Testicular Lesion Excision
Also known as: testicular mass excision, removal of a lump or abnormal tissue from the testicle
Excision of a testicular lesion involves surgically removing abnormal tissue from the testicle. This procedure is often necessary for diagnosing and treating masses that could be benign or cancerous.
Understanding testicular lesions
Testicular lesions are abnormal areas or lumps that can form in the testicles. Most of these are benign (non-cancerous), and many are found by accident during an ultrasound, especially when men are being checked for infertility. Ultrasound is a highly effective tool that can detect even tiny lumps, typically less than 1 cm in diameter, and many of these turn out to be harmless cysts.
However, certain factors can increase the likelihood of a lesion being cancerous, such as its larger size or the person’s age. Testicular cancer is one of the most common cancers in young men, so early detection is critical. Catching it early leads to better outcomes and more effective treatment.
During surgery, doctors often use a technique called a frozen section examination, where a small piece of tissue is tested immediately. This method is highly accurate, with an accuracy rate of over 93%, and helps doctors determine whether the lesion is cancerous or not, allowing them to choose the most suitable treatment during the same surgery.
Not all testicular lesions require immediate removal. If a lump is benign, your doctor might recommend regular ultrasound monitoring instead of surgery. But knowing what the lump is and catching anything serious early can make a big difference in your health and recovery.
When is surgery needed?
Surgery to remove a testicular lump, called an excision, may be recommended for several reasons. Testicular cancer usually shows up as a firm lump on one side and is sometimes found by chance. If you feel a lump or something unusual in your scrotum, contact your GP as soon as possible.
If cancer is suspected, the standard treatment is a radical orchidectomy, which means removing the whole testicle. But not all lumps are cancer. Other conditions, such as hydroceles (fluid-filled sacs), painful cysts, or sperm granulomas (small lumps caused by inflammation), can also necessitate surgery.
Some known risk factors for testicular cancer include:
- HPV or HIV infections
- A family history of testicular cancer
- Undescended testicles
- Previous testicular cancer
Doctors use blood tests to check for tumour markers, such as AFP, β-hCG, and LDH, which can help confirm whether a lump might be cancerous. Ultrasound scans are also key to seeing what’s going on inside the testicle.
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Ways to payBefore surgery
Initial consultation
Before the operation, you will have a consultation with a urologist who will conduct a thorough examination and determine the best approach. You may be asked to undergo blood tests to check your general health, including kidney and liver function, and to rule out conditions such as anaemia. If cancer is suspected, specific tumour marker tests will also be arranged. Depending on the results of the ultrasound, further imaging, such as a CT scan, may be recommended to obtain a more comprehensive picture of your condition.
Pre-surgery preparation
In preparation for surgery, you’ll be given specific instructions about eating and drinking. Typically, you’ll need to stop eating several hours before the procedure, and only clear liquids may be allowed for a short time afterwards. You may also be advised to shower with an antiseptic wash and avoid shaving the surgical area yourself. Your healthcare team will review your medications and inform you if any should be paused before surgery. You’ll also have the opportunity to ask questions and will be required to sign a consent form. These steps help ensure your safety and reduce the risk of complications during and after the procedure.
During surgery
The main goal of the operation is to remove the abnormal tissue while preserving as much of the healthy testicle as possible. The surgeon will make a small incision in the skin near the testicle, through which the lump or part of the tissue is removed. The incision is then closed with dissolvable stitches. The length of the procedure can vary depending on the depth and complexity of the lesion.
The surgeon will carefully assess the lesion and surrounding tissue to ensure the complete removal of any abnormal growths while minimising unnecessary damage to healthy tissue. In many cases, a frozen section test will be performed during the operation to determine whether the lesion is benign or cancerous, which helps guide further treatment immediately.
After surgery
After the procedure, proper care of the surgical area is essential for a smooth recovery. Swelling and bruising are common in the first few days but tend to settle quickly. You will usually be allowed to shower 24 hours after surgery, although you should avoid soaking in a bath until the incision is fully healed. The stitches used are typically dissolvable and will disappear on their own within 2-3 weeks.
