Surgery to remove the testicle

After doing a physical examination, ultrasound, blood tests and sometimes a CT scan, your urologist may strongly suspect testicular cancer. However, none of these tests can give a definite diagnosis. The only way to be sure of the diagnosis is to surgically remove the affected testicle and examine it in a laboratory. The surgery to remove a testicle is called an orchidectomy or orchiectomy.

Learn more about:

• Overview
• Having an orchidectomy
• What to expect after an orchidectomy
• Having a prosthesis

Overview

For other types of cancer, a doctor can usually make a diagnosis by removing and examining some tissue from the tumour. This is called a biopsy. However, doctors don’t usually biopsy the testicle because there is a small risk that making a cut through the scrotum can cause cancer cells to spread. Rarely, for very select cases, only part of the testicle is removed (partial orchidectomy).

A specialist called a pathologist looks at the removed testicle under a microscope. If cancer cells are found, the pathologist can tell which type of testicular cancer it is and provide more information about the cancer, such as whether and how far it has spread (the stage). This helps doctors plan further treatment.

Removing both testicles

Testicular cancer usually occurs in only one testicle, so it is rare to need both testicles removed. If both testicles are removed, you will no longer produce testosterone and will probably be prescribed testosterone replacement therapy. Having both testicles removed will cause infertility.

Having an orchidectomy

An orchidectomy is often done to confirm a diagnosis of testicular cancer. It is also the main treatment for testicular cancer.

• You will be given a general anaesthetic to put you to sleep and temporarily block any pain or discomfort during the surgery.
• The urologist will make a cut (incision) in the groin above the pubic bone. This is shown below with a red line.
• The whole testicle is pulled up and out of the scrotum through this cut.
• The spermatic cord is also removed because it contains blood and lymph vessels that may act as a pathway for the cancer to spread to other areas of the body.
• The scrotum is not removed but it will no longer contain a testicle.
• You may choose to have an artificial testicle inserted to keep the shape called a prosthesis.
• The operation takes about an hour. You can usually go home the same day, but you may need to stay in hospital overnight.
• You will need someone to take you home and stay with you for 24 hours.

The orchidectomy

What to expect after an orchidectomy

Your body needs time to heal after the surgery. You will be given advice about a range of issues. The information below is a general overview of what to expect. If you have any questions about your recovery and how best to look after yourself when you get home, ask the doctors and nurses caring for you.

	Pain relief You will have some pain and discomfort for several days after surgery, but this can be controlled with pain medicines. Let the doctor or nurses know if the pain worsens – don’t wait until it is severe before asking for more pain relief.
	Daily activities You will need to take care while you recover. It will be some weeks before you can lift heavy things, exercise vigorously, drive or resume sexual activity. Ask your doctor how long you should wait before attempting any of these activities or returning to work.
	Underwear For the first couple of weeks, it’s best to wear underwear that provides cupping support for the scrotum. This will offer comfort and protection as you recover, and can also reduce swelling. You can buy scrotal support underwear at most pharmacies. It is similar to brief-style underwear and is not noticeable under clothing. You could also wear regular close-fitting underwear with padding placed under the scrotum. Avoid wearing loose-fitting underwear such as boxer shorts.
	Fertility effects As long as the remaining testicle is healthy, losing one testicle is unlikely to affect your ability to have children. However, some people may have fertility problems if the remaining testicle is small and doesn’t make a lot of sperm. The urologist may advise you to store some sperm at a sperm-banking facility before the surgery, just in case you have fertility problems in the future or need to have chemotherapy after surgery.
	Stitches and bruising You will have a few stitches to close the incision. These will usually dissolve after several weeks. There may be some bruising around the wound and scrotum. The scrotum can become swollen if blood collects inside it (intrascrotal haematoma). If this occurs, the swelling may make it feel like the testicle hasn’t been removed. Both the bruising and the swelling will disappear over time.
	Sex and body image Your ability to get an erection and experience orgasm should not be affected by the removal of one testicle. However, some people find that it takes time to adjust to the changes to their body and this may affect how they feel about sex and intimacy. Some people choose to replace the removed testicle with an artificial one (prosthesis).
	Gentle exercise Try to do some gentle exercise. This can help build up strength and lift mood. Start with a short walk and go a little further each day. Speak to your doctor about when you can return to your usual activities.
	How you might feel After your testicle is removed, you may feel sad, depressed, embarrassed or anxious. Usually these feelings will get better in time, but it may help to talk about how you are feeling with someone you trust such as a partner, friend or counsellor.

Having a prosthesis

You may decide to replace the removed testicle with a testicular prosthesis to improve how the scrotum looks. A prosthesis is a silicone implant similar in size and shape to the removed testicle. There are different brands, and some feel firmer than others. Whether or not to have a prosthesis is a personal decision.

If you choose to have a prosthesis, it can be inserted into the scrotum at the same time as the orchidectomy or at a later time. Ask your urologist for more information about your options.

→ READ MORE: Further tests for testicular cancer

Before having one of my testicles removed, I went to the sperm bank as a safeguard. But after 2 years, I was able to father a child normally.

DJ