Wow, $200! For male cats, it is a simple procedure that I got to do to control strays in Chicago while in vet tech classes volunteering on the weekend to learn from veterinarians. Here at the vet is $80 for cats or dogs.
Must have been gold plated or titanium then Or one really bad vet tech who could't get the IV started. After that, a knife is used for getting in, cutting off, but not for stiches. Scissors are used for that. I won't go into detail how they take care of strays. Even tho it is safe, the description can sound disgusting.
No body likes losing their balls. Of course he's traumatised! On a more practical note, you need separate litter boxes for male and female cats, a female won't go where a male has been.