Resection of the testis

Urologic surgery aimed at removing affected tissues and testicular structures is a resection. Consider the indications for its conduct, types, complications.

Diseases of the genitourinary sphere in men occur at any age. In this case, cases of congenital defects - pathology in the formation of genital organs (testes, scrotum, penis) and their functioning have increased. This leads to serious complications, the only way to treat them is surgical intervention.

Resection of the testicle is an organ-preserving operation that involves wedge-shaped excision of the affected part of the organ. It is performed with traumatic injuries, tumor formations and other painful conditions. A more radical method of treatment is orchiectomy, that is, the removal of male organs. Such an operation is performed only in the presence of strict indications, as the testes provide the male body with the spermatozoa necessary for the conception of the child.

The main types of orchiectomy:

• Simple orchiectomy - the removal of a part of the spermatic cord and testis (testicle).
• Subcapsular - excision of glandular tissue.
• Radical - complete removal of the testis and spermatic cord.
• Hemikastration - removal of one testicle.
• Castration - bilateral removal of organs (threatens infertility and endocrine disorders).

The operation is not technically complicated and is carried out in the in-patient department of the urological department. The procedure is under general anesthesia and does not take much time. The rehabilitation period lasts for 1-3 weeks.

[1], [2], [3], [4], [5], [6], [7]

Indications for the procedure

Male testicles perform important hormonal and reproductive functions, but do not belong to life support. Their surgical treatment is endangered by the risk of endocrine pathologies, decreased sexual desire, and irreversible infertility. The main advantage of resection is low risk of complications and rapid rehabilitation.

Indication for the operation:

• Severe injuries - detachment of the organ from the spermatic cord.
• Infectious diseases - abscessing, tuberculosis or nonspecific orchitis.
• Atrophy - non-admission testis, varicose veins.
• Oncological lesions of the testicle, scrotum, prostate gland.
• Varikotsele - swelling of the testis due to a violation of venous outflow. During surgery, the doctor bandages the damaged veins, thereby preserving reproductive functions.
• Cyst of the epididymis - excision depends on the nature of cystic education. There are purulent, serous and hemorrhagic cysts.
• The hydrocele is the edema of the testicle. Serous fluid accumulates between the parietal and visceral sheets of the inner skin of the testis, causing a significant increase in the scrotum.
• The rupture of the protein coat - occurs due to severe injuries. To the place of the break, seams are placed from the absorbent material, which minimizes the formation of scar tissue.
• Cancer - an oncological process often affects only one testicle. Chemotherapy and radiation therapy are used for treatment. To prevent recurrence, the affected test is removed.
• Testicular torsion - most often due to injuries and is accompanied by a prolonged violation of blood supply. Because of the twisting, arterial blood flow and venous outflow are disturbed, provoking severe pain in the groin.

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

[8], [9], [10], [11], [12], [13]

Preparation

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

Preparation for resection consists of:

• General and biochemical blood tests.
• Urinalysis.
• Blood test for oncomarkers.
• Blood test for HIV and sexual infections.
• Cardiogram.
• Coagulogram.
• Radiography of the breast and bone system (reveals distant foci of pathology in case of cancer).
• Ultrasound examination of the scrotum and abdominal organs.
• CT and MRI.
• Biopsy of a neoplasm.

If surgical intervention is performed because of a malignant neoplasm, the preparation for surgery may include a preliminary course of chemotherapy or radiation exposure. This is necessary to reduce the volume of the tumor and facilitate the work of the surgeon.

With orchiectomy due to sex change, the patient is consulted by an andrologist, urologist, psychiatrist and sexologist. Comprehensive medical report gives the right to conduct an operation. With bilateral resection, the patient must visit a reproductive health expert to conserve genetic material.

On the eve of the operation, hygienic procedures are carried out, that is, shaving of hair from the scrotum. The day before resection, you must stop smoking. 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 training, doctors are limited to a minimum for a safe operation. The whole complex of tests is performed after surgery.

[14], [15]

Technique of the resection of the testis

From the medical indications and the planned volume of resection, the technique of its carrying out depends. The procedure is performed under general anesthesia, spinal or local anesthesia. During resection, the patient lies on his back with his legs split and fixed to the front wall of the abdomen with a penis. The scrotum, that is, the operating field, is treated with an antiseptic and cut. The tissue cut is performed on an anatomical suture, and it can reach 10 cm.

• Through the incision, an egg with an appendage is removed and, after dressing the spermatic cord, is removed. If the skin is preserved, then only the testicle tissue is removed. From the remaining shell, the doctor forms an education similar to the anatomical location of the testis. Fabrics are sutured and drainage is installed.
• In cystic lesions, the operation can be performed by an open method or laparoscopic. Puncture is not recommended, since it often gives relapses. When the operation is open, the doctor makes an incision in the scrotal area and excludes the damaged tissue, keeping the testicle and its appendage. Sewing of tissues is layer-by-layer, drainage is not established.
• Another minimally invasive method for the removal of cystic neoplasm is sclerotherapy. The surgeon introduces into the cavity a chemical substance that causes the tissues to "stick together". The main disadvantage of this method is complications from the spermatic cord. Its sclerosis leads to persistent infertility.
• If the indication for the operation was cancer, then the excision of all the tissues of the scrotum is performed. In prostate cancer, access to the organ is through the inguinal region. The doctor removes the testis, appendage and spermatic cord.

