A radical orchiectomy is the surgical removal of a testicle along with its spermatic cord, performed through an incision in the groin rather than the scrotum. It is the standard first step in diagnosing and treating testicular cancer. The surgery serves a dual purpose: it removes the tumor and provides tissue for a pathologist to determine the exact type and stage of cancer, which guides all treatment decisions that follow.
Why the Incision Is in the Groin
The location of the incision is one of the defining features of this surgery and the reason it’s called “radical” rather than a simple removal. The testicles and the scrotum drain through entirely separate lymphatic pathways. The testicles drain upward along the testicular arteries to lymph nodes deep in the abdomen, near the aorta. The scrotum drains to a different set of lymph nodes in the groin.
Cutting through the scrotum would risk spilling cancer cells into scrotal tissue and its lymphatic channels, creating new pathways for the tumor to spread. A scrotal approach carries roughly a 2.5% risk of local recurrence for this reason. By going through the inguinal canal (the natural passage in the lower abdomen where the spermatic cord runs), surgeons can clamp the cord’s blood supply before handling the tumor, then pull the entire testicle up and out without disturbing the scrotum’s lymphatic system.
When It’s Recommended
This surgery is recommended whenever imaging, typically an ultrasound, reveals a suspicious solid mass within the testicle. Unlike most cancers, testicular tumors are rarely biopsied with a needle beforehand. The risk of seeding cancer cells outside the testicle outweighs the benefit of a pre-surgical biopsy, so the orchiectomy itself serves as both the diagnostic tool and the primary treatment.
Before surgery, blood is drawn to measure three tumor markers: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). These proteins help identify what type of tumor is present and whether it may have already spread. After the testicle is removed, these markers are measured again. hCG has a short half-life and should normalize within 4 to 6 days after surgery if all cancer has been removed. AFP takes longer, returning to normal within 20 to 28 days. If either marker stays elevated after surgery, it strongly suggests cancer remains somewhere in the body, even if imaging doesn’t show it.
What the Pathology Report Reveals
Once removed, the testicle goes to a pathologist who examines it in detail. The report identifies the tumor type (seminoma, nonseminoma, or mixed), its size, and how deeply it has invaded surrounding structures. This information determines the pathological stage:
- pT1: The tumor is confined to the testicle with no invasion of blood or lymph vessels. For seminomas, tumors under 3 cm are further classified as pT1a.
- pT2: The tumor has invaded blood or lymph vessels, broken through the outer covering of the testicle, reached the epididymis (the coiled tube behind the testicle), or invaded surrounding soft tissue.
- pT3: The tumor has grown into the spermatic cord.
- pT4: The tumor has invaded the scrotal wall.
Tumor size carries particular prognostic weight for seminomas. Combined with post-surgery blood marker levels and imaging results, this pathology staging shapes whether further treatment like chemotherapy, radiation, or surveillance is needed.
Recovery After Surgery
Radical orchiectomy is typically an outpatient procedure, meaning most people go home the same day. The groin incision is relatively small, and the surgery itself usually takes under an hour. The first few days involve rest, loose-fitting clothing, and managing discomfort with prescribed pain medication.
For the first three to four weeks, you should avoid heavy lifting, running, sports, and sex to allow the incision to heal fully. Most people can return to desk work within a week or two, though physically demanding jobs require a longer break. Your surgeon will confirm when specific activities are safe to resume.
Testosterone and Hormonal Effects
A common concern is whether losing one testicle will cause a drop in testosterone. The remaining testicle can compensate, but it doesn’t always do so fully. About 61% of men maintain adequate testosterone levels one month after surgery. However, that number drops over time. One study in Medical Oncology found that roughly half of men had clinically significant testosterone deficiency a year after treatment, defined as levels low enough to potentially cause symptoms like fatigue, reduced sex drive, mood changes, or loss of muscle mass.
This doesn’t mean half of all men will need testosterone replacement. Some fall into a borderline range and remain symptom-free. But it does mean testosterone levels should be monitored in the months and years following surgery, not just immediately afterward. If levels are consistently low and causing symptoms, replacement therapy is straightforward.
Fertility Preservation
Sperm banking before surgery is strongly recommended. While a single testicle can produce enough sperm for natural conception, the picture gets more complicated if chemotherapy or radiation follows. These treatments can temporarily or permanently impair sperm production in the remaining testicle, and it’s impossible to predict exactly how any individual man will be affected.
Banking sperm before the orchiectomy, rather than after, has practical advantages. Ejaculating is easier without a fresh groin incision. If a man turns out to have no sperm in his sample, surgical sperm retrieval can sometimes be performed during the orchiectomy itself, under the same anesthesia. Sperm cryopreservation remains the only proven pre-treatment strategy for preserving male fertility, and it should ideally be completed before any cancer therapy begins.
Testicular Prosthesis Options
A testicular prosthesis is a cosmetic implant placed in the scrotum to restore a natural appearance and feel. The only FDA-approved implant currently available in the United States is a saline-filled silicone shell called the Torosa, made by Coloplast. Silicone gel-filled implants were discontinued in the U.S. in 1995 due to concerns about connective tissue disease, though outside the U.S., gel-filled and solid silicone options are also available.
The implant can be placed at the same time as the orchiectomy or in a separate procedure later. Studies show that complication rates are similar whether it’s done simultaneously or delayed. However, doctors may recommend waiting if chemotherapy or radiation is planned afterward, since those treatments can compromise healing. Previous scrotal surgery or radiation to the area also favors a delayed approach.
Despite the low complication rate and the option for same-day placement, studies show that prosthesis options are inconsistently discussed before surgery. If appearance or how the scrotum feels matters to you, it’s worth raising the topic early in surgical planning so it can be incorporated into the procedure if appropriate.