Introduction 

This article aims to outline the reasons for and types of testicular surgery and describes care and recovery considerations needed following it. 

Testicles

The testicles, or testes, are two egg-shaped organs forming part of the male reproductive system. They are held within a sac of skin called the scrotum and have two main functions: producing sperm and hormones, especially testosterone.

Testicular surgery 

There are many reasons why people need testicular surgery, for example: 

• Testicular cancer refers to the uncontrolled growth of abnormal cells in the testicles. The type of testicular cancer you have depends on the cell where the cancer starts, and surgery is often the first-line treatment for testicular cancer
• Undescended testicles are a childhood condition whereby one or both of the testicles are not in their usual place. If hormone treatment is not appropriate or does not work, surgery is needed to move the testicles
• Testicular torsion occurs when the testicle twists, twisting the spermatic cord (a collection of nerves and blood vessels that runs through the male reproductive system), thus reducing the blood supply to the testicles. This causes severe pain and requires emergency surgery
• An epididymal cyst is a collection of fluid on the epididymis, a tube attached to the back of each testicle that stores and transports sperm. While small epididymal cysts often do not require treatment, large, painful epididymal cysts can be surgically removed
• Varicocele refers to the enlargement of the veins near the testicle (similar to varicose veins). Surgery may be considered for those experiencing delayed testicular development, severe pain, and infertility

There are also different types of testicular surgery, including: 

• An orchidectomy refers to the surgical removal of the testicle. The testicle(s) can be removed via an incision in the groin or in the scrotum
• An orchidopexy is a surgical procedure that repositions undescended testicle(s). The procedure conducted depends on where the testicle(s) are positioned
• Scrotal exploration is an emergency procedure for testicular torsion whereby an incision is made in the scrotum to untwist the affected testicle and secure both testicles in place¹ 
• An epididymal cystectomy is a surgical procedure that involves making an incision into the scrotum to separate the cyst from the epididymis
• A varicocelectomy surgery redirects blood flow in veins near the testicles from enlarged veins to healthy veins. There are many approaches to varicocelectomy; however, many techniques have similar outcomes ² 

Testicular surgeries such as orchidectomy are typically conducted under general anaesthetic, a medication that makes you unconscious for the surgery. Alternatively, a spinal anaesthetic could be injected into your back to make you feel numb from the waist down.

The type of anaesthesia you receive will depend on the surgery you are going to have, your overall health and your preferences, which you can discuss with the anaesthesia team.³

Importance of proper post-operative care

Proper post-operative care is important, as it can reduce the risk of infection, help manage complications, and aid recovery.^4,5

While testicular surgeries typically do not require a long hospital stay, surgery can have an immense impact on the body, bringing about complex changes in the endocrine and immune systems.⁶ It is, therefore, important to engage with the guidance given by your surgical team to help you recover.

Immediate post-operative care

Monitoring in the recovery room/ward

Following surgery, you will be monitored by nurses as you regain consciousness. They will be regularly monitoring your vital signs, such as your heart rate, respiratory rate, oxygen saturation level, blood pressure, and temperature.⁷

You may feel drowsy, nauseous, or have a headache following general or spinal anaesthesia, so you may be given anti-sickness medication to help with this.³

Managing the surgical site

There may be a dressing over the surgical site to absorb any discharge. The nursing team looking after you will be looking out for signs of complications such as redness, tenderness, and swelling of the skin around the surgical site.⁷

Initial pain relief

Your surgical team will discuss options for post-operative pain management before your surgery and make a plan based on your age, allergies, current medication, surgical procedure, and preferences.

Inform the nurse looking after you if you feel any pain or discomfort so that pain relief can be given as soon as possible. You may be given paracetamol, ibuprofen, opioids, ketamine, or gabapentin.

The nursing team in the postoperative recovery area will make sure to pass on information regarding your pain management to the nurses in the ward you are moved to.⁷

At-home recovery care

Wound care and hygiene

Many testicular surgeries use dissolvable stitches to close the wound. These stitches do not need to be removed and typically disappear in about three weeks.

You may be able to remove your surgical dressing and take a shower after 24 to 48 hours; however, consult your surgical team for specific advice. Depending on your procedure, you may be advised not to take baths in order to minimise the risk of infection.

