My Clinical Approach
A diagnosis of suspected testicular tumour causes immediate anxiety — both about the disease itself and about fertility, testosterone, and body image. In my clinical practice, I always want the patient to understand that orchiectomy is simultaneously a diagnostic and therapeutic act — and that the next steps depend on histology, not assumptions made before surgery.
A suspicious intratesticular tumour ≠ a simple scrotal orchiectomy. The indication and surgical approach depend on the underlying condition.
The Term “Orchiectomy” Does Not Describe a Single Procedure
The indication and surgical approach always depend on the underlying condition.
Radical inguinal orchiectomy
The standard approach when there is serious suspicion of a primary malignant testicular tumour.
Simple orchiectomy
A different procedure, for other selected indications (see section below).
Bilateral orchiectomy
Has entirely different endocrine and reproductive consequences than unilateral surgery.
Testis-sparing / partial orchiectomy
Preservation of part of the testis, only in selected cases.
When We Suspect a Testicular Tumour
- A painless firmness or palpable mass.
- Increase in testicular size.
- Change in consistency.
- A sensation of heaviness or discomfort.
- Incidental finding on ultrasound.
Pain does not rule out a tumour. Pain or swelling of the scrotum can delay diagnosis if mistakenly attributed to another cause.
At the same time, not every scrotal pain or swelling is cancer — epididymitis, hydrocele, spermatocele, and other benign conditions are far more common causes.
Ultrasound Before Orchiectomy
High-frequency scrotal ultrasound helps determine:
- whether the lesion is intra- or extratesticular
- the morphology of the lesion
- its vascularity
- the state of the testicular parenchyma
- the contralateral testis
- any associated scrotal pathology
Hydrocele, varicocele, epididymal cyst, and an intratesticular tumour are different entities. See our pages on Hydrocele, Varicocele and Spermatocele.
AFP, β-hCG, and LDH Before Surgery
The serum tumour markers AFP, β-hCG, and LDH are obtained before and after orchiectomy. They support the diagnosis, may suggest histology, and are used for staging, prognostic assessment, and monitoring.
AFP (alpha-fetoprotein)
May be elevated in selected non-seminomatous germ-cell tumours. Pure seminoma should not produce AFP — a significant elevation raises suspicion of a coexisting non-seminomatous component.
β-hCG
May be elevated in both seminomas and non-seminomatous tumours. It is not used alone to determine the exact histological type.
LDH
Less tumour-specific, may relate to tumour burden. It is not a standalone diagnostic test.
Normal Markers ≠ No Cancer
A patient can have testicular cancer with normal AFP, β-hCG, and LDH.
Current tumour markers have limitations due to low sensitivity — normal levels do not exclude the presence of disease.
Why the Inguinal Approach
For a suspected germ-cell malignancy:
- the standard approach is inguinal
- the spermatic cord is approached through the groin
- the testis is removed intact
- routine scrotal violation is avoided
A simple scrotal biopsy of a suspected primary testicular tumour is not usually performed — a scrotal approach is associated with a higher rate of local recurrence than the inguinal approach.
Why Not a Needle Biopsy
Routine trans-scrotal needle biopsy of a suspected primary germ-cell tumour is generally avoided. Reasons include potential disruption of lymphatic drainage, local contamination/management considerations, and the fact that radical inguinal orchiectomy provides definitive histological diagnosis.
Cancer orchiectomy ≠ micro-TESE. These are entirely different procedures with different purposes. See our page on Micro-TESE for microsurgical sperm retrieval in infertility.
What Is Radical Inguinal Orchiectomy
This page describes the procedure at a patient-friendly level — it is not a surgical technique manual.
What the Histological Examination Shows
Histological type
Seminoma, non-seminomatous, or mixed germ-cell tumour.
Tumour size
Recorded in the pathology report.
Tunica invasion
Reported when present.
Lymphovascular invasion
An important prognostic factor.
Spermatic cord involvement
Assessed histologically.
Pathological T stage
Determined according to current TNM/WHO classification.
Seminoma vs Non-Seminomatous Germ-Cell Tumour
Seminoma
A distinct histological type of germ-cell tumour, with its own biological behaviour and treatment approach.
Non-seminomatous germ-cell tumour (NSGCT)
May include embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma, or a combination (mixed germ-cell tumour).
The next step depends on the combination of histology, stage, markers, and risk profile — not the histological type alone.
Orchiectomy ≠ Automatic End of Treatment
In some patients, orchiectomy is the only treatment required. In others, it is the first step before surveillance or additional treatment.
Possible pathways after orchiectomy:
- Surveillance
- Chemotherapy
- Selected radiotherapy
- Retroperitoneal lymph node dissection (RPLND)
- Other stage-specific management
Staging
Staging combines histology, serum tumour markers, and imaging (usually contrast-enhanced CT of the chest, abdomen, and pelvis when markers are elevated or there is clinical suspicion of metastasis).
