When we talk about surgery for testicular cancer, there are two prominent surgeries or commonly performed surgeries that we do as urologists. Almost all testicular cancer patients will undergo a procedure called a radical inguinal orchiectomy. This is a procedure where by the testis is removed through an incision in the groin area and this is almost always the first surgical procedure that's performed. It allows us to provide a diagnosis for the patient's cancer and allows us to remove the affected testicle.
Now, that procedure is performed through an incision in the groin. And as with any surgery, we talk about potential complications or risks of surgery. The risks of this particular operation include bleeding, infection, what we call a hematoma or clot formation within the scrotum, numbness of the skin area, development of the hernia following surgery. There's always risks of complications related to anesthesia, however those risks are extremely minimal.
There is a larger procedure that we do for testicular cancer in cases where we need to remove the lymph nodes from the area called the retroperitoneum. The retroperitoneum is an area from here to here and it surrounds the aorta and the vena cava, which are the largest artery and vein in your body.
To do this procedure, we have to get access to that area. In order to do so, commonly an open incision is made, although the procedure can be done through minimally invasive approaches such as laparoscopic or robotically-assisted surgery. But, the most common approach still remains an open incision here. During the surgery, the bowels are moved out of the way in order to gain access to this area called the retroperitoneum. The lymph nodes from around the aorta and vena cava are completely removed and these large vessels are skeletonized all the way from the kidneys, down to the level of the pelvis.
Now, during removal of these lymph nodes, during this type of the procedure, there are some complications that should be discussed with the patient. Some complications that are specific to this type of an operation include damages surrounding organs, such as the bowel, the kidneys, critical blood vessel structures. There can also be what's called a bowel obstruction that can occur after a procedure like this, where the bowels get jammed up and the intestinal contents are not able to move through quite as readily. And this can occur due to things like adhesions, where you get bands of tissue that ties up the intestinal tract. That occurs any time the intestines are mobilized, whether it's with this operation or any other operation that involves the abdominal cavity.
Another unique complication with this particular surgery is something called retrograde ejaculation. There are nerves that come off of the spine and they go through the area of the retroperitoneum down into the pelvic area. These nerves are called sympathetic nerves and they allow for the process of ejaculation.
In some cases, the surgeon will try to preserve these nerves to try to preserve the process of ejaculation. However, some cases, it may not feasible to do that, especially in the case of extensive disease. And in those cases, there can be damage to these nerves. When that occurs, then the process of ejaculation may be affected. What then happens is, during the course of ejaculation, rather than semen being ejected through the urethra, it can actually go backwards into the bladder. This is why why we call it retrograde ejaculation.
Now, this can affect the ability for a man to conceive a child or to have a pregnancy. It does not mean that the patient will be infertile. Sperm is still produced and he can still usually go on to father a child if they desire. However, it may require the use of assisted reproductive techniques.
So, there are many risks with surgery in general, but there are few specific risks to the surgeries that we do for testicular cancer that we don't see with some other surgeries. And it's important to be aware of these and ask the appropriate questions to your urologist.