Testicular Cancer Surgery

Introduction

A diagnosis of testicular cancer — or a strong suspicion of it from an ultrasound and blood tests — brings up many questions at once. You may be thinking about the surgery itself, about fertility and fatherhood, about whether you will need chemotherapy, and about how this will affect your body, your work, and your sense of self in the years ahead. These concerns are normal and shared by almost every man who has stood where you are now.

The reassuring clinical picture is that testicular cancer is among the most treatable solid cancers, with very high long-term survival when treated appropriately, even in cases where the disease has spread. Surgery — specifically the removal of the affected testicle through a small groin incision — is almost always the first step. It both confirms the exact tumour type and treats the primary tumour. From there, your team uses the surgical findings, imaging, and blood markers to decide whether any further treatment is needed.

This guide explains what testicular cancer surgery is, who it is for, the main surgical approaches, what happens before and during the operation, what recovery looks like, the risks involved, and what life and follow-up typically look like in the years afterwards. It is written for someone who already has the diagnosis or is in active workup, and who is now planning the next steps of care.

What Is Testicular Cancer Surgery?

Testicular cancer surgery is the removal of the testicle (or, in some cases, of nearby lymph nodes) to treat cancer that has started in the testis. The main operation is called a radical inguinal orchiectomy. “Inguinal” refers to the groin, which is where the incision is made, and “orchiectomy” means removal of the testicle. The whole testicle and the spermatic cord that connects it to the abdomen are removed together through this groin cut.

This surgery is unusual compared with most cancer operations in one important way: it is performed before a tissue biopsy is taken. For nearly every other cancer, doctors first take a small sample (biopsy), confirm the diagnosis, and then plan surgery. In testicular cancer, a needle biopsy through the scrotum is avoided because it can disturb the natural drainage pathways of the testicle and may increase the risk of spreading cancer cells. Instead, when imaging and tumour markers strongly suggest a malignant testicular tumour, the entire testicle is removed through the groin. The pathologist then examines it under the microscope to confirm the diagnosis, identify the exact tumour type, and look at how far it has invaded the surrounding structures.

The two main types of testicular cancer that this surgery treats are seminoma and non-seminomatous germ cell tumours (often shortened to NSGCT). Both start in the germ cells, which are the cells that would normally produce sperm. Seminomas tend to grow more slowly and are very sensitive to radiation and chemotherapy. Non-seminomatous tumours are a mixed group (including embryonal carcinoma, yolk sac tumour, teratoma, and choriocarcinoma) and tend to behave more aggressively, but they also respond very well to modern chemotherapy. Less common tumours of the testis include Leydig cell tumours, Sertoli cell tumours, and lymphoma; the surgical approach for these may differ.

For some patients, a second operation called retroperitoneal lymph node dissection (RPLND) is needed. The retroperitoneum is the space at the back of the abdomen where the lymph nodes that drain the testicles sit. Removing these lymph nodes can be both diagnostic (to know whether cancer has spread there) and therapeutic (to remove any disease that is present).

Why Is Testicular Cancer Surgery Performed?

The surgery has several purposes that happen in a single operation:

• Treatment of the primary tumour. Removing the affected testicle takes out the source of the cancer.
• Definitive diagnosis. The pathologist studies the entire testicle and determines the tumour type, sub-type, and whether features such as lymphovascular invasion (cancer cells inside small blood or lymph vessels) are present.
• Staging. The pathology report, combined with imaging of the abdomen and chest and blood tests, is used to assign a stage. Stage guides what, if any, further treatment is needed.
• Reducing risk of further spread. By removing the tumour early, doctors aim to prevent further spread through the lymphatic system or bloodstream.

Surgery is typically recommended when:

• A solid mass inside the testicle has been seen on a scrotal ultrasound.
• Blood tumour markers — alpha-fetoprotein (AFP), beta human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH) — are elevated, or even when they are normal but imaging is concerning.
• The clinical picture cannot be confidently explained by a benign cause such as a cyst, hydrocele, or infection.

Major guidelines from the National Comprehensive Cancer Network (NCCN), the European Association of Urology (EAU), and the American Urological Association (AUA) describe radical inguinal orchiectomy as the standard initial surgical management in almost all confirmed or strongly suspected germ cell tumours of the testis.

