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As described in the section "How
Is Testicular Cancer Diagnosed?" testicular cancer 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. This procedure is known as a radical inguinal orchiectomy.
The surgeon takes special precautions to avoid spreading cancer cells
into the surgical wound or dislodging them from the tumor in the
bloodstream. All stages of testicular cancer are treated with surgery.
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. This operation, called retroperitoneal lymph node dissection,
can be a major operation. A large incision is often made to remove
these lymph nodes. Approximately 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 a
very small skin incision 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 as to whether
it is as good as the open surgery in terms of safety and efficiency in
removing all of the potentially cancerous lymph nodes.
In laparoscopic surgery, after being put to sleep, the patient
is turned onto the side. Small “keyhole” 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
keyhole 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 keyhole 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 operation should
only be done if the surgeon is very experienced in this procedure.
Surgery to remove retroperitoneal lymph nodes may damage
nearby nerves that control ejaculation. If these nerves are damaged,
when a male ejaculates, the sperm are not deposited outside the body
but rather end up deposited in 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 after retroperitoneal lymph
node dissection. 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 (in experienced hands)
of success.
If both testicles are removed, sperm cells cannot be produced
and a man becomes infertile. In some patients, after the affected
testis is removed, surgery will not be performed on the retroperitoneal
lymph nodes, but the patient is carefully watched with frequent
clinical exams and CT scans .. Also, without testicles, a man cannot
produce 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 who may still be trying to
start a family or have more 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.
Sexual impact of losing one or
both testicles
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 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
had a testicular prosthesis, to see what their experience was 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 Revised: 11/14/2007
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