Surgery for testicular hydrocele

Surgery for testicular hydrocele is perhaps the only effective way to treat this disease. Traditional methods are often ineffective. However, they are also used, mainly, in the early stages of the disease, or when it is necessary to postpone surgery, delay and stop the disease.

Indications for the procedure

Hydrocele is also called dropsy of the testicle. This is the main indication for surgery. Hydrocele is a pathological process accompanied by the accumulation of a large amount of fluid in the space between the membranes of the testicle. There may be many reasons, but most often in children it is a congenital pathology, and in adults it is an injury or an inflammatory process. In the case of an acute inflammatory and infectious process, injury, surgery may be required. In children, hydrocele often develops if the child's peritoneum has not healed. This is often an indication for surgery. It is also worth noting that against the background of dropsy, pain, pressure, a feeling of heaviness, discomfort, and difficulty urinating may develop.

Preparation

Preparation for the operation to remove a testicular hydrocele is standard and is carried out in advance. It is carried out according to the same principles as all surgical manipulations. At the first stage, it is necessary to pass a set of necessary examinations (clinical and biochemical blood and urine tests, blood clotting test). At the second stage, instrumental examinations are carried out (ECG, fluorography, ultrasound). Infection tests are mandatory, including HIV infection, the Wasserman reaction. At the third stage, consultations with specialists are carried out, including an anesthesiologist, surgeon, cardiologist, urologist. At the fourth stage, it is necessary to obtain a conclusion from a pediatrician or therapist, which will indicate whether the patient can undergo surgery.

To plan methods of pain relief, anesthesia, anaesthesia, it is necessary to consult with a specialist anesthesiologist. The anesthesiologist definitely needs a complete anamnesis.

If the operation is not contraindicated, careful preparation is necessary. The first thing to do is to switch to a balanced diet about 2-3 weeks before. You need to exclude all fatty, fried, smoked, marinated, pickled, spicy, seasoning, and alcohol from your diet. Confectionery, coffee, and strong tea should be completely excluded. Anticoagulants and other medications should be discontinued. 2-3 weeks before, you can start drinking a decoction of anti-inflammatory herbs instead of tea, in particular, chamomile or calendula. You can also drink a decoction of rose hips - this is a huge source of vitamins and minerals. This will allow you to tolerate the operation well and recover quickly after it. The last meal should be 7-8 hours before the operation. Also, on the day of the operation, you must thoroughly wash the genitals, do hair removal without damaging the skin.

An additional examination is carried out immediately before the operation. Such methods as diaphanoscopy and ultrasound are used. The essence of diaphanoscopy is that a flashlight is shined through the enlarged testicle. The refractive indices of light are used to judge the condition and severity of the pathology, the amount of fluid. Thus, water freely transmits light unchanged. If there is a tumor or other compaction, neoplasm, light does not pass. It should also be taken into account that in the presence of a scar, or after a recent operation in the scrotum, with inflammation of the testicles. In this case, when performing diaphanoscopy, blood will accumulate between the membranes of the testicle. It also transmits light poorly.

Ultrasound is used when diaphanoscopy fails to establish a diagnosis. Ultrasound clearly shows the structure of the pathology, and it is possible to clearly differentiate a tumor, hernia, hydrocele, and other similar conditions.

Another important feature of preparation for surgery is that immediately before the operation, all inflammatory and infectious processes must be cured, including colds and caries. In case of acute inflammatory, infectious diseases, exacerbation of chronic pathologies, the operation must be postponed.

Technique testicular hydrocele surgery

Let's take a closer look at the technique of performing an operation to remove a testicular hydrocele. There are several methods of surgical treatment. In particular, there is minimally invasive and radical treatment. Minimally invasive treatment is most often puncture and sclerotherapy. The main methods of radical intervention are suturing the testicular membranes. The operation will simply be ineffective if the main causes causing the development of dropsy are not completely eliminated. If the causes are not eliminated, the effect of the procedure will be temporary.