Who Is a Candidate?

Almost every man with a suspected malignant testicular tumour is a candidate for radical inguinal orchiectomy. Age is not an absolute barrier; the operation is performed in adolescents through to older adults. The decision points are usually less about whether to operate and more about timing, fertility planning, and the choice of any further treatment after surgery.

Situations that require particular discussion include:

• Bilateral disease or a tumour in a solitary testicle. If both testicles are affected (rare), or the patient has only one functioning testicle, removing all testicular tissue would mean lifelong testosterone replacement and complete loss of fertility from his own sperm. In these specific situations, doctors may consider testis-sparing surgery (partial orchiectomy), in which only the tumour and a small margin are removed. This is offered selectively, usually for small tumours, and requires careful surveillance afterwards.
• Widespread metastatic disease at presentation with very high tumour markers. Occasionally, a patient is so unwell from advanced disease that chemotherapy is started first to stabilise him, with orchiectomy performed after the initial chemotherapy. This sequence is decided by a multidisciplinary team.
• Suspected benign lesions. If imaging and markers point strongly to a non-cancerous lesion, the surgeon may explore through the groin and assess the testicle during surgery (with frozen section pathology if available) before deciding whether full removal is needed.

Whether you proceed straight to surgery, or whether something else needs to happen first, is decided in your urology and oncology consultation.

Alternatives

For a confirmed or strongly suspected testicular germ cell cancer, there is no true non-surgical alternative to removing the affected testicle. Unlike many other cancers, testicular tumours are not effectively managed with chemotherapy or radiation alone while leaving the tumour in place. The testicle has a partial “blood-testis barrier” that limits how well drugs reach tumour cells inside it, and the primary tumour itself needs to be removed and examined to plan the rest of treatment.

However, some alternatives or modifications exist around the edges of the standard approach:

• Testis-sparing surgery (partial orchiectomy). As described above, this is offered only in specific situations — bilateral tumours, a solitary testis, or small lesions where benign disease is plausible.
• Observation of a small, indeterminate lesion. Very small testicular lesions found incidentally, especially when tumour markers are normal, may sometimes be followed with repeat ultrasound, particularly if a benign cause is likely. This is a decision made by your urologist based on individual findings.
• Neoadjuvant chemotherapy first. In patients with advanced disease who are very unwell, chemotherapy can be given before orchiectomy. The surgery is still done, just later.
• Treatment of residual disease after chemotherapy. After chemotherapy for advanced disease, leftover masses in the retroperitoneum or elsewhere may need to be removed surgically. This is part of the overall treatment plan rather than an alternative to the initial orchiectomy.

For seminoma and non-seminoma alike, current guidelines consistently describe radical inguinal orchiectomy as the standard first step. Discussion of any deviation from this is a clinical conversation with your urologist and oncologist.

Surgical Approaches

Several surgical procedures fall under the umbrella of “testicular cancer surgery.” You may need one, or a combination, depending on your stage and tumour type.

Radical inguinal orchiectomy

This is the standard operation for almost all testicular cancers. A 5–10 cm incision is made in the groin above the inguinal canal — not in the scrotum. The spermatic cord (which carries the blood supply, lymphatics, and vas deferens) is identified high up, clamped, and divided. The testicle is then delivered up through the groin and removed together with the entire cord. Removing the cord high up reduces the risk of leaving behind any cancer cells that may have travelled along it. The operation usually takes 30–60 minutes under general or spinal anaesthesia, and most patients go home the same day or after one overnight stay.

Partial orchiectomy (testis-sparing surgery)

In selected patients — typically those with bilateral tumours, a solitary testis, or small lesions suspected to be benign — the surgeon removes only the tumour and a margin of surrounding tissue, preserving the rest of the testicle and its hormonal function. This is performed with the testicle delivered through a groin incision and often with intra-operative ultrasound and frozen section pathology. It is not appropriate for typical malignant germ cell tumours in a man with a healthy second testicle.

Retroperitoneal lymph node dissection (RPLND)

• Primary RPLND — soon after orchiectomy in selected stage I or II non-seminomas as part of definitive treatment.
• Post-chemotherapy RPLND — to remove any masses remaining in the retroperitoneum after chemotherapy for advanced disease.

RPLND can be performed through different approaches:

• Open RPLND — through a long incision down the middle of the abdomen. This remains the standard, particularly after chemotherapy, when scar tissue makes dissection more demanding.
• Laparoscopic RPLND — through several small incisions using a camera and instruments.
• Robotic-assisted RPLND — using a surgical robot controlled by the surgeon. Available in experienced centres.

One important issue in RPLND is preservation of the small nerves that control ejaculation, which run alongside the lymph nodes being removed. A nerve-sparing technique aims to protect these nerves so that normal ejaculation is maintained. Whether nerve-sparing is feasible depends on the extent of disease and the surgeon’s experience.

Testicular prosthesis placement

After orchiectomy, some men choose to have a saline- or silicone-filled testicular implant placed in the scrotum for cosmetic symmetry. This can be done at the same time as the orchiectomy or as a separate, later procedure. The prosthesis has no functional role — it does not produce hormones or sperm. It is purely cosmetic and is a personal choice. Many men opt not to have one and report no significant impact on quality of life; others find it helpful for body image. Either choice is reasonable.

Preparing for Testicular Cancer Surgery

Before surgery, your team will perform a complete evaluation to confirm the diagnosis, assess the extent of disease, and check that you are fit for the operation.

Diagnostic and staging workup

• Scrotal ultrasound — to characterise the testicular mass.
• Blood tumour markers — AFP, beta-hCG, and LDH. These are measured before surgery and again afterwards to see how they fall.
• CT scan of the abdomen and pelvis — to look at the retroperitoneal lymph nodes and other organs.
• Chest imaging — chest X-ray or CT, to check the lungs for spread.
• Brain or bone imaging — only if the clinical picture or markers suggest possible spread to those areas.
• Routine pre-operative blood tests, ECG, and anaesthetic review.

Fertility counselling and sperm banking

This is one of the most important conversations to have before surgery. Testicular cancer and its treatments can affect fertility in several ways:

• The cancer itself can reduce sperm production.
• Removing one testicle reduces total sperm-producing tissue, although many men with a healthy remaining testicle still have normal fertility.
• Chemotherapy and radiation, if needed later, can temporarily or permanently reduce sperm counts.
• RPLND, even when nerve-sparing, may sometimes affect ejaculation.

For these reasons, major guidelines recommend that men of reproductive age be offered sperm banking (cryopreservation) before orchiectomy when feasible. Sperm is collected, frozen, and stored for possible later use in assisted reproduction. Even one or two samples banked before surgery can preserve future options. If sperm cannot be obtained by ejaculation, surgical sperm retrieval techniques are sometimes possible. Discuss this option with your urologist and a fertility specialist before surgery if future fatherhood matters to you.

Practical preparation

• Stop blood-thinning medicines as instructed by your surgeon.
• Inform your team of all medicines and supplements you take.
• Stop smoking as early as you can — this helps wound healing and reduces anaesthetic risk.
• Arrange for someone to drive you home after discharge.
• Prepare loose, comfortable underwear and supportive briefs for after surgery.

What Happens During Surgery

For a radical inguinal orchiectomy:

1. Anaesthesia. Usually general anaesthesia, though spinal anaesthesia is sometimes used.
2. Positioning and preparation. You lie on your back. The lower abdomen, groin, and genital area are cleaned with antiseptic and draped.
3. Incision. A 5–10 cm incision is made in the groin, similar to a hernia repair incision — not in the scrotum.
4. Cord control. The spermatic cord is identified at the inguinal canal, clamped high up, and gently freed.
5. Delivery of the testicle. The testicle is brought up through the incision from the scrotum.
6. Removal. The cord is divided high, and the testicle and entire cord are removed as one specimen.
7. Optional prosthesis. If chosen, a testicular implant is placed in the scrotum.
8. Closure. The wound is closed in layers, often with dissolvable sutures and skin glue or steri-strips.

The operation typically lasts 30 to 60 minutes. The removed specimen is sent to pathology, where it is examined over the following days to confirm the tumour type, sub-types within mixed tumours, and important features like lymphovascular invasion or extension into the cord or surrounding tissues. These findings, together with your markers and scans, decide your stage and risk group.

If RPLND is planned (either at the same admission or later), it is a longer and more complex operation, lasting several hours. It requires a hospital stay of several days and a longer recovery.