To help manage swelling, gently apply ice packs to the area for short periods during the first day or two. It’s also a good idea to be aware of constipation, which can be caused by pain medications or the effects of anaesthesia. Staying hydrated and eating high-fibre foods can help prevent this issue. You should not drive or operate machinery for at least 24 hours after your operation.
To avoid straining the surgical site, you should limit lifting to about 10 pounds and refrain from intense physical activity for 4-6 weeks after the operation. Your surgeon will give you personalised advice based on your recovery progress.
Long-term recovery
In the weeks after surgery, you’ll have follow-up appointments to check on your healing and make sure there are no signs of the lesion returning. These visits typically take place 2-4 weeks after the operation and may continue for some time, especially if there was concern about cancer.
It’s also essential to prioritise your emotional well-being. Some men feel anxiety about their health or fear that the lesion might come back, even if the surgery was successful. Talking to your doctor, a counsellor, or support groups can be very helpful in managing these feelings.
Risks and complications
As with any surgery, there are potential risks and side effects to consider. These may include infection, especially if the wound is not kept clean, and some bleeding after the operation. Scarring is usually minimal, but can occur due to the thin skin around the scrotum. Other common side effects include temporary swelling, inflammation, and mild discomfort, which usually resolve with time and proper care.
Although uncommon, more serious complications can happen. These may include damage to nearby veins or tissue, or in rare cases, reduced fertility if the remaining testicle is affected. It’s essential to discuss these possibilities with your surgeon before the operation, so you are fully informed and prepared.
Appointment and Treatment Plan
Initial Consultation
You’ll meet with a urologist to discuss any symptoms and undergo a physical exam and ultrasound to confirm the presence of the lesion. Your doctor will explain whether surgery is recommended and go over the available treatment options.
Pre-Surgery Preparation
Before the operation, you’ll receive instructions about fasting and may need to temporarily discontinue certain medications. A short pre-operative assessment will evaluate your overall health, and you’ll need to arrange transportation, as you’ll not be able to drive yourself home after the procedure.
Day of Surgery
The procedure is typically performed under general anaesthesia. A small incision is made in the scrotum or groin area, the lesion is carefully removed, and dissolvable stitches are used to close the wound. You’ll be monitored as you wake up from anaesthesia.
Right After Surgery
After the procedure, it’s normal to have some mild pain, swelling, or bruising in the area. You’ll be given clear home care instructions, including how to manage discomfort and protect the incision. Most patients are allowed to go home the same day.
Recovery at Home
Plan to rest for a few days following surgery. Avoid lifting heavy items or doing strenuous activities. Wearing supportive underwear can help reduce swelling and discomfort. Most people feel well enough to return to normal daily activities within one to two weeks.
Follow-Up Appointment
You’ll have a follow-up appointment within 1-2 weeks after surgery. This visit allows your doctor to check that the area is healing correctly and to address any symptoms, questions, or concerns you may have.
Long-Term Outlook
Most people recover completely after testicular lesion removal, with no long-term complications. Recurrence is rare, and fertility and hormone levels are typically unaffected. Regular check-ups may be recommended if the lesion has any concerning features.
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FAQs
Common symptoms of testicular lesions include the presence of lumps, swelling, and discomfort in the testicles. It is essential to seek medical attention if these symptoms arise.
You should see a doctor immediately if you notice a lump inside the scrotum, as prompt evaluation is essential for proper diagnosis and treatment.
The primary risk factors for testicular cancer include a family history of the disease, undescended testis, previous instances of testicular cancer, and infections such as HPV and HIV. These factors significantly increase the likelihood of developing this type of cancer.
During pre-surgical preparation, you can expect to follow dietary restrictions, undergo general and specific blood tests, and possibly imaging tests such as ultrasounds or CT scans. These steps are essential to ensure a safe and successful surgery.
Potential complications of the surgical procedure include infection, bleeding, scarring, and, in rare instances, infertility. It is essential to discuss these risks with your healthcare provider.