Patient Guide: High Inguinal Orchiectomy
(Surgical Removal of the Testicle for Suspected Cancer)
What is a High Inguinal Orchiectomy?
This is a surgery to remove the entire testicle and the spermatic cord (the tube containing the blood vessels and sperm duct).
Crucial Distinction: Unlike a simple removal for benign conditions, this surgery is NOT performed through the scrotum. Instead, we make an incision in the groin (inguinal area), just above the pubic bone.
Why is the incision in the groin?
This is done for oncological safety.
Preventing Spread: Testicular cancer cells can spread through the lymphatic channels. The scrotum has a different lymphatic drainage system than the testicle itself. Cutting through the scrotum could accidentally alter the drainage and cause cancer cells to spread to the skin or lymph nodes in the groin.
Complete Removal: Approaching from the groin allows us to remove the entire testicle and the spermatic cord high up, ensuring no cancer cells are left behind in the cord.
The Procedure: What to Expect
Anesthesia: You will be under general anesthesia (asleep) or spinal anesthesia (numb from the waist down).
Duration: The surgery typically takes 45 to 60 minutes.
The Steps:
A small incision (2–3 inches) is made in the groin crease.
The testicle is pushed up from the scrotum and removed through this incision.
The spermatic cord is tied off and cut.
The incision is closed with dissolvable stitches under the skin.
Testicular Prosthesis (Implant)
Option: You have the option to have a prosthetic testicle (a silicone implant) placed inside the scrotum during the same surgery to restore a natural appearance.
Choice: This is purely cosmetic. Some men choose to have it immediately, some wait until later, and many choose not to have one at all. There is no medical "right" answer.
Recovery: Healing & Comfort
1. Pain & Swelling
Scrotal Support: This is the most important tip. Wear a tight pair of supportive underwear (briefs) or a jockstrap for 2 weeks. This prevents the empty scrotum from swelling and reduces pain.
Ice: Apply ice packs to the groin area (over the underwear) for 20 minutes on, 20 minutes off, for the first 48 hours.
Medication: You will be given pain medication. Most men switch to Tylenol/Ibuprofen within 2–3 days.
2. Activity
Walking: Encouraged immediately.
Lifting: No heavy lifting (>10-15 lbs) for 4 weeks. Straining can cause a hernia at the incision site.
Work: Desk jobs: 1 week. Physical jobs: 3–4 weeks.
3. Sensation (Numbness)
You may feel numbness on the inner thigh or the base of the scrotum. This is because small skin nerves run near the incision site. This numbness usually fades over a few months but can sometimes be permanent. It does not affect leg movement.
Pathology & Next Steps
The removed testicle is sent to the lab for analysis. About 1 week after surgery, we will review the Pathology Report. This determines the type of cancer (Seminoma vs. Non-Seminoma) and the exact stage.
Based on this, your future plan will be one of three paths:
Surveillance: Regular scans and blood tests (active monitoring).
Chemotherapy or Radiation: To treat any microscopic cells elsewhere.
Further Surgery: Removing lymph nodes (RPLND) if needed.
⚠️ When to Call the Doctor
Contact us immediately if:
Huge Swelling: The scrotum suddenly swells to the size of a grapefruit and is painful (Hematoma).
Fever: Temperature over 101°F (38.3°C).
Wound Issues: Redness, pus, or the incision opening up.
Severe Pain: Pain that is not relieved by the prescribed medication.
Patient Guide: Fertility Preservation & Sperm Banking
(Protecting Your Future Family)
Why are we discussing this?
Treatments for testicular cancer and other urological conditions—such as surgery, chemotherapy, and radiation—can sometimes affect your ability to have children naturally.
Orchiectomy (Removal of Testicle): While one healthy testicle is usually enough to produce sperm for natural conception, your overall sperm count may temporarily drop after surgery due to stress or inflammation.
Chemotherapy & Radiation: These treatments target rapidly dividing cells (like cancer), but they can also damage sperm cells. This damage can be temporary or permanent.
RPLND Surgery: In rare cases, this surgery can affect the nerves that control ejaculation.
Sperm Banking (Cryopreservation) is an "insurance policy." It allows you to freeze and store healthy sperm before treatment begins, ensuring you have the option to father a child in the future, even if your fertility is affected.
When should I do it?
Ideally, BEFORE any treatment.
Best Time: Before your orchiectomy (surgery to remove the testicle).
Second Best: After surgery but before starting chemotherapy or radiation.
Why? Once chemotherapy starts, sperm quality can drop significantly and may take 2–5 years to recover, if at all.
The Process: Step-by-Step
1. The Referral We will provide you with a referral to a Fertility Clinic or Sperm Bank. You will need to call them to set up an urgent appointment (tell them you are a cancer patient starting treatment soon; they usually prioritize you).
2. The Collection
You will be asked to provide a semen sample in a private room at the clinic.
Abstinence: For the best sample, try not to ejaculate for 2 to 3 days before your appointment (but no longer than 5 days).
Multiple Samples: Depending on the quality of your sperm, the clinic may recommend banking 2 or 3 separate samples over a few days.
3. Analysis & Freezing
The lab analyzes the sample for sperm count (quantity) and motility (movement).
The sperm is mixed with a protective solution and frozen in liquid nitrogen tanks at -196°C.
It can remain viable for decades.