If your condition has been diagnosed as testicular cancer, surgery is usually the gold standard treatment. The procedure you have will depend on the type and stage of cancer and if surrounding tissues are involved.

Testicular cancer starts in the testicles or their supportive tissues. It isn’t a common cancer, but it affects an estimated 1 out of every 250 males at some point in their lifetime.

If your condition has been diagnosed as testicular cancer, jumping right to surgery may sound overwhelming, but this method of cancer treatment has a high success rate and is often curative.

Language matters

You’ll notice that the language used to share stats and other data points is pretty binary, especially with the use of the terms “males” and “men.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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There are two main surgeries used to treat testicular cancer:

Almost all testicular cancer surgery involves a radical inguinal orchiectomy, which is the complete removal of a cancerous testicle and its spermatic cord.

Partial removal isn’t an option. The entire testicle is taken to help ensure no cancerous cells are left behind.

Unlike other orchiectomy approaches, testicle removal to treat cancer isn’t done through an incision in the scrotum. A radical inguinal orchiectomy is done through an opening in the groin to prevent exposure of lymph vessels to cancer cells.

If your testicular cancer has progressed to the lymph nodes and the large blood vessels at the back of your abdomen, you may also need an RPLND. This surgery can be done at the same time as the radical inguinal orchiectomy or as a separate procedure.

RPLND is a major surgery. It’s complex, lengthy, and can be performed as an open surgery or done using less invasive surgical methods such as a laparoscopy.

Testicular cancer surgery comes with the potential of standard surgical risks, including:

Most men see no difference in fertility or sexual ability if only one testicle is removed. As long as your remaining testicle is functioning and is of average size, hormone levels typically remain stable.

If you have both testicles surgically removed, your body will be able to produce a small amount of testosterone, but it won’t be enough to keep your systems in balance. You may notice a loss of libido, infertility, and increased erectile dysfunction.

Other signs and symptoms related to low testosterone include:

  • loss of muscle and bone mass
  • hot flashes
  • fatigue
  • mood changes
  • depression

According to a 2020 research paper, other possible risks of a radical inguinal orchiectomy include:

RPLND complications

RPLNDs don’t usually affect your sexual desire or ability to maintain an erection, but this procedure can result in nerve damage that affects ejaculation control. If this nerve damage happens, semen may travel backward into the bladder rather than out of the urethra in a process known as “retrograde ejaculation.”

Bowel obstruction and infection are also potential short-term risks of RPLND.

Cosmetic concerns

If you’re concerned about how noticeable a missing testicle will be, a doctor can discuss the option of prosthetics.

Prosthetic testicles approved for use in the United States are filled with a saline solution. The prosthetics are implanted into your scrotum and are sized to match your natural testicle.

It’s not necessary to have a prosthetic after an orchiectomy, but a study from 2019 found men who chose prosthetic implants reported improved self-confidence and self-esteem after surgery.

If testicular cancer hasn’t metastasized, or spread to other areas of the body, radical inguinal orchiectomy has a cure rate of 80–85%.

The success rate of RPLND varies depending on how many lymph nodes are involved. According to the American Society of Clinical Oncology, with minimal lymph node involvement, surgery is successful for 80–90% of people.

If many lymph nodes are affected or cancer sites are large, the surgical success rate drops to 50%, with 50% of people experiencing cancer recurrence.

Overall, testicular cancer has a high rate of survival. The American Cancer Society indicates the lifetime risk of dying from testicular cancer is low — approximately 1 in 5,000 — and this type of cancer has a 5-year survival rate of 95%.

Is testicular surgery risky or painful?

A radical inguinal orchiectomy is an uncomplicated surgery that may cause mild to moderate pain, but many people are able to go home the same day or after a one-day hospital stay.

RPLND is lengthy and is a major abdominal surgery. Postsurgical pain is expected and is managed during your hospital stay with intravenous drugs given through a catheter into your vein.

Neither orchiectomy nor RPLND is considered “risky,” but RPLND is complex and is best performed by a surgeon who has extensive experience.

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Recovery times vary depending on the type of testicular cancer surgery. A doctor will go over pain management protocols with you and how to care for your incision site at home.

Swelling of the scrotum is typical, and you may experience delayed bowel movements and stomach upset as side effects of the anesthetic.

Walking 4–6 times a day postsurgery is recommended to help prevent blood clots and pneumonia.

In most cases of nonmetastasized testicular cancer, recurrence happens in the first 2 years after surgery. During this time, you’ll enter a phase of close observation and monitoring.

In the first year, follow-up appointments occur every other month, and CT scans every 4–6 months are routine. At the second year mark, the time between appointments and scans becomes slightly longer.

Do you still need chemotherapy after testicular cancer surgery?

Testicular cancer surgery alone is often curative, but, if cancer has spread outside of the testicles or returned after initial treatment, you may need to follow up testicular cancer surgery with chemotherapy.

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There are two main types of surgery for testicular cancer. Radical inguinal orchiectomy involves the complete removal of a testicle, whereas an RPLND is done when cancer affects your abdominal lymph nodes.

Testicular cancer surgery has a high rate of success and is curative for many people. If cancer returns or has spread beyond the testicle, you may need additional forms of treatment.