Surgery for testicular cancer
Surgery is most often the first treatment for testicular cancer. It is used even when the cancer has spread.
Radical inguinal orchiectomy
All stages of testicular cancer are treated with this surgery. The testicle (or testicles) with cancer are taken out of the scrotum through a cut (incision) made just above the pubic area. The surgeon cuts through the spermatic cord that attaches the testicle to the belly (abdomen).
Retroperitoneal lymph node dissection (RPLND)
Depending on the type and stage of your cancer, some lymph nodes at the back of the belly (abdomen) may also be removed. This can be done at the same time as the orchiectomy or during a second operation. Not all patients with testicular cancer need to have lymph nodes removed, so it’s important to discuss this with your doctor.
The lymph nodes are usually removed through a large cut (incision) down the middle of the belly.
In some cases, the surgeon can remove lymph nodes through very small cuts in the belly using a narrow lighted tube with a small video camera (called a laparoscope) and special instruments. Although the patient recovers much more quickly with this type of surgery, doctors are not sure if it is as good as the standard operation. So if the removed lymph nodes have cancer cells, the patient is often treated with chemotherapy, as well. This approach should only be used if the surgeon has a lot of experience with this surgery.
Possible risks and side effects of surgery
The short-term risks of surgery include problems with anesthesia, bleeding, blood clots, and infections. Most men have some pain after the operation, which can often be helped with pain medicines, if needed.
If both testicles are removed:
- The body can’t make sperm, so the patient becomes infertile
- The body doesn’t make enough testosterone, which can lower sex drive and the ability to have erections and cause other effects, as well.
Men who have had both testicles removed will need to take testosterone, either as a gel, a patch, or a shot.
If one testicle is removed, the remaining testicle can make sperm and testosterone.
Most men with testicular cancer are young, and they might be concerned about their appearance after the loss of a testicle. To restore a more natural look, a man can have a testicular implant filled with saline (salt water) put in his scrotum. When in place, it can look like a normal testicle.
Effects of RPLND: Serious problems, such as bowel problems or infections after surgery are not common, but they can happen.
This type of surgery does not affect a man’s ability to have sex. But it might damage some of the nerves that control the release of semen. This can lead to sperm going into the bladder instead of out the penis (retrograde ejaculation). Surgeons often try to avoid damaging these nerves when they can by doing nerve-sparing surgery. Still, sometimes nerve damage does occur.
For more information about surgery for testicular cancer, including possible side effects, see our document Testicular Cancer.
If you are concerned about fertility after treatment, see Fertility and Men With Cancer.
Last Medical Review: 01/20/2015
Last Revised: 02/23/2015