According to current guidelines, PET-CT and bone scan are not recommended for initial staging of testicular cancer.
Post-Operative Markers
Markers are repeated after orchiectomy, taking their half-life kinetics into account. Their kinetics may influence staging. No rigid self-monitoring schedule is provided — follow-up is determined by the oncology/urology team.
Stage I ≠ Automatic Chemotherapy
Depending on whether it is seminoma or NSGCT, pathological risk factors, markers, patient preference, and feasibility of regular surveillance, management differs. There is no universal adjuvant-treatment statement that applies to everyone.
Orchiectomy and Fertility
Before treatment, when clinically feasible, reproductive history, semen analysis where appropriate, sperm cryopreservation, and reproductive counselling are discussed.
Cancer treatment must not be unsafely delayed solely for sperm banking. Safety first, balanced with reproductive counselling where feasible.
Sperm Cryopreservation
Discussion of sperm banking is recommended for all men before starting testicular cancer treatment, especially before:
- chemotherapy
- radiotherapy
- retroperitoneal lymph node dissection (RPLND)
- bilateral testicular procedures
- in men with already impaired contralateral testicular function
This does not mean every unilateral orchiectomy causes infertility — the need is assessed individually.
One Testicle and Fertility
A healthy remaining testis can often maintain spermatogenesis, testosterone production, and sexual function.
However: the cancer itself may already affect fertility; pre-existing infertility may exist; and any further oncological treatment may further impair fertility. There are no absolute guarantees.
Testosterone After Unilateral Orchiectomy
The healthy contralateral testis often compensates adequately. However, selected men may develop:
- Low testosterone
- Elevated LH
- Compensated Leydig-cell dysfunction
- Clinical hypogonadal symptoms
Assessment is performed when clinically indicated. See also our page on Male Hypogonadism & Low Testosterone.
Bilateral Orchiectomy
After bilateral orchiectomy: endogenous testosterone falls dramatically, natural sperm production is lost, and long-term endocrine management is generally required. This must not be confused with unilateral cancer surgery.
Sexual Function
Removal of one testis does not mechanically prevent erection, orgasm, ejaculation, or sexual intercourse. Sexual function can, however, be influenced by testosterone, chemotherapy, anxiety, body image, or fertility concerns.
Fertility ≠ erectile function.
Testicular Prosthesis
A testicular prosthesis is offered to all patients undergoing unilateral or bilateral orchiectomy. It can be placed during the procedure itself or at a later time, without an increased risk of complications from delaying. The purpose is cosmetic symmetry and body-image support.
The prosthesis does not produce testosterone and does not produce sperm.
The choice is entirely personal.
Prosthesis Risks
Infection
A recognised risk.
Hematoma
A possible post-operative complication.
Malposition / migration
May require revision.
Discomfort
A sensation of a foreign body, particularly early on.
Dissatisfaction with size/position
A subjective assessment of the cosmetic result.
Wound complications / need for revision-removal
Rare but recognised.
Can the Testis Be Preserved?
Testis-sparing surgery may be considered only in carefully selected situations: synchronous bilateral tumours, a tumour in a solitary testis, or small/indeterminate lesions with negative tumour markers and a normal contralateral testis.
Partial orchiectomy is not the standard substitute for radical orchiectomy in every suspicious mass. Multifocal or adjacent germ-cell neoplasia in situ (GCNIS) is described in a substantial proportion of patients.
When considered, it is usually performed with frozen-section examination during surgery. The patient is informed about the risk of local relapse if adjuvant radiotherapy is not performed, and about the need for regular endocrine follow-up (testosterone monitoring).
Small Incidental Testicular Masses
Not every small incidental lesion is malignant. Depending on the lesion’s characteristics, options may include:
- Ultrasound surveillance
- Repeat imaging
- Tumour markers
- Testis-sparing surgery
- Radical orchiectomy
The decision depends on the actual characteristics of the lesion — there is no size-alone rule that determines safe surveillance.
The Contralateral Testis
The contralateral testis is assessed clinically and by ultrasound as indicated.
The healthy opposite testis is not routinely removed prophylactically.
Routine biopsy of the contralateral testis is not recommended for every patient. It is discussed in men at high risk for GCNIS (e.g. testicular volume <12mL, history of cryptorchidism). It is not necessary in patients over 40 without risk factors. If GCNIS is diagnosed in an otherwise normal contralateral testis, options include orchiectomy or close observation; in a solitary testis, local radiotherapy is considered, with known effects on fertility.