Recovery and Healing

After orchiectomy

• Hospital stay: Same-day discharge or one overnight stay is typical.
• Pain: Mild to moderate groin and scrotal discomfort, controlled with simple painkillers (paracetamol with or without short-course anti-inflammatories or mild opioids).
• Swelling and bruising: The scrotum often becomes swollen and bruised, sometimes dramatically, during the first 1–2 weeks. This is normal and settles. A supportive undergarment (snug briefs or a scrotal support) helps.
• Wound care: Keep the wound clean and dry. Most dressings can come off within a few days, and showering is usually allowed once the wound is sealed.
• Activity: Walking and light activity from the day after surgery. Avoid heavy lifting (over about 5 kg) and strenuous exercise for 2–3 weeks. Avoid cycling, contact sports, and sexual activity for around 2–4 weeks or as advised by your surgeon.
• Return to work: Desk-based work can usually resume in 1–2 weeks. Physically demanding work may need 4 weeks or more.
• Driving: Usually after about a week, once you can perform an emergency stop comfortably and are off strong painkillers.

After RPLND

• Hospital stay: Several days, depending on whether the open or minimally invasive approach is used.
• Bowel recovery: Abdominal surgery temporarily slows the bowel. Diet is advanced gradually.
• Return to normal activity: Typically 4–6 weeks; longer for very demanding physical work.
• Wound care, mobilisation, and pain control follow standard major abdominal surgery principles.

Emotional recovery

Even when the physical recovery goes smoothly, the emotional adjustment can take longer. Many men describe a mix of relief that the tumour is out, anxiety about pathology results, and unfamiliar feelings about body image. Talking to a partner, family member, or counsellor — and connecting with others who have been through this — can be helpful. These feelings usually settle as scans and markers stabilise and life resumes its rhythm.

Risks and Complications

Radical inguinal orchiectomy is considered a low-risk operation, but as with any surgery, complications can occur.

General surgical risks

• Bleeding or bruising at the wound or in the scrotum (haematoma).
• Wound infection.
• Wound separation or poor healing.
• Reactions to anaesthesia.
• Blood clots in the legs or lungs (uncommon, but a recognised risk of any surgery).

Specific risks of orchiectomy

• Scrotal swelling or fluid collection (haematoma or seroma), usually self-limiting.
• Numbness in the groin, scrotum, or upper inner thigh, due to small nerves crossing the operative area. This is often temporary.
• Chronic groin or scrotal discomfort, uncommon but reported by some patients.
• Reduced testosterone (hypogonadism). Most men with a healthy remaining testicle maintain normal hormone levels. A smaller proportion have lower testosterone and may benefit from monitoring and, if needed, testosterone replacement.
• Reduced fertility. Removal of one testicle reduces total sperm-producing capacity. Many men still father children naturally afterwards, but this cannot be guaranteed, which is why sperm banking is offered beforehand.

Specific risks of RPLND

• Loss of antegrade (forward) ejaculation, due to injury of the small sympathetic nerves that control ejaculation. Sexual sensation and orgasm are preserved, but semen may not emerge during orgasm (“dry orgasm”). Nerve-sparing techniques aim to reduce this risk.
• Injury to nearby structures (bowel, large blood vessels, ureters).
• Chylous ascites (leakage of lymphatic fluid into the abdomen).
• Bowel obstruction or hernia, more common after open surgery.

The exact risk for any individual depends on disease stage, prior chemotherapy, and the surgical team’s experience. Going to a centre with high volume in testicular cancer surgery is associated with better outcomes for the more complex operations.

Adjuvant Treatment After Surgery

For many patients, surgery alone is enough — particularly for early-stage disease confined to the testicle. For others, further treatment is recommended based on pathology and staging. Decisions follow guidelines from NCCN, EAU, and similar bodies and are made in a multidisciplinary meeting (urology, medical oncology, radiation oncology, and pathology).

Active surveillance

For many stage I tumours (cancer confined to the testis with normal post-orchiectomy markers and no visible disease elsewhere), close monitoring without immediate additional treatment is a standard option. This means regular clinic visits, tumour marker tests, and scans. Most men on surveillance never need further treatment; those whose disease recurs are then treated effectively at that point.