Puncture is a type of surgical intervention that can temporarily alleviate the patient's condition. Puncture provides only a temporary effect and is used if a full-fledged operation is contraindicated. As a rule, the effect of this procedure lasts for 5-6 months. The operation is performed under local anesthesia by injecting an anesthetic into the puncture site. The puncture is made with a thin needle. The fluid is pumped out, then the puncture must be sealed with a sterile plaster.

The Ross operation is a surgical intervention method that is indicated for patients under 2 years of age. The operation is performed for congenital pathologies of the testicle. Preparation for the procedure is standard. During the operation, the patient lies on his back, legs apart. The doctor administers anesthesia. After the anesthesia takes effect, the doctor disinfects the skin. Then an incision is made in the lower abdomen. This allows you to visualize the spermatic cord and separate it so as not to damage it during the operation. Then it is necessary to isolate the peritoneal process, due to which the development of hydrocele occurs. The formation is intersected, the stump is bandaged. As a result, an opening is formed on the inner surface of the testicle, in its membrane, through which the fluid outflows. After performing all the necessary manipulations, the doctor puts stitches on the site of the operation and applies an antiseptic bandage.

How long does testicular hydrocele surgery take?

In order to answer the question of how long a testicular hydrocele operation lasts, it is necessary to take into account the severity of the pathology, the patient's age, and other individual characteristics. On average, the duration of the operation is from 30-40 minutes in the simplest cases, to 2-3 hours in more severe cases. At the same time, the simplest procedure is considered to be a puncture, in which the doctor makes punctures with a needle, after which he pumps out the liquid with a special syringe. This is the least dangerous and least traumatic procedure.

Lord's Operation for Hydrocele

The most effective way to treat hydrocele is considered to be a procedure called plication of the membranes. This procedure was developed by Lord, which is why it was called the Lord operation. The advantage of this technique is that with this procedure, the risk of complications and injury to surrounding tissues is minimized. During the operation, the patient lies in a supine position. At the same time, the scrotum is treated with an antiseptic. The lower abdomen, loose and connective tissue are lubricated. After treatment, the affected testicle is pulled down. This allows you to relax the muscle responsible for lifting. Then the spermatic cord is clamped, lidocaine is injected directly into the cord. This drug has an anesthetic effect. After this, the doctor makes an incision along the inner lining of the testicle. The outer tissues are moved apart and fixed with clamps. This prevents bleeding. Coagulation of the affected and damaged blood vessels is performed. Then a deeper incision is made in the inner lining of the testicle. The tissues are again spread and fixed. [ 1 ]

During the operation, the wound has a rounded appearance. At the edges of the wound, you can find skin, subcutaneous tissue, and the outer (fleshy membrane). After the main incision, the doctor makes a puncture of the vaginal membrane, which allows you to remove the fluid. An incision is made in the vaginal membrane and then squeezed into the wound. It is examined in detail in order to identify other concomitant pathologies and take timely measures. After this, the testicle is lifted, the doctor assembles the testicle (plication is performed). This is a specific feature that distinguishes Lord's operation from other similar operations. Then suturing is performed using absorbable threads. The threads are pulled, which allows you to return the testicle to the desired position. If necessary, the doctor applies additional stitches. [ 2 ]

Bergman's operation for hydrocele

Bergman's operation is performed for dropsy, or hydrocele of the testicle. The main indications for the operation are the following symptoms: hyperthermia, accumulation of fluid between the membranes of the testicle, discomfort in the perineum, groin area. An indication for emergency surgery is a rupture of the testicular wall, which leads to severe pain and inflammation.

Bergman's operation is performed under general or local anesthesia. The operation allows to completely cure the disease and avoid impotence. The operation is aimed at removing the accumulated fluid. The Bergman operation is based on tissue excision and fluid pumping.

Before the operation, it is necessary to pass a set of examinations: clinical and biochemical blood and urine tests, blood clotting test, ECG, fluorography. If necessary, bacteriological studies are carried out, studies for infections, including HIV infection, for a complex of viral and bacterial infections. After passing all the examinations, it is necessary to obtain a conclusion from a pediatrician or therapist, which will indicate whether the patient can undergo surgery.

