Epididymectomy

Epididemectomy is an operation to remove the epididymis. It is carried out mainly on serious indications, conditioned by specific factors. Often during the operation, generalization of the inflammatory process is detected, in which the pathology extends to the testicles. Then not only the appendage is removed, but also the testicle. At the same time, you should not remove more than 2 cm in diameter, otherwise there is a risk of developing necrosis of the testicle. Also during the operation part of the spermatic cord is removed.

Often, the operation is performed with the progression of tuberculosis infection. In this case, to prevent the spread of the pathological process, the intersection and dressing of certain parts of the vas deferens healthy side.

[1], [2], [3],

Indications for the procedure

The operation is performed if intensive infectious and inflammatory processes develop, with pronounced pain, frequent relapses occur. It is also recommended in case of transition of epididymitis into a chronic form. The operation is performed in chronic epididymitis with the formation of non-absorbable infiltrates. Tuberculosis infection affecting the appendages, the formation of infiltrates that can not be resorbed - direct indications for the operation.

Many experts believe that in the absence of the effect of treatment, in any case, you need to resort to removal and not delay the process, otherwise you can only aggravate the situation. Any slightest signs of generalization of the infectious and inflammatory process, the nucleation of necrotic sites, abscesses, any damage to cellular elements that do not pass for a long time, serve as an excuse for carrying out the operation urgently. The operation is also performed with acute epididymitis, if there is a risk of developing necrotic orchitis.

[4], [5], [6]

Preparation

Preoperative preparation is simple, no different from preparing for other operations. During the planned operation, a preliminary examination is carried out, during which the obligatory consultation of the andrologist is carried out, including a survey, examination of the patient, palpation of the affected areas. This makes it possible to assess the condition of the epididymis, the spermatic cord, the degree of its involvement in the pathological process. The doctor should carefully evaluate the complaints, the results of an objective examination, to study the medical history, on the basis of which the conclusion is made about the expediency of the operation and the presence of indications.

Then they assign the necessary laboratory and instrumental studies. The most significant are the blood test: general, biochemical. You may need a blood test for sugar, for blood clotting. Be sure to take a smear. Examined from the urethra.

From instrumental studies, scrotal ultrasound, dopplerography, and other studies are prescribed. If there is a suspicion of developing a malignant neoplasm, it is advisable to conduct a biopsy, during which the biological material is taken for histological examination.

It is important that in the presence of tuberculosis infection, a month before the operation, tuberculosis is treated with chemotherapeutic methods. If the operation is emergency, all necessary measures are carried out in the hospital, a few days before the operation.

On the day of surgery, you should not eat, at least 6 hours before surgery. Hair in the groin area is shaved, including in the abdomen. If the patient for any reason can not perform the procedure, there is a pain syndrome, or the risk of damage to the affected area, manipulation is performed by medical personnel.

Anesthesia is also selected in advance. For this, an anesthesiologist must be consulted. The doctor can prescribe additional studies that will help determine and roughly predict the course of the operation and the impact of anesthesia. Blood tests, urine tests, syphilis, HIV, hepatitis, and other infectious diseases may be required. As with any operation performed under general anesthesia, electrocardiography and radiography are prescribed.

[7], [8], [9]

Technique of the epididymectomy

There are many different techniques and methods of conducting an operation. Choose the most appropriate option, based on many factors.

The most commonly used technique is subcapsular epididymectomy by A.V. Vasilyev. In accordance with this method, local infiltration anesthesia is used, during which 0.25% or 0.5% solution of novocaine. Particular attention during surgical manipulation, it is necessary to give anesthesia of the spermatic cord. Many techniques are suitable here, but the technique is considered optimal if it is necessary to completely block the seed cord. First, the skin and testicles are cut in longitudinal section. It originates in the root of the scrotum. The length of the incision is on average 5-7 cm. Then the spermatic duct is separated, wound on a special rubber holder. On the other hand, a careful longitudinal dissection of the vaginal membrane is performed, as a result of which it becomes possible to bring the testicle into the wound. This makes it possible to release the appendage. Sometimes there are spikes located in the interlaminate zone in the vaginal sheath of the testicle. If found, disconnect them.

