Surgery for testicular hydrocele

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

Indications for the procedure

Hydrocele is also called testicular hydrocele. 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 shells of the testicle. There may be many causes, but most often in children it is congenital pathology, and in adults it is trauma, or inflammatory process. In acute inflammatory and infectious process, trauma, may require surgery. In children, hydrocele often develops in the case when the child has not overgrown the peritoneum. This is often an indication for surgery. It is also worth noting that against the background of hydrocele can develop pain, pressure, a feeling of heaviness, discomfort, difficulty urinating.

Preparation

Preparation for the operation for removal of testicular hydrocele is standard, carried out in advance. It is carried out according to the same principles on which all surgical manipulations are carried out. At the first stage it is necessary to take a set of necessary examinations (clinical and biochemical blood tests, urine, blood coagulation tests). At the second stage, instrumental studies are carried out (ECG, fluorography, ultrasound). Obligatory tests for infections, including HIV infection, Wasserman reaction. At the third stage, consultations of specialists are carried out, including an anesthesiologist, surgeon, cardiologist, urologist. At the fourth stage, a pediatrician's or therapist's opinion should be obtained, which will indicate the conclusion whether the patient can undergo surgery.

To plan methods of anesthesia, anesthesia, anesthesia, it is absolutely necessary to consult with a specialist anesthesiologist. The anesthesiologist needs a complete history.

If the operation is not contraindicated, careful preparation is necessary. The first thing you need to do is to switch to a rational diet about 2-3 weeks in advance. From the diet should be excluded all fatty, fried, smoked, marinades, pickles, spices, spices, alcohol. Confectionery, coffee, strong tea should be completely excluded. Cancel the intake of anticoagulants and other drugs. For 2-3 weeks you can start instead of tea to drink decoction of anti-inflammatory herbs, in particular, chamomile, or calendula. You can also drink a decoction of rose hips - this is a huge source of vitamins, minerals. This will allow you to tolerate the operation well, quickly recover from it. The last meal should be 7-8 hours before the operation. Also on the day of the operation it is necessary to thoroughly wash the genitals, wax without damaging the skin.

Immediately before the operation, additional examination is performed. Such methods as diaphanoscopy and ultrasound are used. The essence of diaphanoscopy is that a flashlight is shone through the enlarged testicle. According to the refractive indexes of light judge the state and severity of pathology, the amount of fluid. Thus, water freely transmits light in an unchanged form. If there is a tumor, or other thickening, neoplasm, the 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 shells of the testicle. It also transmits light poorly.

Ultrasound is used if diaphanoscopy fails to make a diagnosis. Ultrasound clearly shows the structure of the pathology and can clearly differentiate between tumor, hernia, hydrocele and other similar conditions.

Another important feature of the preparation for surgery is that immediately before the operation it is necessary to treat all inflammatory and infectious processes, including colds, tooth decay. In acute inflammatory, infectious diseases, exacerbation of chronic pathologies, the operation should be postponed.

Technique of the testicular hydrocele surgery

Let's take a closer look at the technique of testicular hydrocele surgery. There are several methods of surgical treatment. In particular, there are minimally invasive and radical treatments. Minor invasive treatment is most often puncture and sclerosing. The main methods of radical intervention are suturing of the testicular sheaths. Just the operation will be ineffective, if the main causes causing the development of hydrocele are not fully 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 relieve the patient's condition. Puncture has only a temporary effect and is used when a full surgery 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 site of puncture. The puncture is made with a thin needle. The fluid is pumped out, then the puncture should be sealed with a sterile plaster.

The Ross operation is a surgical technique that is indicated for patients younger than 2 years of age. The operation is performed for congenital abnormalities of the testis. Preparation for the procedure is standard. When performing the operation, the patient lies on his back, legs apart. The doctor administers anesthesia. After the anesthesia takes effect, the doctor decontaminates 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 in the process of surgery. Then it is necessary to isolate the outgrowth of the peritoneum, due to which the development of hydrocele occurs. The formation is crossed, a ligation of the stump is performed. As a result, an opening is formed on the inner surface of the testicle, in its shell, through which there is an outflow of fluid. After performing all the necessary manipulations, the doctor sutures the site of the operation, and applies an antiseptic dressing.

