Testicular Surgery: Everything You Need to Know

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Cutting of a testicular ligament with an electric scalpel

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Testicular surgery is used for the treatment of structural conditions affecting the testicles (also called testes). Issues such as misshapen testes, epididymis cancer, or testicular cancer are usually corrected surgically. A variety of surgical interventions can be used to repair and remove abnormalities involving the testicles. The aim of these procedures is to prevent complications, such as the spread of cancer, and to attain or maintain fertility.

What Is Testicular Surgery?

Testicular surgery is a type of operation in which a congenital (from birth) or acquired testicular problem is surgically fixed.

Usually, testicular surgery is a relatively short procedure that involves only one testicle. But in some circumstances, like when it's done for metastatic cancer, surgery on both testicles, as well as nearby structures like the bladder or prostate, may be needed.

A small incision in or near the scrotum, the sac that holds the testicles, is required. The procedure often involves the spermatic cord (a structure containing the vas deferens, the tube that carries sperm, and blood vessels) or epididymis (a coiled tube that stores sperm). In some circumstances, an orchiectomy (complete removal of a testicle) may be necessary.

Typically, a urologist—a surgeon specialized in surgery of the urinary and male reproductive systems—would perform the operation. They may choose to directly access the areas that need to be removed or repaired with an open procedure. Or the procedure could be done laparoscopically, using a minimally invasive surgical method that's done with the assistance of camera-equipped surgical tools.

You will likely have general anesthesia for pain control during your testicular surgery.

Contraindications

Testicular surgery is not considered an option if your issue can be corrected without surgical intervention. And if you have a serious medical condition, such as an acute infection that isn't part of your surgical repair, you may need to postpone your surgery until the issue is resolved.

Potential Risks

There are general risks after surgery and anesthesia. Testicular surgery also poses a risk of some specific surgical complications.

Adverse events that can occur due to testicular surgery include:

  • An infection
  • Edema
  • Structural damage
  • Chronic pain
  • Scarring and obstruction of the vas deferens
  • Infertility

A post-operative infection or excessive swelling can be identified shortly after surgery. Scarring may develop months or years after surgery, and infertility might not be apparent until years later.

Purpose of Testicular Surgery

There are several different reasons why you might have testicular surgery. Removing cancer, correcting a deformity, or repairing traumatic damage are the most common ones.

Some conditions, such as an infection, can often be managed with medication alone. Others, like cysts, might never need any intervention at all. You and your doctor will have to discuss the risks of your condition and when surgery might become an appropriate treatment option.

Generally, the conditions that require surgical intervention with testicular surgery cause an unusual appearance of the testicles or cause testicular pain.

Testicular surgery may be needed to save a testicle, treat pain or discomfort, prevent the spread of disease from a testicle to other areas of the body, and treat fertility issues. Preserving or creating a normal appearance of the testicle is an important aspect of any type of testicular surgery.

Indications for testicular surgery include:

  • Testicular torsion: The spermatic cord can twist, displacing the testicle and potentially leading to obstruction of blood flow, which can cause loss of the testicle if not properly corrected. This condition is a surgical emergency that needs to be urgently addressed.
  • Undescended testes: Usually diagnosed during childhood, this condition occurs when one or both testes remain in the abdomen instead of dropping to their proper position in the scrotum. The condition can increase the risk of infertility, testicular torsion, and cancer. Often, undescended testes can descend into the scrotum on their own before age 1. If they don't, orchiopexy (a.k.a. orchidopexy) is the surgical procedure used to position them in place.
  • Hydrocele: A hydrocele is fluid that accumulates around the testes, causing the scrotum to swell. It can be present without any cause in children or it can develop due to trauma, an infection, or inflammation of the testes or epididymis. Generally, a hydrocele will resolve without surgery, but sometimes non-surgical treatment is ineffective.
  • Traumatic injury: The testes can become damaged or may develop swelling or a hematoma (blood under the skin) due to trauma. Some traumatic injuries require surgical repair. This may be considered an emergency or you may need to wait a few weeks before having a procedure.
  • Infections: Bacterial infections in the epididymis (epididymitis) or testicles (orchitis) will cause swelling or pain in the scrotum. The usual treatment includes antibiotics, ice pack application, and non-steroidal anti-inflammatory medications (NSAIDs). However, in rare cases of severe infection or if an abscess develops, surgical drainage may be necessary.
  • Benign tumors: Lumps outside the testes that can be felt through the scrotum are usually benign. Small, solid masses located in the epididymis are often adenomatoid tumors and may need to be removed if they cause discomfort or become inflamed.
  • Cysts: Cysts are benign fluid-filled pockets that usually don't need treatment. But painful or infected testicular or epididymal cysts may need to be removed.
  • Testicular cancer: A lump in a testis can be a sign of testicular cancer. The lump is generally painless and the diagnosis of testicular cancer is based on imaging studies and a biopsy.

