Urology

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Testicle removal due to tumour

What does this procedure entail?

The essence of this procedure is the removal of the testicle through a cut in the groin. The procedure is performed if there is a clinically justifiable suspicion of ongoing testicular cancer.

Most types of testicular cancer can be detected by ultrasound examination and supplementary blood tests, which assess the level of tumour markers. Additional examinations (X-ray of the lungs, CT) are added to determine the range and spread.

The removal of one testicle should not negatively affect your life. The remaining testicle will take over the function of the removed testicle, so your ability to have sex and sire children should remain intact. However, testicular cancer and its treatment (especially chemotherapy) can change the amount and quality of produced sperm. It is possible to ensure cryopreservation (storage) of semen. These samples can be used in the future for assisted fertilisation methods in case of a clinically significant fertility disorder after the treatment.

If the cosmetic result after removing the testicle is unacceptable for you, it is possible to insert a silicone prosthesis into the scrotum after the end of the oncological treatment. The silicone implant can be inserted into the scrotum immediately in exceptional cases. However, this is limited by the presumed necessity of subsequent irradiation and often by time pressure. In any case, this procedure must be agreed in advance.

What are the alternatives to this procedure?

There are no adequate alternatives.

Exceptionally, a biopsy may be considered during the procedure before testicle removal (under well-defined conditions).
Removal of only a part of the testis with the tumour can be indicated very rarely.

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.

You will be asked not to eat or drink for at least 6 hours before the surgery!

In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.

Remember to inform your physician about the following possible facts before the surgery:

artificial heart valve
coronary artery stent
pacemaker
artificial joint
artificial vascular graft
neurosurgical bypass
other implanted foreign body
use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
drug and other allergies
any abnormalities or eventualities

It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.

The procedure is performed under general anaesthesia (you will be asleep during the procedure). The testicle is removed by an incision in the groin area (similar to hernia surgery). Exceptionally, it may be necessary to take samples from a second testis. After the procedure, it is sometimes necessary to insert a drain (silicone tube) into the surgical wound, which will ensure the drainage of any blood or body fluid.

The surgery takes about 30-45 minutes.

What will happen immediately after the procedure?

You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.

As soon as your medical condition allows, you will be allowed to sit down and then stand up and drink and eat. After that, you will be able to walk slowly and carefully around the room, initially accompanied by medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.

The drain is removed on day 1-2 after the surgery. The total hospitalisation duration is 2 to 5 days, the sick leave 2 to 3 weeks or according to the extent of the disease and the need for further treatment.

Once you are fully conscious, you should:

ask if the planned outcome was achieved
inform the medical staff about any problems
ask what you can and cannot do
ask all the questions you have for the healthcare professionals and members of the medical team.
remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

If malignant tissue is detected, further treatment steps (irradiation, chemotherapy) may follow depending on the nature and extent of the disease.
A need for biopsy from the second testis (e.g. if it is small, abnormal or there is a history of testicular descent disorder)

Occasional (2-10% of procedures of this type)

This procedure removes the testicle through a cut in the scrotum, exceptionally in the groin.
Infection at the incision site requiring further treatment (and possibly removal of the implant).
Bleeding requiring further surgery (and possible implant removal)
Temporary or permanent loss of fertility

Rare (may occur in 2% of procedures of this type)

Pain, infection, or foreign body reaction requiring implant removal (if inserted)
Cosmetic expectations of the patient, which may not be fully met by the implant
The implant may be located higher in the scrotum than common in a normal testicle
A palpable suture at one end of the implant that you can feel
Long-term risks arising from the use of silicone products are unknown

Hospital infections

MRSA colonisation (0.9% – 1 of 110)
Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

Get recommendations on recovery at home
Ask when you can return to normal activities such as work, exercise, driving, housework
Get a contact number for further questions after returning home or in case of trouble
Ask about the date and place of subsequent check-ups (hospital or your doctor)
Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs

At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

What else should I watch out for?

In case more problems occur, unusual bleeding, etc., see your attending physician. You may feel discomfort in your groin and scrotum for one to two weeks. This discomfort is often alleviated by commonly available pain medications. Small bruises often occur in the groin and scrotum. You may feel more comfortable in firm underwear (instead of boxers) – loose underwear is more suitable in case of implant insertion. You can shower 24 hours after the procedure, but palpate the area gently and make sure it is really dry. You can return to work about 2 weeks after the procedure, but it is advisable to avoid strength training for at least 6 weeks.

You can engage in sexual activity after 2 weeks; the procedure may temporarily reduce sexual desire in some men. Testicular cancer cannot be transmitted to your partner during sex.

Skin sutures are removed on day 9 after surgery.

Important information?

Results of histological analysis will be routinely available after 7-21 days. It is common for the results to be consulted by a multidisciplinary team before further treatment is decided. You and your doctor will be informed of the results after this discussion.

Further treatment, if indicated, is usually lead by the department of clinical oncology. The disease also requires long-term follow-up after the end of treatment.