Epididymectomy

Epididymectomy is an operation to remove the appendages of the testicle. It is performed mainly for serious indications caused by specific factors. Often during the operation, generalization of the inflammatory process is detected, in which the pathology spreads to the testicles. Then not only the appendage is removed, but also the testicle. In this case, no more than 2 cm in diameter should be removed, otherwise there is a risk of testicular necrosis. Also, during the operation, part of the spermatic cord is removed.

Often, the operation is performed when tuberculosis infection progresses. In this case, to prevent the spread of the pathological process, certain sections of the vas deferens of the healthy side are cut and bandaged.

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Indications for the procedure

The operation is performed if intense infectious and inflammatory processes develop, with pronounced pain, and frequent relapses. It is also recommended in the case of epididymitis becoming chronic. The operation is performed in the case of chronic epididymitis with the formation of non-resolving infiltrates. Tuberculosis infection affecting the appendages, the formation of infiltrates that are not resorbed are direct indications for the operation.

Many experts believe that if there is no effect from treatment, in any case it is necessary to resort to removal and not to delay the process, otherwise you can only aggravate the situation. Any slightest signs of generalization of the infectious and inflammatory process, the emergence of necrotic areas, abscesses, any damage to cellular elements that do not go away for a long time, serve as a reason for urgent surgery. Also, surgery is performed in acute epididymitis, if there is a risk of developing necrotic orchitis.

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Preparation

Preoperative preparation is simple and does not differ from preparation for other surgeries. During a planned operation, a preliminary examination is carried out, during which a mandatory consultation with an 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 appendage itself, the spermatic cord, the degree of its involvement in the pathological process. The doctor must carefully evaluate the complaints, the results of the objective examination, study the medical history, on the basis of which a conclusion is made about the advisability of the operation and the presence of indications.

Then the necessary laboratory and instrumental studies are prescribed. The most significant are blood tests: general, biochemical. Blood tests for sugar and blood clotting may be required. A smear is taken. The discharge from the urethra is examined.

Instrumental examinations include ultrasound of the scrotum, Dopplerography, and other examinations. If there is a suspicion of the development of a malignant neoplasm, it is advisable to perform a biopsy, during which biological material is taken for histological examination.

It is important that if there is a tuberculosis infection, a month before the operation, tuberculosis treatment is carried out using chemotherapeutic methods. If the operation is urgent, all necessary measures are carried out in the hospital, several days before the operation.

On the day of the operation, you cannot eat for at least 6 hours before the operation. The hair in the groin area is shaved, including the abdominal area. If the patient for some reason cannot perform the procedure, there is pain, or there is a risk of damage to the affected area, the manipulation is performed by medical personnel.

Also, anesthesia is selected in advance. For this, a consultation with an anesthesiologist is necessary. The doctor may prescribe additional studies that will help determine and roughly predict the course of the operation and the effect of anesthesia. Blood and urine tests, tests for syphilis, HIV, hepatitis, and other infectious diseases may be required. As before any operation performed under general anesthesia, electrocardiography and radiography are prescribed.

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Technique epididymectomies

There are many different techniques and methods of performing the operation. The most suitable option is selected based on many factors.

The most commonly used technique is subcapsular epididymectomy according to A.V. Vasiliev. In accordance with this method, local infiltration anesthesia is used, during which 0.25% or 0.5% novocaine solution is used. Particular attention during surgical manipulation should be paid to anesthesia of the spermatic cord. Many techniques are suitable here, but the technique used in cases where it is necessary to completely block the spermatic cord is considered optimal. First, a longitudinal incision is made in the skin and membranes of the testicle. It originates at the root of the scrotum. The length of the incision is on average 5-7 cm. Then the vas deferens is separated and wound on a special rubber holder. On the other hand, a careful longitudinal incision is made in the vaginal membrane, as a result of which it becomes possible to bring the testicle out into the wound. This makes it possible to release the appendage. Sometimes adhesions are found located in the interlaminar zone in the vaginal membrane of the testicle. If detected, they are separated.

