A unilateral orchiectomy is the surgical removal of only one testicle, typically performed to treat testicular cancer, address severe trauma, or manage infection. The procedure is generally considered safe and routine. Understanding the potential short-term and long-term side effects is important for those facing this procedure.
Immediate Post-Surgery Experience
The acute phase of recovery immediately following a unilateral orchiectomy focuses on managing discomfort and allowing the incision site to heal. Patients can expect a period of mild to moderate pain, which is typically managed with prescription or over-the-counter pain medication for the first one to two weeks after the procedure. This discomfort usually diminishes significantly after the initial healing period.
Swelling and bruising in the scrotum are common and expected physical side effects that can persist for two to four weeks. Applying a cold pack or ice to the area for short periods during the first couple of days can help reduce this swelling. Wearing a scrotal support or snug-fitting underwear for several weeks is often recommended to help minimize swelling and provide comfort.
Physical activity must be strictly limited during the initial recovery phase. Strenuous activities like jogging, heavy lifting, or intense exercise should be avoided for two to three weeks. Most healthcare providers advise against lifting anything heavier than 10 pounds for approximately four to six weeks. Patients should also use a stool softener to avoid straining during bowel movements.
Impact on Hormone Production and Fertility
The long-term physiological concern is the capacity of the remaining testicle to maintain normal function. A single, healthy testicle is generally capable of compensating for the loss by increasing its hormone production to maintain testosterone levels within the normal range. This compensation occurs because the pituitary gland releases more Luteinizing Hormone (LH), which stimulates the remaining testicle to produce more testosterone.
While most men do not experience a decline in hormone levels, a small subset may develop insufficient testosterone production, a condition known as hypogonadism. Signs of inadequate testosterone may include persistent fatigue, reduced muscle mass, or a noticeable drop in sex drive (libido). In these cases, monitoring testosterone levels is recommended, and testosterone replacement therapy (TRT) may be indicated to alleviate symptoms.
Regarding fertility, the removal of one testicle reduces the overall capacity for sperm production. The remaining testicle continues to produce sperm, often in sufficient quantity and quality for successful conception. However, if the orchiectomy was due to testicular cancer, the health of the remaining testicle may already be compromised, potentially leading to a pre-existing reduction in sperm quality or count.
For patients facing additional cancer treatments, such as chemotherapy or radiation, the risk to sperm production increases. Therefore, fertility preservation options, such as sperm banking, are frequently discussed and recommended before the unilateral orchiectomy or any subsequent treatments. This ensures men maintain the option of biological fatherhood.
Psychological and Appearance Considerations
Beyond the physical and hormonal changes, the emotional and psychological impact of losing a testicle can be significant. Feelings of anxiety, depression, or a sense of loss are not uncommon following the surgery. These emotional responses are often tied to concerns about body image and how the change may affect self-perception.
Concerns about appearance can extend into a person’s sexual confidence and intimacy. Some individuals may feel self-conscious about the change in body structure, especially with a partner or in public settings like a locker room. Open communication with a partner and seeking support from mental health professionals or support groups can be very beneficial in navigating these feelings and restoring self-esteem.
To address concerns about symmetry and appearance, the option of a testicular implant or prosthesis is available. This device, typically a saline-filled silicone implant, is surgically placed in the scrotum to mimic the size and feel of the removed testicle. The choice is purely cosmetic, as the implant serves no biological function. Studies have shown that receiving a testicular prosthesis can improve body image and help alleviate the psychosocial burden.