How long does testicular hydrocele surgery last?

In order to answer the question of how long the operation of testicular hydrocele lasts, you need to take into account the severity of the pathology, the age of the patient, other individual characteristics. On average, the duration of the operation ranges from 30-40 minutes in the simplest cases, to 2-3 hours in more severe cases. In this case, the simplest procedure is considered puncture, in which the doctor makes punctures with a needle, and then pumps out the fluid with a special syringe. This is the least dangerous and least traumatic procedure.

Lorde's surgery for hydrocele

The most effective way to treat testicular hydrocele is a procedure called sheath plication. This procedure was developed by Lord, hence the name Lord's operation. The advantage of this technique is that with this procedure, the risk of complications and trauma to surrounding tissues is minimized. During the operation, the patient is in a supine position. At the same time, antiseptic treatment of the scrotum with antiseptic is performed. The lower abdomen, loose and connective tissue is lubricated. After treatment, the affected testicle is pulled downward. This allows you to relax the muscle responsible for lifting. Then the spermatic cord is clamped, and lidocaine is injected directly into the cord. This drug has an anesthetic effect. After that, the doctor makes an incision along the inner shell of the testicle. The external tissues are pulled apart, their fixation with clamps is carried out. This prevents bleeding. Coagulation of affected and damaged blood vessels is performed. Next, a deeper incision of the inner shell of the testicle is made. Once again, the tissues are pulled apart and fixed. [1]

During surgery, the wound has a rounded appearance. At the edges of the wound, you can find the skin, subcutaneous tissue, and the outer (fleshy sheath). After the main incision, the doctor makes a puncture in the vaginal sheath, which allows the fluid to be removed. The vaginal sheath is cut and further extruded into the wound. It is made a detailed study of it in order to identify other associated pathologies and take timely action. After that, the testicle is lifted, the doctor performs testicular assembly (plication is performed). This is a specific feature that distinguishes Lord's operation from other similar operations. Suturing is then performed using absorbable sutures. The threads are stretched, which allows the testicle to be returned to its proper position. If necessary, the doctor will use additional stitches. [2]

Bergman surgery for hydrocele

Bergman surgery is performed in cases of hydrocele, or testicular hydrocele. As the main indications for the operation are considered the main symptoms: hyperthermia, fluid accumulation between the testicular membranes, discomfort in the perineum, inguinal area. Indication for emergency surgery is the rupture of the testicular wall, which leads to severe pain, inflammation.

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

Before the operation, it is necessary to undergo a set of examinations: clinical and biochemical blood tests, urine, blood coagulation tests, ECG, fluorography. If necessary, there are bacteriological studies, tests for infections, including HIV infection, for complex viral and bacterial infections. After passing all examinations, it is necessary to get a conclusion from a pediatrician or a therapist, which will indicate the conclusion about whether the patient can be operated.

It is mandatory to consult with an anesthesiologist, who should choose the best method of anesthesia.

The technique of Bergman's operation is quite simple. In Bergman surgery, the membranes are excised. After making an incision and gaining access to the testicles, the surgeon selects the optimal technique for performing the operation, removes excess fluid. Then it is necessary to twist the testicle in the wound, remove the fluid. After complete elimination of fluid, the vaginal sheath is dissected, the excess tissue is also excised. The residual tissues are sutured with catgut, as a result of which the testicle is returned to its place, there is suturing of the membranes and skin. There is complete resorption of the sutures. As a rule, the sutures dissolve after about 2 weeks. [3]

There are no specific contraindications to the operation. All of them are standard, no different from contraindications to any surgical intervention. After the operation, adverse effects are rarely observed. On the contrary, the condition significantly improves, pain and discomfort cease to bother a person. It should be borne in mind that in the first few days after surgery may remain soreness and swelling at the site of surgical intervention. 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, the reproductive function is restored, in a few weeks you can restore intimate life, return to the usual way of life.