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, the ligament is cut. It is more convenient to use curved scissors. Continue making short incisions, gradually penetrating under the head. Ultimately, it is necessary to get to the area between the appendage and its membrane. 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 membrane are everted outward. Then the tail section is cut off from the testicle itself. Then they proceed directly to the separation of the vas deferens, starting from its initial section. First of all, the vessels that supply the appendage area are cut off. The subcapsular vessels localized in the area of the appendage of the testicle are not affected. The vas deferens is transected in the area of the opening of the vas deferens, having been previously tied with catgut ligatures.

Then, sanitation is performed: the stumps are treated with antiseptics. Most often, carbolic acid (its solutions) is used. After the membranes in the tail area of the appendage are completely dissected, it is necessary to pull the tail area and the initial section of the vas deferens. The distal end is pulled out of the spermatic cord area. Then, the appendage area is sutured to the testicle using catgut sutures. The plate is excised using the Bergman method, or sutured using the Winkelman method. Then, a rubber drain is slowly inserted into the lower angle area, which is then left for 24 hours. The wound surface is sutured along the drain. 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 are severe. The operation cannot be performed if a myocardial infarction or stroke has recently been suffered. The presence of acute and other infections may also be one of the contraindications. It is also not performed in the presence of diabetes in a severe stage and blood clotting disorders. Quite often, the operation is performed on emergency indications, so the significance of each contraindication and the degree of risk it poses for the patient are assessed by the doctor on the spot.

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Consequences after the procedure

After the operation, soft tissues may swell, hyperemia may appear. Bruises may appear. Sometimes minor bleeding opens, hematomas appear. Usually, these symptoms disappear completely after some time, without additional intervention. But in some cases, opening of sutures may be required. This occurs only in the case of rapid swelling and increase in the size of the scrotum. Often, the outcomes are favorable, especially when performing a unilateral operation.

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Complications after the procedure

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

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Care after the procedure

Antibiotics are prescribed in the postoperative period. The average duration of their use is a week. If tuberculosis is detected, a course of anti-tuberculosis therapy is administered. If an oncological process is detected during the operation, chemotherapy is administered. Depending on the type of threads used, the sutures dissolve on their own or are removed after 7-10 days.

If necessary, analgesics, painkillers, and anti-inflammatory drugs are prescribed. Appropriate symptomatic therapy is administered. The duration of hospitalization is determined by the patient's condition, well-being, condition of the postoperative sutures, and wound surface. Individual restorative therapy is recommended after discharge. Sexual activity and heavy physical activity are prohibited during recovery.

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Reviews

If you analyze the reviews, the first thing that catches your eye is that there are very few of them. Those who have undergone the operation try not to discuss it, not to express their opinions. The reviews concern what patients feel when preparing for the operation. Definitely, such manipulation is a severe mental trauma for a man. Not everyone dares to do it. Basically, those who underwent the operation underwent it for emergency reasons.

For a planned procedure, you need to decide to have such an operation. Men ask other patients who have had to deal with a similar problem about this operation, ask questions to doctors. Basically, men want to get comprehensive information about the operation: about all the advantages, disadvantages, and deprivations. They are interested in the consequences and possible complications.

It is also interesting that men consider this operation only as an extreme, backup option in case of ineffectiveness of drug therapy. They are ready to try any means, to endure discomfort, but they try to delay the time of the operation as long as possible. They begin to consider the possibility of performing the operation when the disease progresses, at more severe stages. They decide only after many years of suffering from severe symptoms, and also in the case if, despite long-term treatment, the feeling 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 only with the cessation of spermatogenesis. Almost no one experiences other organic and functional disorders after the operation. Despite the prejudices and other myths surrounding this operation, it is performed quite often and, in most cases, effectively. It allows you to radically solve problems. It does not affect the quality of life in the future. You can have sex, and the man also gets an orgasm. Also, the operation does not affect libido, hormonal levels, or erection.