The short answer
Sperm banking is advised before treatment. Orchiectomy removes the testicle through a cut just above the pubic area. RPLND removes lymph nodes in the belly and can cause retrograde ejaculation. Nerve-sparing surgery may be an option.
Sperm banking is done before surgery or chemotherapy, and NCI notes some testicular cancer treatments can cause permanent infertility.
Radical inguinal orchiectomy removes the testicle and spermatic cord through a cut just above the pubic area.
A saline-filled prosthesis is an option. ACS says to discuss it with your surgeon before the first operation.
RPLND can cause retrograde ejaculation, where semen goes backward into the bladder. ACS says it usually does not cause impotence, so erections and sex are still possible.
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This page is for people with testicular cancer facing surgery to remove a testicle (orchiectomy) or lymph nodes in the belly (RPLND). It covers what to expect before, during, and after.
Sperm banking comes first
Sperm banking is advised before treatment, not after. NCI states that some testicular cancer treatments can cause infertility that may be permanent. Anyone who may want children should consider banking sperm beforehand. ACS notes that men with testicular cancer often have lower than normal sperm counts. Raise it at the first surgical visit if nobody else does.
Radical inguinal orchiectomy
The surgeon makes a cut just above the pubic area. The testicle, the tumor and the spermatic cord (the cord of blood vessels and tubes attached to the testicle) are removed. Your surgical team will tell you what to expect afterward, including pain control, activity limits and wound care.
The prosthesis question
ACS says men who are concerned about how they look can have a saline-filled prosthesis placed to match the other testicle. You can discuss it with your surgeon before the first operation. Ask early, even if you are not sure you want one.
ACS says that if both testicles are removed, the body cannot make enough testosterone, so replacement is needed. If only one is removed, ask your team whether they will check your level. Tell them if you notice tiredness, low mood, or a lower sex drive.
Retroperitoneal lymph node dissection
RPLND removes lymph nodes at the back of the abdomen. ACS says it usually needs a large cut in the belly, with a longer recovery and more scarring. A laparoscopic approach uses small cuts and a camera. It may mean faster recovery and less pain. ACS says how well it works compared with open surgery is still debated.
The side effect people most want to know about is retrograde ejaculation. Semen goes backward into the bladder instead of out through the urethra. ACS says RPLND usually does not cause impotence. A man can still have erections and sex. But it can affect fertility. That is another reason to bank sperm first.
ACS says nerve-sparing surgery can be a good option for some people when done by experienced doctors. Ask whether it is right for you, and how often your surgeon does this operation.
Follow-up afterward
NCI says long-term follow-up exams are very important. Your team will set a schedule for tests and visits. Put the whole schedule in a calendar with reminders. Ask for a written copy.
What to report
- Call 911 or go to an emergency department if you have chest pain or sudden shortness of breath, your belly becomes rigid and severely painful, you feel faint, a wound bleeds heavily, or you are suddenly confused or very hard to wake.
- If you are having chemotherapy, call your care team right away, day or night, if your temperature is 100.4°F (38°C) or higher. CDC says to call your doctor immediately. Fever may be the only sign of an infection, and an infection can be life-threatening during chemotherapy. Also call right away for chills, a sore throat, mouth sores, burning when you urinate, redness at a catheter site, or any other sign of infection, even without a fever. A normal temperature is not permission to wait. If you cannot reach your team quickly, go to an emergency department and say you are having chemotherapy.
- Call your surgical team the same day if you are not on chemotherapy and have a fever of 101°F (38.3°C) or higher, or chills. MedlinePlus lists that fever level for people after bowel surgery. Ask your surgeon what number they want you to use.
- Call the same day for pain that is getting worse and is not helped by your pain medicine, or redness, warmth, drainage or bleeding at an incision. Also call for an incision that opens, scrotal swelling that keeps growing, or calf pain or swelling. Call if you vomit repeatedly or your belly swells or becomes tight.
- Report new numbness, erection changes or absent ejaculate at follow-up rather than waiting to be asked.
Sources
Common questions
Why does sperm banking have to happen before treatment?
NCI states that certain testicular cancer treatments can cause infertility that may be permanent, and that anyone who may want children should consider banking sperm before treatment. ACS notes that men with testicular cancer often have lower than normal sperm counts. Ask about banking at your first visit.
What is retrograde ejaculation, and does it affect erections?
ACS says that with retrograde ejaculation, semen goes backward into the bladder and does not come out through the urethra. ACS also says RPLND usually does not cause impotence, so a man can still have erections and sex. It can affect fertility, which is one reason to bank sperm first. Nerve-sparing surgery may be an option for some people.
Should I ask about a prosthesis even if I don't think I want one?
ACS says men who are concerned about how they look can have a saline-filled prosthesis, and that you can discuss it with your surgeon before the first operation. Asking early keeps your options open.
Will my testosterone drop with one testicle removed?
ACS says that if both testicles are removed, the body cannot make enough testosterone and replacement is needed. Ask your team whether they will check your level if you have only one removed, and tell them if you notice tiredness, low mood or a lower sex drive.
What does recovery from each operation usually involve?
Your surgical team will tell you how long recovery takes and what to avoid. ACS says RPLND usually needs a large cut in the belly, with a longer recovery and more scarring. A laparoscopic approach uses small cuts and may mean faster recovery and less pain, though how well it works compared with open surgery is still debated.
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Written by: Cancer ExplainedSources last checked: 2026-08-13 what this meansLast updated: 2026-09-29Next planned review: 2027-01-30
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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