Complications are rare. Most often there are such complications as inflammatory and infectious processes, painful sensations. These, as a rule, are observed in the case of improper technique of surgery, or failure to comply with sanitary and hygienic regime. It is possible suppuration of the wound, the formation of pus or exudate in the area of the suture. Also possible hernia, divergence of sutures in the case, which is especially common if a person will lift heavy weights, a lot of walking in the first days after surgery. In a severe postoperative period, there may be fever, edema, hyperemia, irritation, itching.

Special postoperative care is required after surgery. Most patients experience significant improvement in their condition as early as 3-4 days after surgery. During the rehabilitation period, the patient must strictly take all medications prescribed by the doctor, comply with all recommendations, to treat the wound. If during the postoperative period will be bothered by pain, swelling, discomfort, it is necessary to consult a doctor who will prescribe painkillers. [4]

Winkelman surgery for hydrocele

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

Hydrocele surgery for a baby

With hydrocele in a child, the operation is carried out according to the same indications and principles as 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, scrapings, smears, urine, blood coagulation tests, ECG. On the day of surgery, you need to arrive at the hospital in advance. All necessary preparatory measures are performed by medical personnel. When carrying out surgery, the child requires mandatory anesthesia. Anesthesia is mandatory, but the method of its implementation is determined by the doctor.

Lorde's operation is often performed on children and is a relatively simple, yet extremely effective procedure. It is possible for small-sized hydrocele, or when a child has the disease. The advantage of the operation is that it rarely causes recurrences. The doctor makes a dissection of the sac with serous lubrication, after which special channels are created, through which excess fluid is eliminated. This prevents its further accumulation.

In the first few days after surgery, there may be some soreness and swelling at the surgical site. But, as a rule, these symptoms disappear quite quickly.

After the operation, the child requires special postoperative care. It takes about 3-4 hours to come out of anesthesia. No drinking is allowed during this time. After coming out of anesthesia, you can start drinking, small sips. It is recommended to drink decoction of rose hips. It is a rich source of vitamin C, also the substances contained in rose hips have a soothing effect on the gastrointestinal tract, which prevents inflammation, pain, spasm.

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

After surgery, the postoperative period must be observed. A special bandage should be worn for some time, which will help to relieve swelling and inflammation. You should not wear tight underwear, tight or tight underwear. Underpants should be made of cotton fabric. From diapers and diapers will have to be abandoned for a while. Physical activity should be limited for at least a week. If during the postoperative period will be bothered by pain, swelling, discomfort, it is necessary to 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 procedures, have certain contraindications to perform. As for the operation for hydrocele, there are no specific contraindications in this case. The operation is not carried out in acute inflammatory processes in the pelvic organs, colds and infectious diseases. It is strictly contraindicated in various serious pathologies of the kidneys, liver, cardiovascular system, respiratory function disorders, hypertension, impaired vascular tone, COPD, CHF, immunodeficiencies, autoimmune pathologies. Also, the procedure is contraindicated in intolerance to anesthesia, pronounced allergic reactions, especially immediate type (anaphylactic shock, choking, Quincke's edema), with increased sensitization of the body, with acute inflammatory and infectious pathologies. The operation is not carried out in severe forms of diabetes mellitus, blood clotting disorders, hemophilia, taking anticoagulants. Caution requires varicose veins, the presence of a history of oncologic pathology.

