Surgical Procedures for Testicular Cancer

Surgery is the main way to treat most types of testicular cancer. The goal is to remove as much cancer, and save as much of the testicles and how they work.

This can be done in 2 ways:

Orchiectomy

A radical inguinal orchiectomy is the removal of one or both testicles. They’re taken out through the groin instead of the scrotum. This helps lower the risk of spreading any cancer.

If only one testicle is removed, the other healthy one can make enough sperm cells and hormones. If both testicles are removed, then no sperm cells or hormones can be made. A drop in testosterone may cause hot flashes, loss of muscle mass, and a lower sex drive. It can be replaced with a patch, shot, or gel.

A prosthetic (fake) testicle will be placed so the scrotum will look normal. This can be done at the same time as the procedure or later.

Retroperitoneal Lymph Node Dissection

If cancer spreads beyond the testicle, it's mainly found in nearby lymph nodes. A retroperitoneal lymph node dissection (RPLND) is done to take these out. RPLND is a long and complex surgery.

If it’s done as open, a long cut is made in the belly. This lets the doctor get to the organs and lymph nodes. All lymph nodes from the sheet of muscle right above the stomach down to the pelvis are checked. Each one is looked at closely. If it shows signs of cancer, it's taken out.

During a laparoscopy, tools are placed into small cuts in the belly. In most cases you will get better faster with this type of surgery.

This can cause some muscle and nerve damage. It can also lead to retrograde ejaculation. Semen is redirected to the bladder instead of through the urethra and out of the body during ejaculation. This can cause problems with your ability to father children.

References:

Surgery for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/treating/surgery.html. Updated May 17, 2018. Accessed October 31, 2018.
Testicular cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer. Updated July 6, 2018. Accessed October 31, 2018.
Testicular cancer. Merck Manual Professional Version. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/testicular-cancer. Updated October 2017. Accessed October 31, 2018.
Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/_50. Updated October 26, 2018. Accessed October 31, 2018.
Last reviewed September 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 10/31/2018

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