An orchiectomy is carried out when the ultrasound and clinical examinations indicated malignancy. In cases where the preoperative diagnosis is ambiguous, an open exploration of the testicle should be performed where a wedge-shaped biopsy is removed for frozen section diagnostics. If the frozen section confirms malignancy, a radical orchiectomy should be performed.
It may also be necessary to take a biopsy from the contralateral testicle to assess if there are carcinoma in situ changes. APF, HCG and LD should be measured before the orchiectomy.
Sperm banking will be offered to the patient if possible. This is done in cases where the patient needs supplementary treatment which will affect fertility or if the other testicle is atrophic or absent.
Retroperitoneal node dissection
A retroperitoneal node dissection is necessary for some patients after chemotherapy treatment is completed. This surgery is performed only for nonseminoma stage II, III, and IV.
This procedure is extensive. A low midline incision is made right below the sternum and down to the navel. The lymph nodes which are associated with the involved testicle is removed. If there is suspicion of metastasis, the contralateral lymph nodes are also checked.
Retroperitoneal node dissections have historically be associated with significant postoperative complications. A large portion of patients undergoing this type of surgery experienced retrograde ejaculation. This has since been reduced due to better surgical techniques applying surgery sparing nerves and lymph drainage.