Testicular cancer most commonly affects males 15 to 35 years old, though it can affect men of any age. Although this cancer is rare, you should not ignore any discomfort or change in your testes (regardless of your age). See your doctor if you have a lump, pain, or swelling in or near your scrotum.

How to Prepare

A physical examination of the scrotum and testes and an ultrasound or a computerized tomography (CT) scan can help distinguish between a benign lesion and a malignant tumor. You may also need a biopsy to distinguish between a cancerous tumor and a non-cancerous one.

Issues like torsion, a hydrocele, or an abscess may be identified with a physical examination, and imaging tests can help in assessing the structural details for surgical planning.

You will also need to have preoperative testing including a complete blood count (CBC) and blood chemistry tests. A chest X-ray and electrocardiogram (EKG) will be done as part of your pre-anesthesia evaluation.

Location

You will have your operation in an operating room that's located in a hospital or surgical center.

Most of the time, testicular surgery is an outpatient procedure. However, you might stay in the hospital if you are having major surgery for something like a severe traumatic injury that requires extensive treatment and recovery.

What to Wear

You can wear whatever you want to your surgery appointment. You will need to wear a hospital gown during your procedure, and you will likely go home wearing a hospital gown to avoid placing pressure on your surgical area as you are recovering.

Food and Drink

You will need to fast from food and drink starting at midnight the night before your surgery.

Medications

If you are having surgery for the treatment of an infection, you may be given a prescription for oral antibiotics before your operation. And if you have swelling in or near the scrotum, you may need to use an oral prescription steroid prior to your surgery.

Your doctor may instruct you to stop or reduce blood thinner medications or non-steroidal anti-inflammatories (NSAIDs) for approximately one week prior to your surgery.

Be sure your surgeon is aware of any and all medications and supplements that you take.

What to Bring

Bring your identification, insurance information, and a form of payment for any portion of the surgery cost you are responsible for.

You will need to have someone drive you home after surgery, so they may want to come along.

Pre-Op Lifestyle Changes

You will not need to make lifestyle changes before your surgery. If you have an infection, you may need to abstain from sexual activity while it is being treated and during any other time before your procedure.

What to Expect on the Day of Surgery

You will be asked to register and sign a consent form upon arrival. You will then go to a pre-operative surgical area and change into a surgical gown.

Your temperature, pulse, blood pressure, respiration, and oxygen saturation level will be checked. You will have an intravenous (IV, in a vein) line placed, and you may have same-day preoperative tests such as a urinalysis, blood chemistry levels, and a CBC.

If you have a severe problem, like a major infection or a substantial sign of illness, you might need to have your surgery postponed.

Before the Surgery

A nurse will place a urinary catheter in your urethra (a tube in your penis), unless they plan to do so once you're in the operating room. Your surgeon and anesthesiologist may check on you now or you may not see them until the surgery is ready to start.

Just before the procedure begins, a surgical drape will be placed over your body leaving a limited area of skin for the surgical incision exposed. Your skin will be cleansed with a surgical cleaning solution.

Anesthetic medication will be injected into your IV to make you sleep, to paralyze your muscles, and for pain control. You will have a breathing tube placed into your throat so that you can have mechanically assisted breathing during your surgery.

Your anesthesiologist will stand ready to monitor your oxygen saturation, respiration, blood pressure, and pulse throughout your procedure.

During the Surgery

Your surgeon will begin your operation by making an incision in or near the skin of your scrotum. The incision will be a few inches long if you are having an open procedure, and it will be less than an inch long if you are having laparoscopic surgery.

After the initial incision, your surgeon might make another incision into the deeper layer of connective tissue underneath the skin if that is necessary to gain access for the surgical repair.

At this point, your surgeon will insert the laparoscope if you are having minimally invasive surgery. Then, either directly or with the laparoscope, the surgical location will be located.

Your surgery will be done with small surgical tools whether it is an open procedure or a minimally invasive method.

