Problems after surgery for testicular cancer

There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

The possible problems depend on the type of surgery you have.

General risks

After any operation there is a risk of:

Infection

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Bleeding from the wound

There is a risk that you might bleed around the area of your operation. Your nurse will monitor you closely for signs of bleeding. The risk of bleeding is higher straight after your operation. But your nurses will continue to check your wound while you are in hospital.

The treatment you need depends on what is causing the bleeding and how much blood you lose.

You might need a blood transfusion. Rarely, you might need to go back for urgent surgery.

Blood collecting around the operation site (haematoma)

Occasionally blood collects in the tissues around the wound. This is called a haematoma. It can cause pain and swelling, and the area might feel hard. 

The haematoma normally goes away on its own, but it can take a few weeks, or sometimes it may be longer. 

Tell your surgeon or nurse if you have any swelling around the wound.

Problems after surgery to remove one testicle

Most people who have testicular cancer have cancer in one testicle. You have surgery to remove the testicle.

You will have some soreness and bruising for a couple of weeks after your operation. 

Your sex life

Having one testicle removed won’t affect your ability to get an erection. The remaining testicle usually makes more testosterone  and sperm. This makes up for the removed testicle. 

You can usually start having sex about 2 to 3 weeks after surgery and the wound has healed. But for some people, it may be longer. You might feel less like having sex for a while after your treatment. Side effects like feeling tired or feeling sick can also lower your sex drive.

Fertility after surgery

For most people, this surgery won’t affect their fertility . But for some, the remaining testicle might not work so well. This could reduce your fertility.

Your surgeon will talk to you about collecting and storing sperm (sperm banking) before you start treatment. This is a way of storing your sperm for use in later fertility treatment. 

Problems after surgery to remove both testicles

It isn't common to have testicular cancer in both testicles. If you do have cancer in both testicles you need surgery to remove them both.

The testicles produce the hormone testosterone. After removal of both testicles, the level of testosterone in the blood falls quickly. This will affect your sex life and your fertility. 

Possible changes to your sex drive and becoming infertile can be difficult to come to terms with. Talking to someone about this could help. This could be a close friend or a professional.

Your sex life

To maintain your sex drive and be able to get an erection you would need testosterone replacement therapy.

Testosterone can be replaced by:

• injections into a muscle
• gel that you rub onto your skin
• skin patches 

Your doctor will give you more information on how these are given and how often. 

Fertility

After surgery to remove both testicles, you won't be able to have children. Your surgeon will talk to you about sperm banking before surgery.

Problems after surgery to remove lymph nodes (retroperitoneal lymph node dissection)

You might need this surgery to remove lymph glands at the back of your tummy (abdomen). This operation is called a retroperitoneal lymph node dissection (RPLND). It is a large operation.

The operation can damage nerves that control the release of sperm (ejaculation). This could affect your sex life and your ability to have children in the future. 

Your sex life

You can still get an erection and have an orgasm. But a side effect of this surgery is dry ejaculation.

The surgery can make you ejaculate backwards. This is called retrograde ejaculation. Your semen and sperm go back into your bladder instead of coming out of your penis.

Fertility

If you have retrograde ejaculation you won't be able to make someone pregnant by having sexual intercourse. But it may be possible to take sperm from your testicles. Or your surgeon might be able to take sperm from urine after masturbation. The fertility doctor can then use your sperm to fertilise your partner with fertility treatment. 

Before the operation, your surgeon will give you more information and talk to you about storing sperm.

Damage to other organs in your tummy (abdomen)

This is a large operation. So there is a risk that the surgery might damage other organs inside your tummy. This includes damage to the small bowel, kidneys, or the tubes that drain urine (ureters). 

Your surgeon will explain the possible risks before your surgery. They usually identify and repair these problems during your operation. 

Leaks

There are lymphatic vessels in your tummy. These are part of the lymphatic system . These vessels drain fluid from the small bowel. The fluid is called chyle. 

The lymphatic vessels can leak chyle after your operation. But this is not very common. When chyle leaks into the abdomen it is called chylus ascites. 

You might not need any treatment for a small leak. But a larger leak can make you unwell. Your surgeon will give you more information if treatment is needed. You might also have a low fat diet for a few weeks afterwards. This lowers how much chyle your body makes. 

Coping

After surgery, it can be difficult to come to terms with your cancer diagnosis and the changes you have to make. You may need a lot of support from your doctors and nurses, family and friends.

It might be helpful to talk to someone close to you about how you feel.