Consequences after the procedure

The procedure can have certain consequences, both negative and positive. For example, a hematoma may occur, which is an internal hemorrhage. This is usually a temporary condition that does not require special treatment. Hematoma occurs for various reasons: hemorrhage, vascular damage, loose sutures. Also, one of the unfavorable consequences of the procedure can be a recurrence of the disease. Most often recurrences develop during minimally invasive procedures such as puncture. Also relapses are possible if the cause of the pathology could not be eliminated. In this case, serous fluid is again formed between the shells of the testicle. In the event that the cause of the development of the recurrence could not be eliminated, the recurrence develops in almost 100% of cases. Recurrences are also often observed during the suturing procedure, especially if a connective tissue pocket is formed around the testicle.

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

In some cases, scrotal edema develops. This may occur for several months after the procedure. As a rule, it goes away by itself, no additional measures are required. In order to accelerate the removal of edema, you need to follow all the recommendations of the doctor, 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 can be the excision of the spermatic cord. This is a rather dangerous injury, which often leads to even more severe complications and consequences, in particular, infertility. It is worth noting that the spermatic cord, as a rule, does not recover. If damage occurs, you need to see a doctor as soon as possible. On how quickly the appropriate measures were taken, the effectiveness of treatment depends.

One of the most dangerous complications of the procedure is testicular atrophy, in which the cells and tissues of the testis gradually die off. This is usually an irreversible process. In this case, the testicle gradually decreases in size, until the process of sperm formation does not stop completely. If the testicle is sharply red or blue, increased or, conversely, decreased in size, it is necessary to consult a doctor as soon as possible.

Pain after hydrocele surgery

For some time after hydrocele surgery, pain may occur. It should not be tolerated. It is worth seeing a doctor who will prescribe the most appropriate treatment: painkillers. As a rule, prescribe mild analgesics: analgin, aspirin, paracetamol, spasmolgon, no-shpa, citramone. If these drugs are ineffective, prescribe stronger ones: ketanol, ketolorac, ketoferil. Also relieve pain and relieve the condition will help special postoperative bandages, frequent change of dressings, treatment of the postoperative wound with special ointments, medications.

Temperature after hydrocele surgery

It is possible to have a fever after hydrocele surgery. Increased temperature may be due to the natural regenerative processes in the body. Any regeneration entails a number of biochemical transformations, tissue and cellular reactions, in connection with which there is a slight increase in temperature. As a rule, in the normal course of the regenerative period, the temperature does not exceed 37.0-37.2 degrees. Temperature may also rise as a natural reaction in response to mechanical tissue damage. However, if the temperature rises above these figures, it is an unfavorable sign. As a rule, an increase in temperature above 37.5 indicates the development of complications. This can be inflammatory, infectious process, suppuration in the area of the wound, sutures. With the accession of hospital infection, which is the most dangerous form of infection, there is a sharp rise in temperature 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 the conditions of the hospital, operating rooms, well enough adapted to life in the external environment, outside the human body. Through conventional disinfection and sanitation are not killed. Once in the human body, cause severe complications, generalized inflammatory-infectious processes that progress, not amenable to treatment, often lead to rapid development of bacteremia and sepsis. A person can die not a few days or even hours from blood poisoning. The sooner treatment is started, the more effective it will be. Therefore, any increase in temperature should be a reason to contact a doctor, to take serious measures. The situation is complicated by the fact that after surgery, immunity is sharply reduced, which creates a favorable soil for the unimpeded development and multiplication of hospital strains of microorganisms.

Hard testicle after hydrocele surgery

For a few days after hydrocele surgery, there may be a hard testicle. This is often due to the development of hematomas, subcutaneous hemorrhages, and inflammation. In some cases, caked blood may accumulate in the testicular sheaths, which can also cause hardness. The development of edema, swelling, can cause hardness. Tissue swelling usually subsides within 2-3 days. You should also make sure that there is no tumor, neoplasm. Usually in doubtful cases, an ultrasound is performed to make a diagnosis.