Simple Orchiectomy
Simple orchiectomy is a different procedure, not synonymous with radical inguinal orchiectomy. Possible indications include selected cases of a non-viable testis, severe trauma, infection, or hormonal treatment in advanced prostate cancer. A complete treatment algorithm for these scenarios is not covered here.
Testicular Torsion
Emergency:
In acute torsion, urgent surgical exploration is performed, with an attempt at testicular salvage. Orchiectomy is done only if the testis is no longer viable.
Sudden severe testicular pain is a medical emergency.
See our page on Testicular Torsion.
Recovery After Orchiectomy
Groin discomfort
Expected, resolves gradually.
Bruising
Common, transient.
Mild scrotal swelling
Expected to some degree.
Wound care
According to the surgeon’s instructions.
Walking
Gradually encouraged, according to comfort.
Return to work
Depends on the type of work — not a fixed number of days for everyone.
Exercise
Gradual resumption according to the surgeon.
Sexual activity
Resumes once discomfort and healing allow.
Possible Complications
Swelling / bruising
Expected, transient reaction.
Hematoma
Mild bruising is expected; a worsening hematoma needs reassessment.
Wound infection
Redness, pus, or fever require evaluation.
Local groin numbness
May persist in selected patients.
Chronic pain
Rarely possible.
Prosthesis complications
Infection, hematoma, malposition, need for revision (see prosthesis section).
When to Contact Us Urgently
Contact us immediately if you notice:
- Rapidly increasing swelling
- Severe or worsening pain
- Significant bleeding
- Fever
- Purulent discharge from the wound
- Wound dehiscence
- Marked redness
- General deterioration
Can I Live Normally With One Testicle?
Most men with a healthy remaining testis can continue normal daily activity, sexual activity, testosterone production, and fertility. Individual evaluation remains important.
Concerns about body image, cancer anxiety, fertility anxiety, and sexual confidence are understandable and common. Testicular prosthesis and psychological support are available options.
The Patient Journey
Palpable lump / suspicious ultrasound finding
Starting point of evaluation.
Clinical examination
—
Scrotal ultrasound
—
Suspicious intratesticular mass?
No → alternative diagnosis/appropriate follow-up. Yes → continue below.
AFP + β-hCG + LDH
—
Fertility counselling ± sperm cryopreservation + prosthesis discussion
—
Radical inguinal orchiectomy
—
Histopathology
Seminoma or NSGCT.
Post-operative markers + staging imaging
—
Stage/risk assessment
Surveillance, chemotherapy, selected radiotherapy, RPLND, or other treatment according to guidelines.
Frequently Asked Questions (FAQ)
What is orchiectomy?
It is the surgical removal of the testis. The term does not describe a single procedure — the indication and surgical approach depend on the underlying condition.
What is radical inguinal orchiectomy?
It is the standard procedure when there is serious suspicion of a primary malignant testicular tumour. The testis is removed intact through an incision in the groin, with ligation of the spermatic cord at the level of the internal inguinal ring.
When is it needed?
Mainly when clinical examination or ultrasound shows a suspicious intratesticular mass concerning for primary malignancy. The decision is based on clinical examination, imaging, and serum tumour markers.
Is every testicular mass cancer?
No. Many intra- and extratesticular lesions are benign (epididymal cyst, hydrocele, spermatocele). Distinction is made through clinical examination and ultrasound, not simply the presence of a “mass.”
Is ultrasound always needed?
Yes. High-frequency scrotal ultrasound assesses whether the lesion is intra- or extratesticular, its size and location, and the contralateral testis.
What are AFP, β-hCG, and LDH?
These are serum tumour markers obtained before orchiectomy. They support the diagnosis and may suggest histological type, but they do not replace histological examination.
Can testicular cancer exist with normal markers?
Yes. The markers have limited sensitivity — normal values do not exclude testicular cancer.
Is AFP a marker of seminoma?
No. Pure seminoma should not produce AFP. A significant AFP elevation in a patient with seminoma histology raises suspicion of a coexisting non-seminomatous component.
Can seminoma have elevated β-hCG?
Yes, a proportion of pure seminomas can have mildly elevated β-hCG. β-hCG alone does not determine the exact histological type.
Why is the procedure performed through the groin rather than the scrotum?
The inguinal approach, with ligation of the spermatic cord at the internal inguinal ring, is the standard of care for a suspected germ-cell tumour. A scrotal approach is avoided because it is associated with a higher rate of local recurrence.
Why is a needle biopsy through the scrotum not done first?
Routine trans-scrotal needle biopsy of a suspicious primary tumour is generally avoided. Radical inguinal orchiectomy provides definitive histological diagnosis with safer control of the local disease.
What is the difference between cancer orchiectomy and micro-TESE?
These are entirely different procedures. Orchiectomy for cancer removes the entire testis for oncological diagnosis/treatment. Micro-TESE is a microsurgical sperm-retrieval search for infertility, without removing the testis. See our micro-TESE page for details.
