What to Expect From Testicular Cancer Surgery

If you’ve been diagnosed with testicular cancer, you’re likely facing surgery. This is the first option in almost all cases.

It’s one of most successfully treated forms of cancer. About 95% of men will survive more than 5 years after it’s found.

For almost all stages and types of testicular cancer, the testicle is removed. You might hear a doctor call this a radical inguinal orchiectomy.

Getting Ready for Surgery

This is a good time to talk to the doctor about any concerns you have: how the surgery will work, and how you should expect to feel afterward.

You may hope to have children afterward. Most men who are fertile before the cancer diagnosis are able to father a child after a testicle is removed. But you still might want to talk to your doctor about saving, or “banking,” some of your sperm beforehand just to be safe.

Other things you’ll want to remember:

  • Be prepared to take it easy for 2 to 4 weeks after surgery.
  • Make sure you have someone to take you home from the hospital. You won’t be able to drive.
  • Wear loose-fitting pants.
  • Leave your valuables at home.
  • Have your insurance papers in order.

What Happens in Testicular Surgery?

Before: When you’ve checked in, you’ll be taken to an operating room and put on a table. You won’t feel pain during the procedure. The doctors will numb your groin area so you can have the surgery while you’re awake, or you will be given something to make you sleep.

During: Your surgeon will make a small incision – a cut -- into the abdomen just above your pubic area. He will take out the whole testicle.

He will then cut what’s called the “spermatic cord,” which holds the vessels that carry blood and fluid to the testicles. This is done to keep cancer cells from going to other parts of your body.

The surgery usually takes about 30 minutes.

The testicle is examined to check for cancer or signs that it has spread.

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After: You are sent to a recovery room, where you wake up or wait for the sedative to wear off. The staff will give you something if you start to feel pain. 

You’ll probably will be able to go home the same day, but you should always be ready for an overnight stay at the hospital just in case.

Risks and side effects: Any surgery carries risks. The most likely problem you’ll have is bleeding into the scrotum. That’s called a hematoma. If the sac looks enlarged and purple, you might have one. You can try to prevent this with ice packs, a tight dressing or even snug-fitting underwear.

You may also have a bad reaction to the anesthesia that made you sleep. There’s also a chance of infection or blood clots.

There’s also likely to be some pain. The scrotum can be bruised and swollen for up to 4 weeks.

Remember to take it easy for a while. If you start your normal activities and lifting too soon, you could get a hernia, which can result from weakness or strain in the abdominal muscles.

What Happens in Lymph Node Surgery?

Sometimes, the surgery to take out a testicle isn’t enough.

If cancer has spread to the lymph nodes at the back of the abdomen, those may need to be taken out as well. This can happen at the same time or in a second surgery.

RPLND: You might hear your doctor call this retroperitoneal lymph node dissection, or RPLND. This kind of surgery requires anesthesia. The doctor makes a cut down the middle of the abdomen and takes out the nodes. The operation usually takes about 6 hours.

But this kind of surgery is less common than it used to be.

Laparoscopic surgery: Doctors today are more likely to take out lymph nodes with laparoscopic surgery. This is the surgery with long, thin tools. Using a small tube with a light and camera at the end, the surgeon inserts the tools through small cuts and takes out the nodes. His hands are never inside your body.

Risks and side effects: Though it is major surgery, serious complications after lymph node removal are not common.

Between 5% and 10% of people have temporary problems such as wound infections or bowel obstructions.

You will need time to heal, and you may not be up and around for a while. But men generally recover much faster from the laparoscopic surgery. 

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What About My Sex Life?

This is likely one of biggest questions on your mind or that of a spouse or partner. You should be able to get an erection and have sex if you lose just one testicle.

If both testicles have to be taken out, you lose the ability to produce sperm and would be unable to father children.

There are some other things you might want to consider.

  • Sex drive: Since the testicles produce the male hormone testosterone, taking out both could result in a lower sex drive. Supplements that come in patches, gels, or shots can help reduce those effects.
  • Control: There’s a chance that surgery to remove lymph nodes may damage the nerves that control ejaculation. Talk with your doctor to find out more.
  • Appearance: You may be concerned how your scrotum looks, post-surgery. Talk to your doctor if you feel this way. He can tell you about a procedure to place an artificial, or prosthetic, testicle in the scrotum. These prostheses are made with silicone rubber and filled with either saline, which is salt water, or a silicone gel. 
WebMD Medical Reference Reviewed by Laura J. Martin, MD on August 12, 2018

Sources

SOURCES:

American Cancer Society; “Surgery for testicular cancer,” “Retroperitoneal lymph node dissection (RPLND),” “Treatment options for testicular cancer, by type and stage”

National Cancer Institute, Surveillance, Epidemiology and End Results Program: Testis Cancer.

University of Rochester Medical Center: “Testicular Cancer: Surgery.”

Cancer Research UK: “Fertility -- having children after testicular cancer.”

Johns Hopkins Medicine, James Buchanan Brady Urological Institute: “Orchiectomy.”

Testicular Cancer Awareness Foundation.

Cleveland Clinic: “Testicular Prosthesis”

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