The next steps can include one or more of the following:

  • Removal of a tumor or growth
  • Resection of one or more areas of cancer
  • Repair of an injury
  • Drainage of excess blood
  • Drainage of excess fluid
  • Removal of an abscess
  • Correction of the placement of structures
  • Stitching structures in place
  • Opening a blockage
  • Placement of a prosthesis (artificial replacement) in place of a testicle that was removed

Throughout the procedure, bleeding is controlled. When the surgery is complete, your doctor will remove surgical tools and close the layers that were cut with suture. Your wound will be covered with surgical dressing.

Your anesthesia will be stopped and your breathing tube will be removed. The anesthesia team will ensure that you are breathing comfortably without assistance, upon which time you can taken to the surgical recovery area.

After the Surgery

You will begin to wake up in the hours after your surgery. You will be monitored for complications and receive pain medication as needed. You should be able to eat and drink normally.

Once you wake up, your urinary catheter will be removed and you will be able to use the toilet or a bedpan with assistance. Your medical team in the post-operative recovery area will help you walk when you first start to get up and take a few steps.

Your surgeon may check on you a few hours after your surgery. Before you are discharged, you will receive instructions regarding wound care, follow-up evaluations, and more.

Recovery

As you are recovering after surgery, you will need to follow up with your doctor to have your surgical area examined and your sutures removed. You will also have to modify your activity in the days and weeks ahead.

Healing

As you are healing, take care of your wound and keep it clean and dry. Follow your doctor's instructions about bathing and showering during this period. Given the location of your incision, you will need to take extra care to keep the wound from becoming contaminated when you urinate or have a bowel movement.

Your doctor might give you dietary instructions or medication to prevent constipation because straining can place pressure on (and potential tear) your sutures as you are healing.

You will need to use any medications, such as antibiotics, as directed. And you may be instructed to use over-the-counter pain or prescription medication for pain control during your recovery.

If you experience swelling, you can use covered ice packs on your groin as permitted by your doctor. Never place ice packs directly on your wound or surgical dressing.

Signs to watch out for include:

  • Increasing pain
  • Swelling
  • Redness
  • Bleeding
  • Bruising
  • Warmth in or around the scrotum
  • Pus draining from the wound
  • Fevers

If you experience these problems, be sure to talk to your doctor.

Coping With Recovery

You can go back to wearing underwear and pants the day after surgery, and you may be instructed to wear certain supportive underwear for the first week as you are recovering.

Your doctor will give you specific instructions regarding physical activities. In the days after your surgery, you will have to avoid running and strenuous exercise like lifting or straining). You will need several weeks before you can get permission to swim, bike ride, and engage in sexual activity.

Trying to Conceive

Whether you had testicular surgery to treat infertility or you experience temporary fertility impairment while you are healing, if you want to conceive, your doctor will tell you how soon after surgery you can begin trying.

If you are going to conceive with vaginal intercourse, your doctor may give you instructions regarding the optimal frequency and timing of sexual intercourse. And if you are trying to conceive with in vitro fertilization, you will have a schedule for that process as well.

Long-Term Care

Once you recover from surgery, you probably won't need additional medical or surgical care that's specifically related to your testicular surgery.

However, if you have testicular cancer, you will likely need additional treatment, such as chemotherapy.

Possible Future Surgeries

Generally, testicular surgery is a single operation without the need for additional procedures.

Sometimes surgery for undescended testes might involve several surgeries. This sequential plan would be determined in advance of the first surgery. And extensive disease (such as metastatic cancer), may involve additional surgeries in the future.

If you have serious complications after your surgery, such as an obstruction due to scarring, you might need a surgical repair.

Sometimes issues like benign cysts may be recurrent. If you develop additional benign testicular cysts after you've had a benign cyst removed, you and your doctor would have to evaluate the pros and cons of removal depending on their location, size, and whether you're experiencing any pain.

Lifestyle Adjustments

After you recover from your testicular surgery, you should be able to resume your normal activities without having to make any long-term adjustments.

A Word From Verywell

It is normal for males of any age to have some unevenness of the testicles. However, you should get a medical evaluation if you have a change in the shape, appearance, size, or sensation of your testicles. Typically, structural issues that involve the testicles can be repaired with a simple treatment. If surgery is needed, recovery involves a few weeks of restricted activity before you can get back to your normal level of activity.

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Article Sources
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