Radical inguinal orchidectomy is the standard first operation for most suspected testicular cancers. The affected testicle and spermatic cord are removed through an incision in the groin—not through the scrotum—so the tumour can be treated and accurately examined by pathology without disrupting normal lymphatic drainage. The operation provides the definitive diagnosis and local stage. Removing one testicle usually does not impair erections or testosterone if the other testicle is healthy, but fertility should be discussed before treatment because sperm quality may already be reduced and later chemotherapy can affect it further.

Why is the incision in the groin?

Testicular germ-cell cancers spread through predictable lymphatic pathways. An inguinal approach allows high control of the spermatic cord and avoids scrotal violation, which can complicate lymphatic staging and subsequent treatment.

What happens during surgery?

1. General or regional anaesthesia is given.
2. A groin incision is made and the spermatic cord is controlled.
3. The testicle is delivered from the scrotum through the same incision.
4. The cord is divided at an appropriate high level and the specimen is sent intact for pathology.
5. The wound is closed; a scrotal prosthesis can be discussed if desired.

Before surgery: markers and fertility

AFP, beta-hCG and LDH should be measured before orchidectomy. Sperm banking may be appropriate, especially when the opposite testicle is abnormal, semen quality is a concern or chemotherapy is likely. In urgent cancer situations, surgery should not be delayed unnecessarily.

Can the testicle ever be preserved?

Orchidectomy is the standard operation for a typical suspicious germ-cell tumour because it gives definitive treatment and pathology. Testis-sparing surgery is reserved for unusual situations, such as selected small tumours in a solitary testicle or bilateral tumours, and requires specialist assessment. The trade-off is a higher need for careful local surveillance and, in some cases, treatment of adjacent germ-cell neoplasia. For most men with a normal opposite testicle, radical inguinal orchidectomy remains the safest standard.

Risks and recovery

• Bruising or swelling of the groin/scrotum
• Bleeding or haematoma
• Wound infection
• Numbness or altered sensation near the incision
• Chronic groin discomfort in a small proportion
• Psychological/body-image impact

What should you expect in the first week?

Most patients walk the same day or the next day. Groin discomfort, bruising and mild scrotal swelling can occur and usually improve steadily. Supportive underwear can make movement more comfortable. Heavy lifting, gym training and strenuous sport are usually avoided until the incision has healed and the surgeon is satisfied with recovery. The pathology and post-operative tumour-marker review are more important than the wound alone because they determine whether any further cancer treatment is needed.

What the pathology report decides

Pathology identifies seminoma versus non-seminoma, tumour size, local invasion and other features. Tumour markers are repeated and CT staging is reviewed. The next step may be surveillance, chemotherapy or another treatment depending on stage and risk.

What happens to testosterone after one testicle is removed

One healthy remaining testicle is usually enough to maintain normal testosterone and often fertility. Symptoms such as persistent low libido, fatigue, erectile difficulty or hot flushes after treatment should prompt assessment rather than automatic testosterone use, because some survivors have pre-existing or treatment-related gonadal dysfunction.

A prosthesis is optional, not oncological treatment

A testicular prosthesis can be placed at orchidectomy or later for cosmetic symmetry if appropriate. It does not restore sperm or hormone production and does not affect cancer control. Some men value it greatly; others prefer no implant. The decision is personal and should be discussed before surgery when feasible.

When to seek earlier medical review

After orchidectomy, contact the team for fever, increasing groin/scrotal swelling, wound discharge, uncontrolled pain or difficulty passing urine. New calf swelling or breathlessness after surgery requires urgent assessment for thrombosis.

What to bring to your consultation

• Scrotal ultrasound and tumour markers
• Any sperm-banking record
• Current medicines/blood thinners
• Relevant anaesthesia or medical fitness records

Questions to ask your doctor

• Why is an inguinal rather than scrotal approach used?
• Can a testicular prosthesis be placed now if I want one?
• When should post-operative tumour markers be repeated?

FAQs

Related reading

• Testicular Cancer: Symptoms and Treatment
• Painless Testicular Lump: When to Worry
• Tumor Markers AFP, Beta-hCG and LDH Explained
• Testicular Cancer and Fertility
• Seminoma vs Non-Seminoma
• Urologist in Latur

References

• European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Diagnostic Evaluation https://uroweb.org/guidelines/testicular-cancer/chapter/diagnostic-evaluation
• European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Disease Management https://uroweb.org/guidelines/testicular-cancer/chapter/disease-management
• European Association of Urology (EAU). Testicular Cancer Guidelines, 2026. Follow-up After Curative Therapy https://uroweb.org/guidelines/testicular-cancer/chapter/followup-after-curative-therapy
• National Cancer Institute. Testicular Cancer Treatment (PDQ) – Patient Version https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq