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by Polsdorfer R

Surgical Procedures for Testicular Cancer

Surgery is the main treatment for most testicular cancers. The goal of surgery is to remove the cancerous tumor and preserve as much testicular tissue and function as possible. There are 2 procedures used to treat testicular cancer.

Orchiectomy

A radical inguinal orchiectomy is the surgical removal of one or both testicles. The testicle is completely removed via the groin rather than through the scrotum. This helps minimize the potential for the spread of cancer cells.
If only one testicle is removed the other healthy one can produce adequate amounts of sperm cells and hormones. If both testicles are removed, then no sperm cells or hormones are produced. A drop in testosterone may cause hot flashes, loss of muscle mass, and a decrease in sex drive. Testosterone can be replaced with a patch, injection, or gel.
It is possible during this procedure or at a later date a prosthetic (fake) testicle will be placed to recreate a normal appearance.

Retroperitoneal Lymph Node Dissection

If cancer spreads beyond the testicle, it generally can be found in the surrounding lymph nodes. A procedure called a retroperitoneal lymph node dissection (RPLND) is done to remove the affected lymph nodes. RPLND is a long and complicated surgery.
During an open procedure a long incision is made in the abdomen. This exposes the organs so the lymph nodes can be accessed. All lymph nodes from the diaphragm (which is the structure right above the stomach) down to the anal area are examined. Each one is evaluated under a microscope. If it shows signs of cancer, it is removed.
A less invasive laparoscopy procedure may be an option for some. Tools are inserted into small incisions in the abdomen instead of opening the entire abdominal cavity. Healing and recovery time for laparoscopic surgery is generally faster than open surgery.
This procedure can cause some muscle and nerve damage in the area. This can lead to a complication known as retrograde ejaculation. Semen is redirected to the bladder instead of through the urethra and out of the body during ejaculation. This can also have an effect on fertility.

References

Surgery for testicular cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/testicular-cancer/treating/surgery.html. Updated February 12, 2016. Accessed September 22, 2017.
Testicular cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T907377/Testicular-cancer. Updated May 31, 2017. Accessed September 22, 2017.
Testicular cancer. Merck Manual Professional Version. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/testicular-cancer. Updated November 2013. Accessed September 22, 2017.
Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/%5F50. Updated July 7, 2016. Accessed September 22, 2017.

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