If the testicle has been removed during surgery, then prosthetics are performed to eliminate the external defect. To do this, use silicone implants that repeat the size and shape of the organ. Prosthesis is possible only after the elimination of inflammatory processes and complete recovery of the body.

Resection of the epididymis

Adherence of the testicle is a narrowed canal in testes, the main function of which is carrying out spermatozoa. It has three divisions: head, body and tail. Inflammatory processes and mechanical damage lead to disruption of its work.

Resection of the epididymis is performed with such diseases:

• The cyst is a tumor with a serous fluid. It arises because of violations of the function of excretory ducts and the evacuation of sperm. Very often, cysts are formed with traumatic damages of the scrotum.
• Epididymitis - inflammation of the epididymis. A painful condition is a reaction of the body to the penetration of pathogens. Pathology can occur after hypothermia, with sexually transmitted diseases, various injuries, taking medications of certain pharmacological groups. It is manifested by swelling of the scrotum, fever and pain in the groin.
• Cancer - malignant neoplasm often affects the body or tail of the appendage, has a tuberous structure. Its danger in metastasizing to distant organs. For treatment, surgical treatment and radiotherapy of pelvic lymph nodes are indicated to prevent relapses.

Resection of the appendage is carried out under local anesthesia. The surgeon dissects the scrotum and the testicles, leads the testicle into the prepared hole and removes its appendage. The operation is carried out as carefully as possible, so as not to damage the testicle vessels.

After excision, the vas deferens are bandaged. The envelope of the appendage is fixed to the testis, the wound is sutured and drainage is put. A pressure bandage is applied, which gives the body an elevated position.

The recovery period lasts 5-7 days. The patient is prescribed antibiotics to prevent postoperative complications of an infectious nature. The forecast is favorable.

Resection of testicles in men

To carry out a testicle resection in men, there must be serious reasons. Surgical treatment requires an urgent need. Most often, the operation is associated with such factors:

• Traumas with rupture of the protein coat.
• Malignant neoplasms, whose treatment with conservative methods (chemotherapy, radiation therapy) is impossible.
• Cysts of the epididymis.
• Twisting the spermatic cord.
• Varikotsele.
• The hydrocele.

In addition to the above cases, surgery is performed with sex change, and also as a radical contraceptive. The operation can be carried out in various ways. When choosing a method of treatment, the risk of side effects and possible prognosis are taken into account.

Contraindications to the procedure

Resection, like any surgical operation, has contraindications to the application:

• Diseases of the kidneys and liver.
• Cardiovascular pathologies, myocardial infarction.
• Severe bleeding disorders.
• Diseases of the lungs in the stage of decompensation.
• Respiratory failure 2-3 stages.
• Risk of bleeding.
• Infectious and inflammatory diseases.
• Cancerous tumors with multiple metastases.

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

[16], [17], [18], [19], [20], [21], [22], [23]

Consequences after the procedure

Eggs are the main source of the male hormone - testosterone, which is responsible for sex drive. The postoperative period depends on the indications for carrying out, the type of resection and individual characteristics of the patient's body.

If the orchiectomy was one-sided, the remaining testicle assumes the functions of producing hormones, so the operation does not impose a negative impact on the erection and the production of spermatozoa. In bilateral surgery, the patient is prescribed hormone replacement therapy. It is necessary to minimize hormonal disorders.

The most severe consequences after resection:

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

A sharp decrease in the production of testosterone 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 depression. To eliminate this condition, the patient needs the support of close people. Implantation is indicated for correction of cosmetic inconveniences. The surgeon stitches into the scrotum plastic or silicone implants.

[24], [25], [26], [27], [28], [29], [30]

Complications after the procedure

Like any operation, resection of the testicle can cause certain complications, consider them:

• Painful sensations.
• Severe bleeding.
• Elevated body temperature.
• Inflammation in the area of a postoperative wound.
• Divergence or loosening of stitches (possible if the bed rest is not respected).
• Prolonged edema due to impaired lymph drainage.
• Allergic reaction to suture material.
• Pathological scarring.
• Relapses of tumor neoplasms.

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

[31], [32], [33], [34], [35], [36]

Care after the procedure

The length of the recovery period after resection depends on compliance with medical care recommendations. Let's consider the basic postoperative rules which should be adhered to within 2-3 weeks:

• Reception of antibacterial and pain medications.
• Refusal of exercise.
• Wearing a special bandage for two weeks.
• Refusal of sitting baths and a hot shower.
• Refusal of sexual contacts.
• Drinking lots of fluids.
• Dietary balanced nutrition.
• Applying a pack of ice to prevent swelling.

During the entire rehabilitation period, it is necessary to treat the wound surface with antiseptic solutions daily and make bandages. A week later, sutures are removed, but tenderness in the perineum can be maintained until complete recovery.

[37], [38], [39], [40]

Reviews

Resection of the testicle has different responses from patients. With one-sided treatment, the patient's condition quickly returns to normal, and hormonal changes are minimal. In lateral orchiectomy, a number of serious complications can occur that aggravate the postoperative period and require additional treatment. But a timely and successfully performed operation allows to cure the disease, and in malignant neoplasms increases life expectancy.