Then, using a thin needle, the head and body of the appendage are treated with a solution of novocaine, or another anesthetic. In the area between the appendage and the testicle, a ligament is cut. It is more convenient to use curved scissors. Continue to make short sections, gradually penetrating the head. In the end, you need to get to the area between the appendage and its shell. It is important to do everything slowly and carefully so as not to damage anything. Slowly moving in the direction from the head to the body, the appendage and its shell are turned outward. Then, the tail section is cut off from the testicle itself. Then proceed directly to the separation of the vas deferens, starting from its initial section. In the first place, the vessels that supply the subordinate area are cut off. The subcapsular vessels localized in the epididymis are not affected. Conduct the intersection of the vas deferens in the area of the opening of the vas deferens, having pre-tied with catgut ligatures.

Then the sanation is carried out: the stumps are treated with antiseptic means. Carbolic acid (its solutions) is most often used. After the envelopes in the tail area of the epididymis are completely cut, the tail region and the initial section of the vas deferens should be pulled. The distal end is pulled from the area of the spermatic cord. Then, the subordinate region is sewn to the testicle with catgut sutures. The plate is excised by the Bergman method, or sutured by the Winckelmann method. Then, a rubber graduate is slowly introduced into the zone of the lower corner, which then remains for 24 hours. Produce stitching of the wound surface on the graduate. At the end of the operation, a pressure bandage is necessarily applied, the scrotum is lifted.

Contraindications to the procedure

The operation is contraindicated in the presence of severe somatic diseases, especially if they occur in severe form. It is impossible to carry out the operation in the event that the myocardial infarction was recently transferred, a stroke. The presence of acute and other infections, can also be one of the contraindications. Also do not spend at presence of a diabetes in a serious stage and infringement of coagulability of a blood. Quite often, the operation is carried out for emergency indications, so the doctor evaluates the significance of each contraindication and the degree of risk that it carries for the patient on the spot.

[10], [11]

Consequences after the procedure

After surgery, soft tissues can swell, hyperemia may appear. There may be bruising. Sometimes there is a slight bleeding, there are bruises. Usually these symptoms disappear after a while without additional intervention. But in some cases, it may be necessary to open the seams. This occurs only in the case of rapid edema and enlargement of the scrotum in size. Often the outcomes are favorable, especially when performing a one-way operation.

[12], [13], [14]

Complications after the procedure

One of the main complications is the formation of hematomas and their suppuration. A purulent-inflammatory process can develop in the scrotum. In order to prevent this, it is necessary to provide complete hemostasis during the operation and to drain the wound well.

[15], [16]

Care after the procedure

In the postoperative period, antibiotics are prescribed. The average duration is a week. When tuberculosis is detected, a course of antituberculous therapy is conducted. When an oncological process is detected during surgery, chemotherapy is performed. Depending on the type of threads used, the seams dissolve independently, or they are removed after 7-10 days.

If necessary, prescribe analgesics, analgesics, anti-inflammatory drugs. Appropriate symptomatic therapy is performed. The time of hospitalization is determined by the patient's condition, his state of health, the state of postoperative sutures, and the wound surface. After discharge, individual restorative therapy is recommended. During recovery, sex life and heavy physical activity are prohibited.

[17]

Reviews

If you analyze reviews, the first thing that catches your eye is that there are very few of them. Those who have undergone surgery, try not to discuss, do not express their opinion. The reviews relate to what patients feel when they are preparing for surgery. Definitely, such manipulation is a serious mental trauma for a man. Not everyone does not dare. Basically, those who underwent surgery underwent it on emergency indications.

For the planned conduct, it is necessary to decide on carrying out such an operation. Men ask for an opinion on this operation in other patients who have had to deal with a similar problem, ask questions to doctors. In general, men seek to obtain comprehensive information about the operation: about all the advantages, disadvantages, deprivations. Interested in the consequences and possible complications.

It is also interesting that men view this operation exclusively as an extreme, emergency option in case of ineffectiveness of drug therapy. Are ready to try any means, to suffer discomfort, but time of operation try to delay as much as possible. Begin to consider the possibility of performing an operation with the progression of the disease, at more severe stages. They are solved only after long years of suffering with severe symptoms, and also if, despite long-term treatment, the sensation of the inflammatory process remains, as well as acute burning and pain in the scrotum and further spread throughout the body.

According to practicing urological surgeons, epididymectomy is fraught with the cessation of spermogenesis only. There are almost no other organic and functional disorders after the operation. Despite the prejudices and other myths that have enveloped this operation, it is carried out quite often and in most cases, effectively. Allows you to solve problems radically. On the quality of life in the future does not affect. You can have sex, an man also gets an orgasm. Also, the operation has no effect on the libido, hormonal background, erection.