Testicular resection

Urological surgery aimed at removing damaged tissues and structures of the testicle is resection. Let's consider the indications for its implementation, types, complications.

Diseases of the genitourinary system in men occur at any age. At the same time, cases of congenital defects have become more frequent - pathologies in the formation of the genitals (testicles, scrotum, penis) and disruption of their functioning. This leads to serious complications, the only way to treat which is surgical intervention.

Testicular resection is an organ-preserving operation that involves wedge-shaped excision of the affected part of the organ. It is performed in cases of traumatic injuries, tumors, and other painful conditions. A more radical method of treatment is orchiectomy, that is, removal of male organs. Such an operation is performed only if there are strict indications, since the testicles provide the male body with spermatozoa necessary for conceiving a child.

The main types of orchiectomy:

• Simple orchiectomy is the removal of part of the spermatic cord and testicle.
• Subcapsular – excision of glandular tissue.
• Radical – complete removal of the testicle and spermatic cord.
• Hemicastration is the removal of one testicle.
• Castration is a bilateral removal of organs (risks infertility and endocrine disorders).

The operation is not technically complicated and is performed in a hospital setting of the urology department. The procedure is performed under general anesthesia and does not take much time. The rehabilitation period lasts for 1-3 weeks.

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Indications for the procedure

Male testicles perform important hormonal and reproductive functions, but are not considered life-support organs. Their surgical treatment is dangerous due to the risk of endocrine pathologies, decreased sexual desire, and irreversible infertility. The main advantage of resection is the low risk of complications and rapid rehabilitation.

Indications for surgery:

• Severe injuries – detachment of the organ from the spermatic cord.
• Infectious diseases – abscess formation, tuberculous or non-specific orchitis.
• Atrophy - undescended testicle, varicose veins.
• Oncological lesions of the testicle, scrotum, prostate gland.
• Varicocele is swelling of the testicle due to impaired venous outflow. During the operation, the doctor ligates the damaged veins, thereby preserving reproductive functions.
• Epididymis cyst - excision depends on the nature of the cystic formation. There are purulent, serous and hemorrhagic cysts.
• Hydrocele is a drop of the testicular membrane. Serous fluid accumulates between the parietal and visceral layers of the inner membrane of the testis, causing a significant increase in the scrotum.
• Rupture of the protein membrane - occurs due to severe injuries. The site of the rupture is sutured with absorbable material, which minimizes the formation of scar tissue.
• Cancer - the oncological process most often affects only one testicle. Chemotherapy and radiation therapy are used for treatment. To prevent relapses, the affected testicle is removed.
• Testicular torsion – most often occurs due to trauma and is accompanied by a long-term disruption of blood supply. Due to torsion, the inflow of arterial blood and the outflow of venous blood are disrupted, causing severe pain in the groin.

In addition to the above indications, the operation can be performed on healthy testicles in case of gender reassignment or as a method of contraception.

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Preparation

Before the operation, the patient must undergo a series of diagnostic examinations. First of all, a consultation with an endocrinologist, urologist, hepatologist, oncologist and other specialists is necessary. A few days before the operation, you should stop taking all medications that affect blood clotting.

Preparation for resection consists of:

• General and biochemical blood tests.
• Urine analysis.
• Blood test for tumor markers.
• Blood test for HIV and sexually transmitted infections.
• Cardiogram.
• Coagulogram.
• X-ray of the chest and skeletal system (reveals distant foci of pathology in case of cancer).
• Ultrasound examination of the scrotum and abdominal organs.
• CT and MRI.
• Biopsy of the neoplasm.

If the surgery is performed due to a malignant tumor, preparation for the operation may include a preliminary course of chemotherapy or radiation. This is necessary to reduce the tumor volume and make the surgeon's work easier.

In case of orchiectomy due to gender reassignment, the patient undergoes consultation with an andrologist, urologist, psychiatrist and sexologist. A comprehensive medical report gives the right to perform the operation. In case of bilateral resection, the patient must visit a reproductive specialist to preserve the genetic material.

On the eve of the operation, hygienic procedures are carried out, that is, shaving the hair from the scrotum. You must stop smoking the day before the resection. The last meal should be no later than 6 pm, but you can drink water two hours before the treatment. In the case of acute pathology, when there is no time for examinations and preparation, doctors limit themselves to the minimum for a safe operation. The entire range of tests is carried out after surgery.

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Technique testicular resection

The technique of performing the resection depends on the doctor's indications and the planned volume of the resection. The procedure is performed under general, spinal or local anesthesia. During the resection, the patient lies on his back with his legs apart and the penis fixed to the anterior abdominal wall. The scrotum, that is, the surgical field, is treated with an antiseptic and cut. The tissue incision is performed along the anatomical suture, and it can be up to 10 cm.

• The testicle with the appendage is brought out through the incision and after the spermatic cord is tied, it is removed. If the protein coat is preserved, then only the testicular tissue is removed. From the remaining coat, the doctor forms a formation similar to the anatomical location of the testicle. The tissues are sutured and drainage is installed.
• In case of cystic lesion, the operation can be performed openly or laparoscopically. Puncture is not recommended, as it often causes relapses. In case of open surgery, the doctor makes an incision in the scrotum and excises the damaged tissue, preserving the testicle and its appendage. The tissues are sutured layer by layer, drainage is not installed.
• Another minimally invasive method of removing a cystic neoplasm is sclerotherapy. The surgeon injects a chemical substance into the cavity, causing tissue to "stick together". The main disadvantage of this method is complications with the spermatic cord. Its sclerotherapy leads to persistent infertility.
• If the indication for surgery is cancer, then all scrotal tissue is excised. In case of prostate cancer, the organ is accessed through the groin area. The doctor removes the testicle, appendage, and spermatic cord.