It is imperative to consult with an anesthesiologist who will select the optimal method of anesthesia.

The Bergman operation technique is quite simple. During the Bergman operation, the membranes are excised. After making an incision and gaining access to the testicles, the surgeon selects the optimal technique for performing the operation and removes excess fluid. Then it is necessary to evert the testicle into the wound and remove the fluid. After the fluid has been completely removed, the vaginal membrane is dissected and excess tissue is excised. The remaining tissue is sutured with catgut, as a result of which the testicle is returned to its place, and the membranes and skin are sutured. The sutures are completely absorbed. As a rule, the sutures dissolve in about 2 weeks. [ 3 ]

There are no specific contraindications to the operation. They are all standard, no different from contraindications to any surgical intervention. After the operation, adverse effects are rare. On the contrary, the condition improves significantly, pain and discomfort cease to bother the person. It should be taken into account that in the first few days after the operation, pain and swelling at the site of the surgical intervention may persist. You will have to give up driving for a few days, since the surgical wound prevents this. Also, the pressure on the scrotum and testicles is significantly reduced, reproductive function is restored, in a few weeks you can restore your intimate life, return to your usual way of life.

Complications are rare. The most common complications are inflammatory and infectious processes, pain. They are usually observed with improper surgery technique or failure to comply with sanitary and hygienic conditions. Suppuration of the wound, formation of pus or exudate in the suture area are possible. A hernia is also possible, suture divergence in the case that is especially often observed if a person lifts weights, walks a lot in the first days after surgery. In a difficult postoperative period, the temperature may rise, edema, hyperemia, irritation, itching may develop.

After the operation, special postoperative care is required. Most patients experience a significant improvement in their condition within 3-4 days after the operation. During the rehabilitation period, the patient must strictly take all medications prescribed by the doctor, follow all recommendations, and treat the wound. If pain, swelling, or discomfort occurs during the postoperative period, you should contact a doctor who will prescribe painkillers. [ 4 ]

Winkelmann's operation for hydrocele

A fairly common procedure for hydrocele is the Winkelmann operation. During this operation, the doctor makes a series of staged incisions. First, an incision is made in the skin and outer membranes of the testicle (5-6 cm). After this, a continuous incision is made through several layers, to the internal vaginal membrane. Then the accumulated fluid is pumped out. The doctor turns the edges of the wound, examines them, then the organs are sutured from behind. As a result, the area of the membrane is sharply reduced. Accordingly, further accumulation of fluid does not occur, which will facilitate further absorption of the fluid. Sutures are applied, using various threads, including absorbable and non-absorbable. Sutures made of non-absorbable threads are removed after about 12-14 hours.

Hydrocele surgery for a child

In case of hydrocele, the operation is performed on a child according to the same indications and principles as on an adult. First of all, it is necessary to pass a set of necessary examinations. First of all, clinical and biochemical tests will be required: blood, scraping, smears, urine, blood clotting test, ECG. On the day of the operation, you need to arrive at the hospital in advance. All necessary preparatory activities are carried out by medical personnel. During the operation, the child requires mandatory anesthesia. Anesthesia is mandatory, but the method of its implementation is determined by the doctor.

Lord's operation is often performed on children; it is a relatively simple, yet extremely effective procedure. It is possible with small-sized dropsy or with the disease in a child. The advantage of the operation is that relapses rarely occur. The doctor makes an incision in the sac with serous lubricant, after which special channels are created through which excess fluid is removed. This prevents its further accumulation.

During the first few days after surgery, there may be some pain and swelling at the site of the surgery. However, these symptoms usually go away fairly quickly.

After the operation, the child requires special postoperative care. It takes about 3-4 hours to come out of anesthesia. During this time, you cannot drink. After coming out of anesthesia, you can start drinking, in small sips. It is recommended to drink rosehip decoction. This is a rich source of vitamin C, and the substances contained in rosehip have a softening effect on the gastrointestinal tract, which prevents inflammation, pain, and spasm.