The hospital may provide scrotal support garments and recommend wearing tight-fitting underwear to help support the testicles and prevent haematoma.⁸

Rest and activity limitations

You should not drive a vehicle, use machinery, drink alcohol, or make any important decisions within the first 24 hours after anaesthesia.

After you are discharged from hospital, you should avoid heavy lifting and strenuous work for a few weeks. This is to allow for the wound to heal and to avoid hernia, especially if the surgery involves the inguinal canal – a passage in the lower abdominal wall through which the spermatic cords pass.⁹

For similar reasons, you should also avoid sports and vigorous exercise for 4 to 6 weeks.

Your doctor may advise that you return to work when you feel comfortable to do so. Similarly, you should avoid sexual activity until your wound has healed and when you feel comfortable.

Pain management

It is normal to feel some pain and discomfort in the groin and scrotum for around sevento 10 days. Paracetamol or ibuprofen can be used to manage pain following surgery. Make sure to follow the instructions on the medication packet, and do not exceed the recommended doses. 

Managing swelling and bruising

It is normal to experience swelling and bruising following testicular surgery.⁸ You can apply an ice pack to the groin for no longer than 20 minutes to help with this.

Complications 

The common postoperative complications of testicular surgery are:⁵

Blood clots

A blood clot can stop the normal flow of blood in our body and lead to serious medical conditions such as deep vein thrombosis, pulmonary embolisms, and heart attacks. Symptoms of a blood clot include:

• Chest pain
• Shortness of breath
• Dizziness
• Coughing up blood

It is important that you call 999 or go to A&E if you experience any of the symptoms of a blood clot.

Doing leg exercises and wearing compression stockings can help reduce the risk of blood clots.

Infection 

An infection is one of the most common complications following surgery.^4,5 While you are often given antibiotics soon after your surgery, look out for the following symptoms of infection: 

• High temperature
• Fever
• Chills
• Cough
• Burning sensation when urinating

Contact your healthcare provider if you have any of these symptoms as soon as possible.

Sepsis

Sepsis is a life-threatening condition whereby the immune system overreacts to an infection, causing severe damage to the body’s tissues and organs. While sepsis is a rare complication of surgery affecting up to 1% of patients undergoing routine surgery, it is important to be aware of the symptoms of sepsis so you can recognise them and inform your nursing team or seek medical attention.⁵

The symptoms of sepsis include:

• Confusion
• Slurred speech
• Severe breathlessness
• Pale, blue-ish or mottled skin
• Extreme shivering/muscle pain
• A sense that something is badly wrong
• Passing no urine in 18 hours to a day

Follow-up appointments

Follow-up appointments are an opportunity for the surgeon to examine your wound, assess how well you are recovering, and discuss and arrange any further treatments or ongoing care arrangements you may need. It will also provide you a chance to ask any questions or raise any concerns you may have.

Long-term recovery and lifestyle adjustments

Sex and fertility 

Testicular surgery can have an impact on your ability to get an erection, sex life, and fertility.^10,11 The level of impact can depend on the condition being treated and the procedure carried out. For example, a unilateral orchidectomy (removal of one testicle) for testicular cancer will typically not affect your ability to get an erection, but you may experience a reduction in your fertility if the remaining testicle does not function well.

On the other hand, a bilateral orchidectomy (removal of both testicles) results in complete infertility. Conversely, varicocele is a common cause of infertility, and varicocelectomies are used to improve fertility.¹²

You can find help with sex life and relationships at the following sites: 

• College of sexual and relationship therapists
• Relate  

Psychological well-being

In addition to your physical well-being, your emotional and psychological well-being are also of utmost importance.

People report feelings of loss, uneasiness, shame, and anxiety following testicular surgery.¹¹

While you may feel a range of complex emotions, it is important to remember there are sources of support available to help you.

Below are some sources of support:

• Cancer Support UK
• Macmillan Cancer Support
• GPs and nurses
• The Patients Association
• Local Healthwatch

Summary

• Several different types of testicular surgeries are carried out to treat different conditions that affect the testicles
• Postoperative care is important as it reduces the risk of infection, helps manage complications, and aids recovery
• Monitoring, pain management, wound care and activity limitation are key parts of postoperative care
• It is important to be aware of the symptoms of blood clots and infection
• Testicular surgery can have impacts on your sex life and fertility and may require emotional support