an Simple Bilateral Orchiectomy, but with LOCAL anesthetic (needles) rather than general or epidural anesthesia?
Submitted: 4 months ago.
Category: Urology
Expert:  Dr. Y. replied 4 months ago.
While it technically may be possible to perform the orchiectomy with only local anesthesia, you're not going to find a surgeon who would be willing to do this. The reason is that there could be the potential for lots of leading that would require cautery during the procedure. If this is the case, there's a possibility that the local anesthesia may not provide adequate pain control. If they cannot control your pain, then the only other option would be to perform general anesthesia at the time of the procedure. It sounds like you are a very high-risk patient and a surgeon is not going to want to rest performing this procedure just under local anesthesia