Chemotherapy

Chemotherapy is highly effective in germ cell tumours. The most commonly used regimen is BEP (bleomycin, etoposide, cisplatin), given in cycles over several weeks. Indications include higher-stage disease, certain pathological features that raise the risk of recurrence, or relapse after surveillance.

Radiation therapy

Radiation has a more limited role today but is still used for some seminomas, particularly in selected stage I or II disease, because seminomas are very radiosensitive. Modern radiation uses smaller fields and lower doses than in the past.

RPLND as adjuvant therapy

For some non-seminoma patients, primary RPLND after orchiectomy is an alternative to surveillance or chemotherapy. The choice between these options is individualised based on pathology, marker trends, patient preference, and the local team’s expertise.

Testicular cancer is well known among oncologists for being one of the most chemotherapy-responsive solid tumours, which is part of why long-term outcomes are so favourable. The exact combination and sequence of treatments for your situation is best discussed with your oncology team.

Outcomes and Prognosis

Testicular germ cell tumours have among the highest cure rates of all solid cancers in adults. The combination of orchiectomy with risk-adapted use of chemotherapy, radiation, or RPLND results in very high long-term survival across nearly every stage group, including many patients with metastatic disease.

The outlook for any individual depends on:

• Tumour type (seminoma versus non-seminoma, and the specific sub-types within these).
• Stage at diagnosis (confined to the testis, spread to local lymph nodes, or distant metastases).
• Tumour marker levels after orchiectomy.
• Response to any adjuvant treatment.
• General health and fitness.

Because individual outcomes vary, specific survival numbers for your situation are best discussed with your oncologist, who can interpret your pathology, stage, and marker behaviour in context. Across the literature, long-term cancer-specific survival in early-stage disease is very high, and even men with widespread disease at diagnosis often achieve long-term cure.

Life After Testicular Cancer Surgery

Hormonal health

Most men with a healthy remaining testicle maintain normal testosterone production. Some, however, develop lower levels — either at diagnosis or over time — and may experience symptoms such as fatigue, low mood, reduced libido, or loss of muscle mass. A simple blood test can check testosterone, and replacement therapy is available when needed. Periodic checks are reasonable, particularly in the first year and if symptoms develop later.

Sexual function

Sexual function — erections, sensation, orgasm — is generally preserved after orchiectomy. The remaining testicle continues to produce testosterone. Men who undergo RPLND may notice changes in ejaculation, as described earlier. Sexual confidence often takes some time to recover, and open conversation with a partner helps.

Fertility

Many men father children naturally after orchiectomy with one healthy remaining testicle. For those who undergo chemotherapy or RPLND, fertility may be more affected. Banked sperm, when available, can be used in assisted reproductive techniques later. A semen analysis some months after treatment is reasonable if you are planning children. Discuss timing with your oncologist; conception is typically recommended only after a treatment-free interval that varies by therapy.

Body image and identity

The loss of a testicle does not change your identity as a man, your sexual function, or your hormonal health (in most cases). Some men feel comfortable with the change quickly; others take longer. Testicular prostheses are an option if you would like one, either at the time of surgery or later.

Long-term health considerations

Long-term survivors of testicular cancer are followed not only for cancer recurrence but for late effects of treatment, especially after chemotherapy or radiation. These can include cardiovascular risk, secondary cancers, hearing changes (after cisplatin), and effects on kidney function. Healthy lifestyle measures — regular exercise, no smoking, a balanced diet, controlling blood pressure and cholesterol — are particularly important.

Self-examination of the remaining testicle

Follow-up and Surveillance

Structured follow-up is a key part of treatment. Most relapses, when they occur, happen in the first two years, which is why surveillance is most intensive during this time. Follow-up typically includes:

• Clinical examination, including the remaining testicle and lymph node areas.
• Tumour marker blood tests (AFP, beta-hCG, LDH).
• CT scans of the abdomen, pelvis, and sometimes chest, on a schedule.
• Chest X-ray or CT chest at intervals.

A typical schedule (varying by stage, tumour type, and treatment received) is:

• Every 3–4 months in the first 1–2 years.
• Every 6 months in years 3–5.
• Annually thereafter, often out to 10 years or beyond.

Your exact schedule will be tailored to your situation and the protocols of your treating team.