The child can be fed after 4-5 hours. A postoperative diet is recommended (table No. 0). Most patients experience an improvement in their condition after 3-4 days after surgery. It takes from one to several months for the body to fully recover.

After the operation, it is necessary to observe the postoperative period. For some time, it is necessary to wear a special bandage, which will help relieve swelling and inflammation. You should not wear tight-fitting underwear, tight or tight underwear. Panties should be made of cotton fabric. You will have to give up diapers and nappies for some time. Physical activity should be limited for at least a week. If pain, swelling, discomfort bothers you during the postoperative period, you should consult a doctor. The doctor can prescribe painkillers. After 10 days, a follow-up examination by a doctor is required. [ 5 ]

Contraindications to the procedure

All medical procedures, especially surgical ones, have certain contraindications. As for the operation for hydrocele, there are no specific contraindications in this case. The operation is not performed in case of acute inflammatory processes in the pelvic organs, colds and infectious diseases. It is strictly contraindicated in case of various serious pathologies of the kidneys, liver, cardiovascular system, respiratory dysfunction, hypertension, vascular tone disorders, COPD, CHF, immunodeficiencies, autoimmune pathologies. The procedure is also contraindicated in case of intolerance to anesthesia, severe allergic reactions, especially immediate type (anaphylactic shock, suffocation, Quincke's edema), increased sensitization of the body, acute inflammatory and infectious pathologies. The operation is not performed in severe forms of diabetes mellitus, in case of blood clotting disorders, in case of hemophilia, in case of taking anticoagulants. Varicose veins and a history of oncological pathology require caution.

Consequences after the procedure

The procedure may have certain consequences, both negative and positive. For example, a hematoma may occur, which is an internal hemorrhage. As a rule, this is a temporary condition that does not require special treatment. Hematoma occurs for various reasons: hemorrhage, damage to blood vessels, loose suturing. Also, one of the adverse consequences of the procedure may be a relapse of the disease. Most often, relapses develop during minimally invasive procedures, such as puncture. Relapses are also possible if it was not possible to eliminate the cause of the pathology. In this case, serous fluid is formed again between the membranes of the testicle. If the cause of the relapse could not be eliminated, a relapse develops in almost 100% of cases. Relapses are also often observed during the suturing procedure, especially if a pocket of connective tissue forms around the testicle.

One of the consequences after the operation can be called a cosmetic defect, in which a lump is formed. This phenomenon is observed with a strong hydrocele. In this case, gathered tissue is formed at the site of the operation, an unpleasant appearance occurs. Similar cosmetic defects also occur when suturing large volumes of tissue, large membranes.

In some cases, swelling of the scrotum develops. It can be observed for several months after the procedure. As a rule, it goes away on its own, no additional measures are required. In order to speed up the removal of swelling, you need to follow all the doctor's recommendations, periodically apply cold compresses to the area of the operation. It is necessary to check that the testicles remain soft. [ 6 ]

Complications after the procedure

One of the complications after surgery may be excision of the spermatic cord. This is a rather dangerous injury, which often leads to even more serious complications and consequences, in particular, to infertility. It is worth noting that the spermatic cord, as a rule, is not restored. If damage occurs, you need to see a doctor as soon as possible. The effectiveness of the treatment depends on how quickly the appropriate measures were taken.

One of the most dangerous complications of the procedure is testicular atrophy, in which the cells and tissues of the testicle gradually die off. As a rule, this is an irreversible process. In this case, the testicle gradually decreases in size until the process of sperm formation stops completely. If the testicle suddenly turns red or blue, increases in size, or, conversely, decreases in size, you need to see a doctor as soon as possible.

Pain after hydrocele surgery

For some time after the hydrocele operation, pain may appear. You should not tolerate it. It is worth contacting a doctor who will prescribe the most appropriate treatment: painkillers. As a rule, mild analgesics are prescribed: analgin, aspirin, paracetamol, spazmolgon, no-shpa, citramon. If these drugs are ineffective, stronger ones are prescribed: ketanol, ketolorac, ketoferil. Also, special postoperative bandages, frequent dressing changes, treatment of the postoperative wound with special ointments and medications will help relieve pain and alleviate the condition.

