Surgery to remove the testicle

After doing a physical examination, ultrasound and blood tests, 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 surgery
• 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.

Tissue removed during the orchidectomy is sent to a laboratory. A specialist called a pathologist examines the cells under a microscope and provides information about the cancer, such as the type, and whether and how far it has spread. This helps doctors plan further treatment.

In most cases, only one testicle needs to be removed. It is rare for both testicles to be affected by cancer at the same time.

Having an orchidectomy

An orchidectomy is an operation to remove a testicle. This is often done to confirm a diagnosis of testicular cancer. It is also the main treatment for testicular cancer that has not spread.

• You will be given a general anaesthetic before the orchidectomy.
• The urologist will make a cut (incision) in the groin above the pubic bone. This is shown below with a blue 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. This is called a prosthesis).
• The operation takes about 30 minutes.
• After the orchidectomy, you can usually go home the same day, but may need to stay in hospital overnight.
• You will need someone to take you home and stay with you for the first 24 hours.

The orchidectomy

What to expect after surgery

After an orchidectomy, you will need to take care while you recover. Talk to your treatment team about managing side effects.

	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 haematoma will disappear over time.
	Having pain relief Your doctor can prescribe medicines to control any pain you have after the operation. Let the doctor or nurses know if the pain worsens – don’t wait until it is severe before asking for more pain relief.
	Avoiding strain You’ll probably be advised to avoid strenuous activities, such as heavy lifting and vigorous exercise, for about six weeks after the operation. It is usually okay to have sex 2-4 weeks after surgery. Your doctor will discuss these precautions with you.
	Wearing supportive 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 regular underwear and is not noticeable under clothing. You could also wear your usual underwear with padding placed under the scrotum.
	Returning to driving and work You should be able to drive after 2-4 weeks and go back to work when you feel ready.
	Fertility effects As long as the remaining testicle is healthy, losing one testicle is unlikely to affect your ability to have children (fertility). However, some people may have fertility problems as the other testicle may be small and make less 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.
	Emotional effects Losing a testicle may cause some people to feel embarrassed or depressed, or could lead to low self- esteem. It may help to talk about how you are feeling with someone you trust, such as a partner, friend or counsellor. See more on information and support for people affected by cancer.
	Effects on sexuality 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. Some people choose to replace the removed testicle with an artificial one (prosthesis).

Having a prosthesis

You may decide to replace the removed testicle with an artificial one called a prosthesis. The 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 one, you can have the operation at the same time as the orchidectomy or at another time. Your urologist can give you more information about your options.

Before you have any surgery, you should ask your doctor for a referral to a fertility specialist if you are wanting to have children in the future. You may be able to store sperm for later use (sperm banking).

My doctor said to me, ‘If you’re going to get a cancer, this is the one to get. The cure rate is high, side effects are minimal and life afterwards is pretty normal.’

— Mark