Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
Send us all your questions or requests, and our expert team will assist you.
The foundational step in treatment is Radical Inguinal Orchiectomy. This procedure involves removing the affected testicle and spermatic cord through an incision in the groin (inguinal canal), rather than the scrotum. This approach respects the embryological lymphatic drainage planes, preventing aberrant spread of tumor cells. Surgical precision is paramount to ensure the cord is ligated high at the internal inguinal ring, removing all potential lymphatic channels that could harbor cancer cells.
For patients with small, non-palpable masses or benign findings, testis-sparing surgery (partial orchiectomy) may be considered. This requires intraoperative ultrasound guidance and frozen section analysis to ensure negative margins. This approach preserves hormonal function and fertility but is reserved for carefully selected cases in specialized centers.
For non-seminomatous tumors with residual masses or high risk of recurrence, Retroperitoneal Lymph Node Dissection (RPLND) is performed. This complex surgery involves removing the lymphatic tissue around the aorta and vena cava. The modern standard is the “nerve-sparing” RPLND. The sympathetic nerve fibers responsible for seminal emission run alongside these vessels. Damage to these nerves results in retrograde ejaculation (dry orgasm).
Robotic-assisted RPLND has emerged as a minimally invasive alternative to open surgery. The robotic platform provides magnified 3D visualization and dexterity, enabling surgeons to meticulously dissect lymph nodes while preserving delicate postganglionic sympathetic nerve fibers. This significantly reduces blood loss, hospital stay, and recovery time, while maintaining oncological equivalence to open surgery in experienced hands.
Chemotherapy is the cornerstone of treatment for metastatic disease. The standard regimen is BEP (Bleomycin, Etoposide, Cisplatin). Cisplatin is a platinum-based agent that cross-links DNA, triggering apoptosis in rapidly dividing germ cells. This regimen is remarkably effective, curing the vast majority of patients. However, the cellular toxicity is systemic.
Bleomycin can cause pulmonary fibrosis by generating free radicals in the lung tissue. Cisplatin is nephrotoxic and ototoxic (damaging hearing). Etoposide carries a small risk of secondary leukemia. Modern care protocols involve strict monitoring of lung and kidney function. Biotechnological advancements are exploring targeted therapies that might replace these cytotoxic agents in cases of resistance, reducing systemic collateral damage. High-dose chemotherapy with autologous stem cell transplant is utilized for relapsed disease, leveraging the principles of bone marrow regeneration to support aggressive treatment.
Radiotherapy is primarily used for seminomas, which are exquisitely sensitive to ionizing radiation. The energy beams damage tumor cells’ DNA, preventing replication. Modern techniques like Intensity Modulated Radiation Therapy (IMRT) allow for the precise shaping of the radiation field to match the lymph nodes, sparing surrounding organs like the kidneys and bowel. Proton beam therapy is also being investigated to reduce the exit dose of radiation further, minimizing long-term risks of secondary malignancies in young survivors.
Preserving reproductive potential is a critical component of care. Sperm banking (cryopreservation) is offered before any chemotherapy, radiation, or RPLND. Chemotherapy targets rapidly dividing cells, and the spermatogonial stem cells are highly susceptible. While spermatogenesis often recovers, there is a risk of permanent azoospermia.
For patients with bilateral cancer or those requiring bilateral orchiectomy, testosterone replacement therapy is initiated to maintain physiological function. Research into testicular tissue banking for prepubertal boys is an active area of regenerative medicine, with the goal of re-implanting stem cells later in life to restore natural fertility.
Send us all your questions or requests, and our expert team will assist you.
Robotic RPLND uses small incisions and high-definition cameras. This allows the surgeon to see the nerves and blood vessels much better than in open surgery. Patients typically have less pain, less blood loss, a shorter hospital stay (often 1-2 days versus 5-7 days), and a faster return to normal activities, with similar cancer cure rates.
Chemotherapy attacks rapidly dividing cells, including sperm producing cells. While many men recover sperm production 1 to 2 years after treatment, there is a risk of permanent infertility, especially with higher doses or certain drugs. This is why sperm banking before starting treatment is strongly recommended for all patients.
For stage I cancer (confined to the testicle), the risk of recurrence after surgery is relatively low (15-30%, depending on type). Instead of giving everyone chemotherapy or radiation (which would overtreat the majority), doctors closely monitor the patient with CT scans and blood tests. Treatment is started only if the cancer comes back. This spares many men from side effects.
Usually, no. A single healthy testicle produces enough testosterone and sperm to maintain normal masculinity, libido, sexual function, and fertility. The remaining testicle often undergoes compensatory growth. However, if the remaining testicle is small or unhealthy, testosterone replacement may be needed.
A testicular prosthesis is a saline-filled silicone implant placed in the scrotum to mimic the look and feel of a natural testicle. It can be inserted at the time of cancer surgery or later. It serves a cosmetic and psychological purpose, helping to restore body image and confidence after orchiectomy.
Your Comparison List (you must select at least 2 packages)
