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 as possible.
This can be done in 2 ways:
A radical inguinal orchiectomy is the removal of one or both testicles. They are 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 is 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.
With open surgery, a long cut is made in the belly. This lets the doctor get to the organs and lymph nodes. The doctor will check all lymph nodes from above the stomach down to the pelvis. Any that show signs of cancer will be taken out.
Sometimes laparoscopy is used instead of open surgery. Tools will be placed into small cuts in the belly. Recovery is usually faster.
This can cause some muscle and nerve damage. It can also lead to retrograde ejaculation. When a man ejaculates, semen goes to the bladder instead of through the urethra and out of the body. This can cause problems with the ability to father children. To prevent this from happening, nerve-sparing surgery may be done. Freezing and storing sperm before surgery is another option.
- Surgery for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/treating/surgery.html.
- Testicular cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/testicular-cancer.
- Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/_50.
- Mohei Abouzied, MD, FACP
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