Surgery is typically the first treatment for all testicular cancers.

Radical inguinal orchiectomy

As described in the section "How is testicular cancer diagnosed?" this type of surgery removes the testicle (or testicles) containing the cancer. An incision is made in the groin, and the testicle is taken from the scrotum through the opening. A cut is made through the spermatic cord that attaches the testicle to the abdomen. The surgeon takes special precautions to avoid spreading cancer cells into the surgical wound or dislodging them from the tumor into the bloodstream. All stages of testicular cancer are typically treated with this type surgery.

Retroperitoneal lymph node dissection

Depending on the type and stage of your cancer, some lymph nodes behind the abdomen may also be removed at the same time or during a second operation. (In some patients, after the affected testicle is removed, surgery will not be done on the retroperitoneal lymph nodes, but the patient is carefully watched with frequent clinical exams and CT scans.)

Retroperitoneal lymph node dissection can be a major operation. A large incision is often made to remove these lymph nodes. About 5% to 10% of patients have temporary complications after surgery, such as bowel obstruction or wound infections. This is a difficult and long operation. It should be done by a surgeon who does them often. Experience counts.

In some cases, the surgeon can remove lymph nodes through very small skin incisions in the abdomen by using a laparoscope (a narrow, lighted tube, which lets doctors operate on the abdomen without making a large incision and scar). Although laparoscopic surgery seems to be a lot easier for the patient, doctors are unsure if it is as safe and efficient as the open surgery in removing all of the potentially cancerous lymph nodes.

In laparoscopic surgery, after being put to sleep, the patient is turned onto his side. Small keyhole-like incisions are made on the abdomen. The surgeon's hands are not inside the patient's body during surgery. A video camera and long instruments are inserted through these incisions. The surgeon sees the inside of the abdomen on a television monitor. Using these long instruments, the lymph nodes around the aorta and inferior vena cava (large blood vessels) can be removed through one of the incisions. The small incisions are closed and the patient is awakened. Patients recover much more quickly from this operation than the standard open procedure and are walking soon after surgery. The hospital stay ranges from 2 to 4 days. There is usually less pain and patients are eating sooner. This procedure should only be done if the surgeon is very experienced.

Possible effects on sexual function and fertility

Surgery to remove retroperitoneal lymph nodes may damage nearby nerves that control ejaculation. If these nerves are damaged, when a male ejaculates, the semen is not deposited outside the body but rather goes into the bladder. This is known as retrograde ejaculation. This type of surgery does not cause impotence -- a man can still have erections and sexual intercourse -- but retrograde ejaculation can make it harder to father children. To save the normal ejaculation function, surgeons have developed a type of retroperitoneal lymph node surgery called nerve-sparing surgery that has a very high rate of success in experienced hands.

If both testicles are removed, sperm cells cannot be produced and a man becomes infertile. Also, without testicles, a man cannot make enough testosterone. He will need to take supplements, either in the form of a gel, a patch, or a shot. Pills are generally not reliable sources of testosterone.

Testicular cancer often affects men at an age when they may be trying to have children. These men may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment). Men with testicular cancer often have lower than normal sperm counts, which may make it difficult to collect a good sperm sample.

Men with testicular cancer are usually young and may be concerned that their appearance has changed. They may be single and dating and worry about a partner's reaction, or they may be athletic and feel embarrassed by the missing testicle when in locker rooms. Since the operation also removes the cord above the testicle, that side of the scrotum can look and feel empty to them.

To restore a more natural look, a man can have a testicular prosthesis surgically implanted in his scrotum. The prosthesis approved for use in the United States is filled with saline (salt water), and it comes in different sizes to match the remaining testicle. When in place, it can look like a normal testicle. There can be a scar after the operation, but it is often partly hidden by pubic hair. Some men want to have a prosthesis and others do not. You should discuss your wishes with your surgeon before considering this surgery. It may also help to talk with someone who has a testicular prosthesis, to see what their experience has been like.

Losing a testicle usually has no effect on a man's ability to get an erection and have sex. Men who have had both testicles removed are also still able to have sex as long as they are getting enough testosterone.

Last Medical Review: 08/03/2009
Last Revised: 08/03/2009