Temperature after hydrocele surgery

Temperature may occur after hydrocele surgery. Temperature increase may be associated with natural recovery processes in the body. Any regeneration entails a number of biochemical transformations, tissue and cellular reactions, due to which a slight increase in temperature occurs. As a rule, during a normal recovery period, the temperature does not exceed 37.0-37.2 degrees. Temperature may also increase as a natural reaction to mechanical tissue damage. However, if the temperature rises above the specified values, this is an unfavorable sign. As a rule, an increase in temperature above 37.5 indicates the development of complications. This may be an inflammatory, infectious process, suppuration in the wound area, sutures. When a hospital infection is added, which is the most dangerous form of infection, a sharp increase in temperature is observed up to 39-40 degrees, and even higher. Hospital strains of microorganisms are resistant to most antibacterial agents and disinfectants. At the same time, they live in hospital conditions, operating rooms, and are quite well adapted to life in the external environment, outside the human body. They are not killed by ordinary disinfection and sanitization. When they enter the human body, they cause severe complications, generalized inflammatory and infectious processes that progress, are not amenable to treatment, and often lead to the rapid development of bacteremia and sepsis. A person can die in a few days or even hours from blood poisoning. The faster the treatment is started, the more effective it will be. Therefore, any increase in temperature should be a reason to contact a doctor and take serious measures. The situation is complicated by the fact that after surgery, immunity is sharply reduced, which creates favorable conditions for the unhindered development and reproduction of hospital strains of microorganisms.

Hard testicle after hydrocele surgery

For several days after the hydrocele operation, the testicle may be hard. This is often associated with the development of hematomas, subcutaneous hemorrhages, and inflammatory processes. In some cases, dried blood may accumulate in the testicle membranes, which can also cause hardness. The development of edema, swelling, can cause hardness. Tissue edema usually subsides within 2-3 days. You also need to make sure that there is no tumor or neoplasm. Usually, in doubtful cases, an ultrasound is performed to make a diagnosis.

A lump in the testicle appeared a year after hydrocele surgery

If a year after the hydrocele operation, a compaction of the testicle sometimes appears. In this case, you need to seek help from a urologist as soon as possible. You need to undergo an examination that the doctor will prescribe. Most often, an ultrasound scan is needed to make a diagnosis and determine the cause of the pathology. The cause may be a relapse of the disease, accumulation of fluid and blood, purulent exudate, development of a tumor, inflammatory or infectious process. It is necessary to exclude trauma, hypothermia.

Recurrence of hydrocele after surgery

After a hydrocele operation, a relapse is possible in cases where the cause of the pathology has not been determined. Hydrocele can only be eliminated if the cause causing the accumulation of fluid is completely eliminated. Otherwise, it will gradually accumulate again. A relapse is also possible if the operation was performed incorrectly, the technique of the operation was not followed, asepsis, if pockets remain after the operation in which fluid can accumulate. A relapse is also possible after a puncture that does not eliminate the cause of the pathology, but is aimed only at removing fluid from the place of its accumulation.

Care after the procedure

After hydrocele surgery, the postoperative period and recovery lasts 2-3 months. During the recovery period, it is necessary to wear loose clothing. You should not wear swimming trunks, other tight underwear, be sure to choose cotton underwear, soft, not pressing. The ideal option is family panties. Small children are not recommended to wear diapers, nappies. This is important, since in a diaper the testicle can overheat, be exposed to evaporation. An exception is the case when the operation was performed by puncture, since during this procedure, on the contrary, it is necessary for the testicle to be pressed tightly. Therefore, after puncture, on the contrary, it is recommended to wear tight-fitting, close-fitting underwear. There is even special postoperative underwear. In other cases, both clothing and underwear should be loose, not tight.

