Surgery to remove dropsy of the testicle

Dropsy (hydrocele) of the testicle - the internal genital organ of a man is congenital, in rare cases acquired. It is an accumulation of serous fluid between the membranes of the testicle, which leads to its enlargement. Identifying  dropsy in a newborn  does not require a quick response, since it usually disappears by the end of the first year of life. Sometimes it is necessary to remove it in both children and adults.

Hydrocele is the most common benign scrotal edema, estimated in 1% of the adult male population. [1]There is controversy over the treatment of primary hydrocele. Aspiration and sclerotherapy are described; however, hydrocelectomy or hydrocelectomy remains the treatment of choice for hydrocele. [2]

Indications for the procedure

When a hydrocele occurs due to trauma of the perineum and scrotum, an inflammatory disease of its organs, impaired lymphatic outflow, testicular torsion, conservative treatment is initially resorted to to eliminate the cause. The fluid from the testicle is removed by puncture, and sclerosing drugs are injected inside. Often it ends with infection, complications.

Indications for surgical removal of dropsy of the testicle are the following symptoms:

• acute pain in the scrotum;
• her redness;
• swelling of the genitals;
• pathological organ dysfunction.

Preparation

The operation is always preceded by a preparation period, which consists in a comprehensive examination of the patient. The urologist conducts an initial tactile examination, will give a referral for an outpatient examination, which consists in passing a blood test,  ultrasound of the inguinal canals and organs of the scrotum ,  [3]diaphanoscopy - transillumination of the testicles.

This is necessary to assess the scale of surgery, to establish the volume of accumulated fluid. When pathologies that provoked dropsy are detected, therapeutic actions are primarily directed at them.

Technique of the removal of dropsy testicle

There are several techniques for performing hydrocephalous testicular surgery in men, named after the surgeons who proposed them. There is no fundamental difference between them, but they differ in the plastic of the testicle membrane.

Surgical  intervention according to Bergman  involves the removal of some part of it after the release of the aqueous humor; Winkelmann's operation involves dissection, turning inside out, and suture behind the testicle. Lord proposed a less traumatic intervention - corrugation. [4]

What technique is rational to apply depends on the size of the dropsy, its old age.

Minimal access [5]hydrocelectomy is performed by fenestration of the membrane and by pulling to remove large sacs of hydrocele through a small incision and with minimal incision. The hydrocele sac is treated through a smaller incision in the skin of the scrotum along with excision of the smaller disc of the hydrocele sac. Minimal access hydrocelectomy provides better surgical outcomes for scrotal edema and scrotal thickening and patient satisfaction than traditional eversion excisional hydrocelectomy. 

Laser therapy is an innovative and effective way of treating pathology. It provides minimal tissue trauma, absence of blood loss, painlessness (performed under local anesthesia), speed of the operation, absence of scars, and a short rehabilitation period. [6]

Removal of dropsy testicle in a child

The procedure for removing dropsy in a child is usually not carried out earlier than 1.5-2 years, since it itself may disappear. The type of operation is selected based on the characteristics of the disease. So, with communicating dropsy (not overgrown vaginal process of the peritoneum), the Ross method is used - the inner inguinal ring of the process is excised and tied, and a space is formed in the testicular membranes. [7]

This procedure involves a small incision in the groin. Sometimes laparoscopy is used for its implementation, but it has more postoperative complications, therefore it is not very popular.

Earlier this age, surgery is resorted to if dropsy is combined with an inguinal hernia, increases and delivers unpleasant sensations, an infection joins it. After 10 years, the same techniques are used as for adults. [8]

Contraindications to the procedure

Removal of dropsy of the testicle is contraindicated in acute inflammatory process of the genitourinary system, purulent abscesses, violation of the surface integrity of the tissues of the scrotum, untreated diagnoses that caused its occurrence.

Consequences after the procedure

After removing dropsy for quite a long time, up to a year, unpleasant painful sensations can be observed at the site of the incision. There may be postoperative discomfort, temporary limitation of normal activities, and complications. This is due to entrapment of tissues or nerve endings in the scar. [9]

Complications after the procedure

According to statistics, complications after the procedure occur in 2-8% of cases: hematoma, infection, persistent edema, chronic pain and decreased fertility. There are relapses, there is a small risk of infertility (5%). The most dangerous is impaired blood circulation in the testicle, which can lead to its atrophy. [10]

Care after the procedure

On the first day after the operation, the patient is given an anesthetic drug; in the next few days, a laxative may be needed so as not to strain during emptying.

After removing dropsy, testicles should not be squeezed, wearing tight underwear. Adults are not recommended to engage in hard physical labor and sex for 2 weeks, children are given a month's exemption from physical education.

Reviews

Parents of boys, faced with this problem, and adult men understand that an operation to remove dropsy is the only way to get rid of it, to find a normal life, including a full sexual life, to have children.

The reviews emphasize that people carefully choose medical institutions for the procedure and well-proven specialists, since there is an Internet where you can get acquainted with various opinions.