Testicular thickening one year after hydrocele surgery

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

Hydrocele recurrence after surgery

After surgery hydrocele recurrence is possible in cases where the cause of the pathology has not been determined eliminate hydrocele can only be eliminated if the cause causing the accumulation of fluid is completely eliminated. Otherwise, it will gradually accumulate again. Recurrence is also possible if the operation is performed incorrectly, not observed technique, asepsis, if after the operation there are pockets in which fluid can accumulate. Recurrence is also possible after puncture, which 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. Do not wear floaty underwear, other tight underwear must necessarily choose underwear made of cotton fabric, soft, not pressing. The ideal option - family underwear. Small children are not recommended to wear diapers, diapers. This is important, because in a diaper, the testicle can overheat, exposed to vapor. The exception is when the operation was performed by puncture, because during this procedure, on the contrary, it is necessary for the testicle to be tightly pressed. Therefore, after puncture, on the contrary, it is recommended to wear tight, tight-fitting underwear. There are even special postoperative underwear. In other cases, both clothes and underwear should be loose, not tight.

Hygiene procedures depend on which method of surgery was performed. As a rule, you should not take a hot bath or hot shower. For the first few days, you should follow a hygienic regime: use hygienic wipes, 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 means. Cosmetics should be natural. You will also have to refrain from sexual intercourse for at least 2-3 weeks. Sometimes drainage is installed. In this case, you need to see a doctor in 2-3 days to remove it. The suture is smeared with a solution of brilliant green, or other anti-inflammatory agents that the doctor prescribes.

After the operation, the patient needs care and rehabilitation. The patient is transferred to a post-operative ward. There he is under the supervision of doctors for several hours. If there are no complaints and complications, the patient is discharged. If there is a risk of complications, the wound bleeds, the patient poorly tolerates the effects of anesthesia, 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 (bandage). This allows you to avoid the development of edema, will provide 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 the stitches are removed. It all depends on what technique of surgery was used, what threads were used. It is also worth noting that it largely depends on age, individual characteristics of the body, the speed of wound healing. If we take the average figures, then usually the stitches are removed on 12-14 days. If special absorbable threads are used, they do not need to be removed at all, they resorb by themselves.

Bandages after hydrocele surgery

Bandages are needed after hydrocele surgery. This is due to the fact that in the first few days after surgery, there may still be soreness and swelling at the surgical site. The bandage fixes the testicle in the desired position, thus reducing the load and the likelihood of injury. Also under the influence of the bandage significantly reduces the pressure on the scrotum and testicles, restores reproductive function. Additionally, the bandage will help to relieve swelling and inflammation. Also, instead of the usual tight underwear, it is necessary to wear suspensory. This is a special supportive garment that relieves unnecessary 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, complications and painful sensations do not arise, after this time, you can resume intimate life. It is worth noting that even if the patient's well-being is satisfactory, pain and discomfort in the area of the operation does not occur, it is still necessary to endure a full rehabilitation period of 2-3 weeks, unless otherwise specified by the doctor. Otherwise, complications or recurrence of the disease may develop.

Treating a hydrocele without surgery

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

Testimonials

We have analyzed reviews about the operation for testicular hydrocele. In most cases, reviews are written by mothers of children who have had this operation. Adult men prefer not to discuss this topic. As reviews show, the operation significantly alleviates the condition of patients suffering from congenital hydrocele. At the same time, the paradox is that much more stress is experienced by the parents of the child. Whereas the child himself quite quickly forgets about the operation, they carry it easily, mostly without complications. As noted by some experts, dropsy in children can be treated conservatively. Therefore, not all specialists immediately prescribe surgery. Others believe that the earlier the operation 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, experience thirst, headache, increased aggressiveness, irritability, or, on the contrary, tearfulness. It is also quite difficult for children to endure bed rest. Nevertheless, for some time it is not recommended to get out of bed. It should also be taken 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, recurrence, infection, varicocele, prostatitis. Nevertheless, in most cases, the prognosis is usually favorable. Surgery for testicular hydrocele is mostly without complications.