If a testicle was removed during surgery, then prosthetics are used to eliminate the external defect. For this, silicone implants are used that repeat the size and shape of the organ. Prosthetics are possible only after the elimination of inflammatory processes and complete restoration of the body.

Resection of the epididymis

The epididymis is a narrowed channel in the testicle, the main function of which is to conduct spermatozoa. It has three sections: the head, body and tail. Inflammatory processes and mechanical damage lead to disruption of its work.

Resection of the epididymis is performed in the following diseases:

• A cyst is a new growth with serous fluid. It occurs due to dysfunction of the excretory ducts and sperm evacuation. Very often, cysts are formed due to traumatic injuries to the scrotum.
• Epididymitis is an inflammation of the tissues of the appendage. The disease is the body's reaction to the penetration of pathogenic microorganisms. The pathology can occur after hypothermia, with venereal diseases, various injuries, taking medications of certain pharmacological groups. It manifests itself as swelling of the scrotum, high temperature and pain in the groin.
• Cancer is a malignant neoplasm that most often affects the body or tail of the appendage and has a tuberous structure. Its danger lies in metastasis to distant organs. Surgical treatment and radiation therapy of the pelvic lymph nodes are indicated for treatment to prevent relapses.

Resection of the appendage is performed under local anesthesia. The surgeon dissects the scrotum and testicular membranes, brings the testicle into the prepared opening and removes its appendage. The operation is performed as carefully as possible so as not to damage the vessels of the testicle.

After excision, the vas deferens is tied. The epididymis is fixed to the testicle, the wound is sutured and drainage is installed. A pressure bandage is applied, giving the organ an elevated position.

The recovery period lasts 5-7 days. The patient is prescribed antibiotics to prevent postoperative infectious complications. The prognosis is favorable.

Testicular resection in men

There must be serious reasons for testicular resection in men. Surgical treatment requires urgent necessity. Most often, the operation is associated with the following factors:

• Injuries with rupture of the protein membrane.
• Malignant neoplasms, the treatment of which by conservative methods (chemotherapy, radiation therapy) is impossible.
• Epididymal cysts.
• Twisting of the spermatic cord.
• Varicocele.
• Hydrocele.

In addition to the above cases, surgery is performed for gender reassignment and as a radical means of contraception. The operation can be performed in various ways. When choosing a treatment method, the risk of side effects and possible prognosis are taken into account.

Contraindications to the procedure

Resection, like any surgical operation, has contraindications for use:

• Kidney and liver diseases.
• Cardiovascular pathologies, myocardial infarction.
• Severe blood clotting disorders.
• Lung diseases in the decompensation stage.
• Respiratory failure stage 2-3.
• Risk of bleeding.
• Infectious and inflammatory diseases.
• Cancerous neoplasms with multiple metastases.

The main contraindication to surgical intervention is the possibility of preserving the organ and the full functioning of the reproductive system.

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Consequences after the procedure

The testicles are the main source of the male hormone testosterone, which is responsible for sexual desire. The postoperative period depends on the indications for the procedure, the type of resection and the individual characteristics of the patient's body.

If the orchiectomy was unilateral, the remaining testicle takes over the functions of hormone production, so the operation does not have a negative impact on erection and sperm production. In case of bilateral surgery, the patient is prescribed hormone replacement therapy. It is necessary to minimize hormonal imbalances.

The most severe consequences after resection:

• Weight gain of 5-10 kg.
• Hair loss on the face and body.
• Specific breast enlargement and soreness.
• Increased weakness and rapid fatigue.
• The appearance of stretch marks on the skin due to a decrease in collagen levels.
• Increased dryness of the skin.
• Irritability and frequent mood swings.
• Decreased libido.

A sharp decrease in testosterone production provokes the development of osteoporosis (a systemic disease of skeletal muscles). Many men face aesthetic and psychological problems. Very often, surgical intervention leads to depression and despondency. To eliminate this condition, the patient needs the support of loved ones. Implantation is indicated to correct cosmetic inconveniences. The surgeon sews plastic or silicone implants into the scrotum.

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Complications after the procedure

Like any surgery, testicular resection can cause certain complications, let's look at them:

• Painful sensations.
• Heavy bleeding.
• Elevated body temperature.
• Inflammation in the area of the postoperative wound.
• Divergence or weakening of the sutures (possible if bed rest is not observed).
• Long-term swelling due to impaired lymph drainage.
• Allergic reaction to suture material.
• Pathological scarring.
• Recurrence of tumor neoplasms.

The above complications appear during the first days after surgery and require immediate medical attention.

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Care after the procedure

The duration of the recovery period after resection depends on compliance with the doctor's recommendations for care. Let's consider the basic postoperative rules that should be followed for 2-3 weeks:

• Taking antibacterial and pain-relieving drugs.
• Refusal of physical activity.
• Wearing a special bandage for two weeks.
• Avoid sitz baths and hot showers.
• Abstinence from sexual intercourse.
• Drinking plenty of fluids.
• Dietary balanced nutrition.
• Applying an ice pack to prevent swelling.

During the entire rehabilitation period, it is necessary to treat the wound surface daily with antiseptic solutions and apply dressings. After a week, the stitches are removed, but pain in the perineum may persist until complete recovery.

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Reviews

Testicular resection has different reviews from patients. With unilateral treatment, the patient's condition quickly returns to normal, and hormonal changes are minimal. With lateral orchiectomy, a number of serious complications may arise that aggravate the postoperative period and require additional treatment. But timely and successful surgery allows you to cure the disease, and in malignant neoplasms increases life expectancy.