Is the entire testis always removed?
In standard radical orchiectomy, yes. In very selected cases (e.g. solitary testis, bilateral lesions, small/indeterminate lesion with negative markers) testis-sparing surgery may be considered.
What does the histological examination show?
It determines the histological type (seminoma or non-seminomatous germ-cell tumour), size, any lymphovascular invasion, spermatic cord involvement, and pathological T stage.
What is the difference between seminoma and a non-seminomatous tumour?
These are different histological types of germ-cell tumour, with different biological behaviour and treatment approach. The next step depends on histology, stage, markers, and risk profile.
Is chemotherapy always needed after orchiectomy?
No. In many patients, orchiectomy is the only treatment required, with surveillance. In others, it is the first step before additional treatment, depending on histology and stage.
Is orchiectomy enough for Stage I disease?
In many Stage I patients, surveillance after orchiectomy is an appropriate option. The strategy is individualised based on pathological risk factors, markers, and patient preference.
Can I father children with one testicle?
Usually yes, provided the remaining testis functions normally. However, the cancer itself may already affect spermatogenesis, and any further oncological treatment may further impact fertility. There is no universal guarantee.
Is sperm cryopreservation needed?
Discussion of sperm banking is recommended for all men before starting any testicular cancer treatment, especially before chemotherapy, radiotherapy, or lymph node dissection.
Will testosterone drop after unilateral orchiectomy?
Often the healthy remaining testis produces sufficient testosterone. In selected men, however, low testosterone or compensated Leydig-cell insufficiency may develop — clinical monitoring is needed.
Will erectile function be affected?
Removal of one testis does not mechanically prevent erection, orgasm, or ejaculation. Sexual function can nonetheless be influenced by testosterone, chemotherapy, anxiety, or body image.
Can I have a testicular prosthesis placed?
Yes. A testicular prosthesis is offered to all patients undergoing unilateral or bilateral orchiectomy. It can be inserted during orchiectomy itself or later, without an increased risk of complications from delaying.
Does the prosthesis produce testosterone or sperm?
No. The testicular prosthesis is purely a cosmetic silicone implant. It has no endocrine or reproductive function.
What are the complications of orchiectomy?
Pain, swelling, bruising, hematoma, wound infection, local groin numbness, rarely chronic pain. With prosthesis placement, dissatisfaction with position/size or the need for revision may additionally occur.
How long does recovery take?
It varies by patient. Generally, light activities resume soon, while full physical activity takes longer — there is no single timeline for everyone.
Is a biopsy of the other testis needed?
Not routinely. It is discussed only in patients at high risk for GCNIS (e.g. testicular volume <12mL, history of cryptorchidism). It is not necessary in patients >40 years without risk factors.
What happens if GCNIS is found in the other testis?
If the contralateral testis is otherwise normal, options include orchiectomy or close observation (the 5-year risk of progressing to testicular cancer is substantial). In a solitary testis, local radiotherapy is considered, with known effects on fertility.
Is PET-CT always needed after orchiectomy?
No. PET-CT is not recommended for initial staging of testicular cancer according to current guidelines.
When should I contact the doctor urgently after surgery?
In case of rapidly increasing swelling, severe or worsening pain, significant bleeding, fever, wound dehiscence or purulent discharge, or general deterioration.
Related Topics
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When there is a suspicious intratesticular mass, the correct management is not usually a simple biopsy through the scrotum. Ultrasound evaluation, appropriate serum tumour markers, and radical inguinal orchiectomy allow safe removal of the primary tumour and definitive histological diagnosis. Fertility, sperm cryopreservation, and the option of a testicular prosthesis should also be discussed in a timely manner.
References
- EAU Guidelines on Testicular Cancer 2026 — Chapter 5, Diagnostic Evaluation (ultrasound, tumour markers, inguinal orchiectomy, testis-sparing surgery, testicular prosthesis, contralateral biopsy, GCNIS).
- Current WHO classification of testicular tumours and TNM staging system.
- ESMO Clinical Practice Guideline for testicular germ-cell tumours.
Medical Review
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Marinos Vasilas provides individualised surgical management of suspected testicular tumours, with emphasis on timely diagnosis, fertility, and informed discussion of testicular prosthesis options.
View Full ProfileThis article is for informational purposes only and does not replace medical advice, diagnosis, or treatment. Not every testicular lesion is cancer; normal tumour markers do not exclude testicular cancer; not every small incidental lesion requires radical orchiectomy; the impact on fertility is individualised; testosterone after unilateral surgery is often preserved but not guaranteed; treatment after orchiectomy depends on histology and staging; and sudden severe scrotal pain requires urgent evaluation. Always consult your urologist for individualised management of your case.