Hygiene procedures depend on the type of surgery. As a rule, you cannot take a hot bath or a hot shower. In the first few days, you need to follow a hygienic regimen: use sanitary napkins or special treatment products. After a few days, you can take a warm shower. It is better to use a soft washcloth and soap foam, but not shower gel or other products. Cosmetics should be natural. You will also have to abstain from sexual intercourse for at least 2-3 weeks. Sometimes drainage is installed. In this case, you need to see a doctor after 2-3 days to remove it. The suture is smeared with a solution of brilliant green, or other anti-inflammatory drugs prescribed by the doctor.

After the operation, the patient requires care and rehabilitation. The patient is transferred to the postoperative ward. There, he is under the supervision of doctors for several hours. If there are no complaints or complications, the patient is discharged. If there is a risk of complications, the wound is bleeding, the patient does not tolerate the effects of anesthesia well, the patient will not be discharged. The patient will need to follow a number of recommendations at home. In general, the rehabilitation period does not exceed 2-3 weeks. For the first 2-3 days, bed rest will be required. It is necessary to wear a special bandage. This prevents the development of edema and ensures reliable fixation. After a few days, the bandage is removed.

How long does it take to remove stitches after hydrocele surgery?

Patients often ask how many days after hydrocele surgery stitches are removed. It all depends on the technique used and the threads used. It is also worth noting that this largely depends on age, individual characteristics of the body, and the speed of wound healing. If we take average figures, stitches are usually removed on the 12th-14th day. If special absorbable threads are used, they do not need to be removed at all, they dissolve on their own.

Bandages after hydrocele surgery

After hydrocele surgery, bandages are needed. This is due to the fact that in the first few days after surgery, pain and swelling at the site of surgery may persist. The bandage fixes the testicle in the desired position, thereby reducing the load and the likelihood of injury. Also, under the influence of the bandage, the pressure on the scrotum and testicles is significantly reduced, and reproductive function is restored. In addition, the bandage will help relieve swelling and inflammation. Also, instead of regular tight underwear, you need to wear a suspensory. This is special support clothing that relieves excess tension in the groin area. If necessary, drainage is applied.

Sex after hydrocele surgery

After hydrocele surgery, sex is contraindicated for 2-3 weeks. If the postoperative wound heals well, there are no complications or painful sensations, after this time, you can resume intimate life. It is worth noting that even if the patient's health is satisfactory, there is no pain or discomfort in the area of the operation, you still need to endure a full rehabilitation period of 2-3 weeks, unless otherwise indicated by the doctor. Otherwise, complications or a relapse of the disease may develop.

Hydrocele treatment without surgery

As practice shows, full treatment of hydrocele without surgery is impossible. Surgical treatment is the only effective means of eliminating this pathology.

Reviews

We have analyzed reviews of the testicular hydrocele surgery. In most cases, reviews are written by mothers of children who have undergone this surgery. Adult men prefer not to discuss this topic. As reviews show, the surgery significantly alleviates the condition of patients suffering from congenital dropsy. At the same time, the paradox is that the child's parents experience much more stress. While the child himself quickly forgets about the surgery, tolerates it easily, mostly without complications. As some experts note, dropsy in children can be treated conservatively. Therefore, not all specialists immediately prescribe surgery. Others believe that the sooner the surgery is performed, the more effective it will be, and try to prescribe it as early as possible, when the first signs appear.

As practice shows, the postoperative period is much more difficult. It is quite difficult to come out of anesthesia: children are capricious, demand to drink, feel thirsty, have headaches, are more aggressive, irritable, or, on the contrary, tearful. It is also quite difficult for children to stay in bed. However, it is not recommended to get out of bed for some time. It is also necessary to take into account that the catheter remains in the child's hand, so you need to carefully monitor that he does not remove it. There are also negative reviews. In particular, some children require a repeat procedure due to a relapse of the disease.

Adult men usually leave reviews only if the result is unfavorable or there were complications. The main complications are inflammation, relapse, infection, varicocele, prostatitis. However, in most cases, the prognosis is usually favorable. Surgery for testicular hydrocele is generally without complications.