Testicular Cancer Surgery in Children and Adolescents

Testicular tumours in children and adolescents are uncommon and behave somewhat differently from adult tumours. Pre-pubertal tumours are more often benign (such as teratomas and epidermoid cysts) or specific subtypes like yolk sac tumour. In this age group, paediatric urologists more often perform testis-sparing surgery, removing only the tumour and preserving the rest of the testicle, when imaging and markers suggest a benign or low-risk lesion.

In adolescents and young men, the spectrum shifts towards the adult-type germ cell tumours, and the standard approach moves closer to the adult protocol of radical inguinal orchiectomy, with paediatric oncology input where appropriate. Fertility considerations, including sperm banking in post-pubertal adolescents, are an important part of the discussion. Care is typically coordinated between paediatric urology, paediatric oncology, and fertility specialists.

Frequently Asked Questions

Will I still be able to have sex normally after surgery?

For most men, yes. Erections, sensation, and orgasm are controlled by structures separate from the testicle itself. The remaining testicle continues to produce testosterone, which supports sexual function. Men who have RPLND may experience changes in ejaculation, but sexual sensation and orgasm are preserved.

Can I still father children after losing one testicle?

Many men do. One healthy remaining testicle can produce enough sperm to support natural conception. However, the cancer itself, surgery, and any chemotherapy or radiation can affect fertility. This is why sperm banking before surgery is offered to men who may want children in the future. A semen analysis some months after treatment can give you a clearer picture.

Why is the incision in the groin and not in the scrotum?

Cutting into the scrotum to remove a cancerous testicle can disturb the natural lymphatic drainage of the testicle and increase the risk of spreading cancer cells. By approaching through the groin and removing the entire spermatic cord, the surgeon keeps the tumour intact and follows its natural drainage pathway. This is the standard approach worldwide.

Do I need a testicular implant?

No — a prosthesis is purely cosmetic and is entirely your choice. Some men prefer the symmetry it provides; others are comfortable without one. It can be placed at the time of surgery or later as a separate procedure. There is no medical disadvantage either way.

Will I need lifelong testosterone replacement?

Usually not, if your other testicle is healthy. Testosterone is checked over time and replacement is only started if levels are low and symptoms are present. Men who have had both testicles removed do need lifelong testosterone replacement.

How soon after surgery will I know if I need chemotherapy?

The pathology report is usually ready within 1–2 weeks. Tumour markers are also rechecked after surgery to see how they fall. Once the pathology, markers, and scans are all available, your team will assign a stage and discuss whether further treatment is recommended.

How will I know if the cancer comes back?

Most recurrences are picked up by routine follow-up — tumour markers, scans, and clinical examination — before symptoms appear. Symptoms that should prompt earlier contact with your team include a new lump in the remaining testicle, persistent back or abdominal pain, unexplained breathlessness, cough, or significant weight loss. Sticking to your follow-up schedule is the most important step.

Is testicular cancer surgery painful?

Most men describe the discomfort as moderate and well-controlled with simple painkillers. Scrotal swelling and bruising can be more uncomfortable than the wound itself but settle within a couple of weeks. Pain after RPLND is more significant because it is major abdominal surgery.

When can I return to exercise and sport?

Light walking from day one. Avoid heavy lifting and strenuous exercise for about 2–3 weeks after orchiectomy and longer (often 6 weeks or more) after RPLND. Contact sports and cycling are typically delayed a little longer. Your surgeon will give you specific guidance based on your operation.

Conclusion

Testicular cancer surgery — usually radical inguinal orchiectomy, sometimes followed or accompanied by lymph node surgery — is the foundation of treatment for one of the most curable cancers in modern medicine. The operation itself is technically straightforward, the recovery is typically faster than expected, and the long-term outlook for most patients is very favourable.

The decisions around your care — whether you need surveillance, chemotherapy, radiation, or further surgery; whether to consider sperm banking; whether to have a prosthesis; how often to follow up — depend on the details of your pathology, your stage, your preferences, and your life plans. These are conversations to have, in time and without rush, with a urologist and oncology team familiar with testicular cancer.

Losing a testicle changes one part of your anatomy. It does not change your identity, your strength, or your future. With appropriate treatment and follow-up, the great majority of men return to full, active lives.