pre-surgery

On Friday, May 17, 2024 I went to one of the hospitals in the area recommended to me by my urologist as having one of the best urology departments in the country. This was just 2 days removed my first consultation with the urologist and MRT scan - as mentioned, things were moving at lightning pace.

I was seen fairly quickly, and after a short check-up (examination of my "guys", an ultrasound, blood sampling) to confirm the diagnosis, we began to discuss what would come next and the decisions that I needed to make:

SURGERY Let's work backwards - I was scheduled in for surgery 10 days out. Fast, but I had read online about guys who had gotten their surgery within a few days of diagnosis. Everyone in the surgery queue had cancer too though, so there was no skipping ahead. The most surprising thing I learned about surgery was from where and how they remove the tumor / testicle. The first thing to know is that they remove the entire testicle, to be safe. This part wasn't such a surprise, but rather about how invasive the surgery itself is. You would think that, as the testicles are amongst the only organs sitting "outside" the body (by way of their home in the scrotum), they'd simply make an incision in the scrotum and pop the sucker out. Not so! The "inguinal orchiectomy" to remove the testicle involves making an incision in the area just below/inside the hip - sort of at the upper corner of where pubic hair grows (sorry for the graphic explanation, hard to explain the area otherwise). The testicles originally descended from your back when you were an embryo, so the idea is to find the pathway and effectively pull the testicle up and out. This is apparently the safer way to go, with lower risk of leaving behind or cross-contaminating your scrotum with cancer cells.

I was furthermore explained that the surgery should not result in any kind of long-term effects in terms on fertility, hormone production, etc. The testicles are like your kidneys - you have 2 only for redundancy, 1 alone is enough to produce what the body needs.

The surgery itself wouldn't take more than an hour, but I was told to plan on staying overnight for observation, and that I definitely couldn't drive myself home (or drive at all for a few days). I was also told not to eat anything on the day of surgery, and to limit my liquid consumption to a little water / tea - in case I had a bad reaction to the anesthesia to avoid vomiting. Which segways nicely to...

ANESTHESIA

I also learned that I would be placed under general anesthetic, something I had never experienced before. This involved a short pre-consultation with an anesthesiologist so they could decide which drugs and how much to give me. Tip for anyone receiving general anesthetic - do not hold back on the details with the anesthesiologist - screwing up the dosage might be more dangerous than the surgery itself, so err on the side of caution and tell the anesthesiologist everything that might affect what they give you (allergies, lifestyle, bad habits etc.). Many doctors/nurses in my personal network told me this.

PROSTHETIC

One of the more important decisions to be handled pre-surgery was the offer to get a fake replacement testicle inserted during the surgery. I have to say, this might have been one of the most funny / surreal parts of the whole process. The nice doctor who walked me through the pre-surgery consultation brought out a keyring of different sized silicon rubber testicles (I was allowed to squeeze them for effect!), suggesting that based on her examination of me earlier I was a medium or large, but probably large. While flattered, I ended up turning down the prosthetic nut. As you can imagine, the decision is based purely on aesthetics and "confidence", and I decided that it wasn't worth the (extremely minor) risk that my body rejected the fake testicle.

SPERM BANKING

I was also strongly advised to make an appointment with the local sperm bank. While remaining perfectly fertile after surgery is the expectation, at this stage it's out of an abundance of caution that they recommend making a deposit. There is an outside chance the body somehow doesn't react well to the surgery, or in a worst case the surgeon might see something during surgery they don't like, and take the other testicle then and there. This is a very minor chance, but of course if it happens, the opportunity to have biological children is fully lost. Getting an appointment on short notice with the fertility clinics may not be an easy one, but at least in my experience telling them the seriousness of the reason why I needed the appointment (i.e. the "C bomb") resulted in them doing everything in their power to fit me in. I was also advised not to ejaculate within a certain window (I believe it was 3 days) prior to the appointment to give the best chance of having a voluminous (but also fresh) sample. Time to practice a little self control!

The visit to the sperm bank was another of those very surreal experiences during this process. But this one was pretty much as expected and as it looks in the movies. Sad looking room lit by fluorescent lighting, cup for the deposit, porno mags on the table. Handing over the cup to the female attendant afterwards was a bit awkward, but otherwise a straightforward process and job done.

If you find yourself in this situation, I highly recommend you make a trip to the sperm bank before surgery, even if you don't plan on having kids. Your thinking could change, and it's good to have the option open. Also, in my case insurance paid for the appointment and storage because of the cancer diagnosis - so definitely worth checking if costs are covered.

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Those were the main components of the process pre-surgery. I was able to live a very normal life in those 10 days, and actually the blessing of the surgery date being a little later than expected was that pre-surgery I got to fly to London to see Arsenal's last game of the season (where sadly they didn't get the miracle needed to win the Premier League title) and go to Sicily for the wedding of one of my best friends. An epic final few days on planet earth for my right testicle!