The short answer
Sperm banking happens before treatment. Orchiectomy removes the testicle through a groin incision; RPLND removes abdominal lymph nodes and can cause retrograde ejaculation unless nerve-sparing technique is used.
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 groin incision; the scrotum is not cut, to avoid spreading cells.
A saline-filled prosthesis can be placed at the same operation or later, and is worth discussing before surgery rather than afterwards.
RPLND can cause retrograde ejaculation, where semen travels backward into the bladder; orgasm still occurs but visible ejaculate does not.
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The full explanation.
Sperm banking comes first
Sperm banking happens before treatment, not after. NCI states plainly that some testicular cancer treatments can cause infertility that may be permanent. Anyone who may want children should consider banking sperm beforehand. This matters even when only one testicle is being removed. Men with testicular cancer often already have lower than normal sperm counts. Raise it at the first surgical visit if nobody else does. The window is short. It closes once surgery or chemotherapy starts.
Radical inguinal orchiectomy
The testicle is removed through an incision in the groin, above the pubic bone. The spermatic cord comes out with it. The scrotum is not cut. A scrotal incision risks spreading cancer cells into scrotal tissue and different lymph nodes. It is usually a same-day or overnight operation.
People commonly report aching rather than sharp pain. Bruising and swelling of the scrotum look alarming and settle over a few weeks. Numbness near the incision and in the upper thigh can last months. Supportive underwear and ice are strongly recommended. Lifting and strenuous activity are restricted for a period your surgeon will specify.
The prosthesis question
A saline-filled implant can be placed to restore appearance. Sometimes it goes in at the same operation. Sometimes it is done later. Have this conversation before surgery, even if you think you do not want one. The decision is easier to make once than to revisit. Men often describe being caught off guard by how the change looks. They describe how it comes up in intimate situations. And they wish they had been offered the discussion earlier.
Testosterone usually stays in the normal range with one healthy remaining testicle. Even so, it is reasonable to ask for a baseline level. Ask for a repeat check if fatigue, low mood, or reduced libido persist.
Retroperitoneal lymph node dissection
RPLND removes lymph nodes at the back of the abdomen. It can be done open, through a long abdominal incision. It can also be done laparoscopically, through small incisions. The laparoscopic route generally means less pain, earlier eating and a quicker return to activity. Either way it is a bigger operation than orchiectomy.
The side effect people most want to know about is retrograde ejaculation. Semen travels backward into the bladder instead of leaving the body. Orgasm still happens. The visible ejaculate does not. It does not cause impotence. But it does complicate natural conception. That is another reason banking is done first. Nerve-sparing RPLND is designed to preserve the nerves that control ejaculation. Ask directly whether nerve-sparing is planned in your case. Ask how often the surgeon performs this operation.
After abdominal surgery, a slow gut is common. Passing gas, walking laps of the ward and slowly restarting food are all expected steps. They are not signs of a problem.
Surveillance afterwards
Follow-up usually involves tumor markers, imaging and clinic visits. It runs on a set schedule for years. Missing appointments is the most common preventable problem. Put the whole schedule in a calendar with reminders. Ask for a written copy.
What to report
Go to an emergency department, or call 911, for chest pain or sudden shortness of breath — that can be a clot on the lung. Do the same if your belly goes rigid and severely painful, if you feel faint, or if a wound bleeds heavily.
If you are having chemotherapy as well as surgery, CDC calls a fever during chemotherapy a medical emergency: a temperature of 100.4°F (38°C) or higher means calling your care team immediately, day or night, rather than leaving a message for the clinic. If you cannot reach them quickly, go to an emergency department and tell them you are having chemotherapy.
Call the same day for a fever or chills when you are not on chemotherapy. Call for increasing pain not controlled by your medicine. Call for redness, warmth or drainage from an incision. Call for scrotal swelling that keeps growing rather than settling. Call if an incision opens. Call the same day too for calf pain or swelling on one side. After abdominal surgery, also call if you cannot pass gas or stool, if you vomit repeatedly, or if your belly becomes tight and distended. Report new numbness, erection changes or absent ejaculate at follow-up rather than waiting to be asked.
Sources
Words to know
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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. The window closes once surgery or chemotherapy begins. The American Cancer Society also notes that men with testicular cancer often already have lower than normal sperm counts, so banking matters even when only one testicle is being removed.
What is retrograde ejaculation, and does it affect erections?
It means semen travels backward into the bladder instead of leaving the body. Orgasm still happens and erections are not affected, but the visible ejaculate is absent and natural conception becomes difficult. It is a recognized effect of RPLND, which is one reason sperm banking is arranged beforehand. Nerve-sparing technique aims to preserve the nerves that control ejaculation.
Should I ask about a prosthesis even if I don't think I want one?
It is worth having the conversation before surgery, because the decision is simpler to make once rather than revisit later. A saline-filled implant can sometimes be placed during the same operation. Men frequently describe being caught off guard by how the change looks and by how it comes up in intimate situations, and by wishing the discussion had been offered earlier.
Will my testosterone drop with one testicle removed?
Testosterone usually stays in the normal range with one healthy remaining testicle. It is still reasonable to ask for a baseline level and a repeat check if fatigue, low mood or reduced libido persist, since those symptoms are easy to attribute to recovery alone.
What does recovery from each operation usually involve?
Orchiectomy is often same-day or overnight. People commonly report aching rather than sharp pain, scrotal bruising and swelling that looks alarming and settles over weeks, and numbness near the incision and upper thigh that can last months. RPLND is a larger operation; open surgery through a long abdominal incision means slower recovery than laparoscopic, and a temporarily sluggish gut is expected.
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Written by: Cancer ExplainedSources last checked: 2026-08-13 what this meansLast updated: 2026-08-18Next planned review: 2027-01-30
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How this page was created
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. We do not employ clinicians and do not intend to — our work 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 checked line by line against the sources listed on it. That confirms the sources support what the page says. 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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