Testicular appendage removal

Anatomically, the testicular appendage is an independent organ that ensures the "maturation" of spermatozoa. Certain factors (trauma, inflammatory and tumor processes) may lead to the removal of the testicular appendage: it is a rare operation, which is prescribed when prolonged conservative treatment is ineffective.

Indications for the procedure

Removal of the testicular appendage is performed only on strict indications and in extreme cases, when conventional conservative treatment does not show visible improvement. Most often, the operation is prescribed in cases of tuberculosis of appendages, less often - in chronic inflammatory processes, cysts and tumors. In general, specialists distinguish such clear indications:

• chronic epididymitis with frequent exacerbations;
• tuberculous epididymitis;
• The presence of tight painful and persistent infiltrates that cannot be resorbed;
• high probability of necrotizing orchitis, abscess development, testicular death;
• structural disorders of the testicle that are not amenable to medication and are accompanied by pain, fever, etc.

Removal of testicular appendage cysts is most often performed by excision, preserving the testicle itself. Complete removal - epididymectomy - is performed only in complicated cases, for example, in the development of complications, when the pathological process involves all the tissues of the organ.

Preparation

When testicular appendage removal surgery is planned, an examination is performed beforehand:

• Urologic examination with palpatory evaluation of the left and right testicle;
• scrotal ultrasound, Doppler ultrasound;
• a standard set of preoperative laboratory tests.

A few days before the intervention exclude the intake of alcohol, as well as any medications not prescribed by the attending physician. The day before the operation adhere to a "light" diet, eating foods that do not weigh down the digestive tract. Exclude from the diet of meat, lard, fatty dishes, mushrooms, nuts, legumes. Dinner is canceled. On the day of surgery do not eat or drink.

If the patient suffers from diabetes mellitus, the correction of his preoperative nutrition is carried out by the doctor individually.

The morning before the removal of the testicular appendage, the patient thoroughly washes under the shower, shaves off the hair in the groin and scrotum area. The need for a cleansing enema is agreed with the doctor.

If the removal of the testicular appendage is performed urgently, then the entire list of preparatory measures is performed in inpatient conditions.

Technique of the testicular appendage removal

The patient is laid on his back, an anesthetic is administered depending on the type of anesthesia. As standard, the testicular appendage is removed in stages:

• Tighten the skin above the testicle and make a transverse incision;
• The edges of the incision and other underlying tissues are fixed with special clips;
• open the serosa;
• If the testicular appendage is removed because of a tuberculous lesion, the incision area is extended to the external inguinal ring, including the sinus foramen;
• from the upper part of the head of the appendage begin to excise, dividing and ligating the spermatic duct;
• The manipulation should be performed as close to the appendage as possible, avoiding damage to the testicular vessels that run along the medial border;
• expose and elevate the appendage, retract and transect the seminal canal with chromed catgut 3.0;
• the wound is sutured with knotted sutures using catgut 3.0;
• move the testicle to the scrotum, suture the tissue;
• the testicle is sutured to the scrotum to prevent it from twisting;
• drainage is usually not required or is installed for up to 24 hours;
• finalize the removal by putting on a suspensor.

The seized material is mandatorily sent for histologic examination.

In general, there are several techniques for removing the testicular appendage. The most appropriate option is selected by the surgeon who will perform the operation.

Contraindications to the procedure

Contraindications to testicular appendage removal can be absolute and relative:

• Absolute contraindications are indicated if the intervention may lead to deterioration of the patient's health or even death. These include fresh myocardial infarction, acute cerebral circulatory failure, etc.
• Relative contraindications are considered diseases, the course of which may be aggravated by the operation - for example, hypertension, diabetes mellitus, bronchial asthma and so on.

In addition, removal of the testicular appendage is postponed if the patient is found to have an obvious bleeding disorder. The operation is scheduled again after the blood clotting pattern has been corrected.

Consequences after the procedure

As a rule, there are no functional or organic consequences after removal of the testicular appendage. Spermatogenesis is stopped, but the functional capacity of the organ is not affected.

Swelling and pain after surgery usually resolve on their own or with supportive recovery treatment. In case of improper care, suppuration rarely develops, which is opened and drained.

In some cases, removal of the testicular appendage is accompanied by the formation of a pronounced scar, or atrophy of the testicle. However, such consequences are rare.

Complications after the procedure

The most common complications after removal of the testicular appendage are bleeding from damaged and poorly ligated vessels. This may result in the formation of interstitial or subgluteal hematoma. The hemorrhage itself does not pose any threat to health and life, but it raises many questions, acting as a cause for concern for the patient. If a hematoma appears, the doctor may insist on a longer hospital stay for the patient.

A serious complication after removal of the testicular appendage can be the accession of infection, with the development of infectious-inflammatory foci. In this case, intensive anti-inflammatory treatment with non-steroidal drugs and antibiotics is performed.

Care after the procedure

Surgery to remove the testicular appendage may proceed differently in different patients. However, the main goal of rehabilitation measures is always the elimination of pain syndrome, acceleration of tissue repair and wound healing, preservation of normal blood flow in the affected area, prevention of postoperative complications. Of great importance is both compliance with asepsis and antisepsis, care of the wound surface, and psychological support of the patient.

Most often, the recovery period after removal of the testicular appendage takes from one to several months, which depends on the general condition and age of the patient, as well as on the quality of rehabilitation measures.

As restorative methods, the doctor may recommend these:

• Physiotherapy - electrophoresis, magnetotherapy, ultrasound and balneotherapy can improve blood circulation, optimize muscle tone, eliminate swelling and inflammatory reaction faster.
• Dietary therapy - involves recommendations for a balanced diet enriched with vitamins and trace elements. Exclude sweets, spicy spices, alcohol. The menu is selected individually.
• Psychotherapy is very important for men who are worried about their future sexual possibilities. Often patients find it morally difficult to cope with the problem, and depressed and depressed mood inhibits recovery. To avoid this, patients sometimes need not only the support of family members, but also the help of a psychotherapist.

Psychologists advise, if possible, to make a special diary of recovery, in which you should write down all the nuances of well-being, noticing the progress of recovery. Such a simple measure sets you up for positive thinking and adds strength.

Postoperative period after removal of the testicular appendage

The period after testicular appendage removal surgery is always accompanied by antibiotic therapy: drugs are prescribed for an average of 7-10 days. If the intervention was performed for tuberculosis inflammatory process, anti-tuberculosis treatment is prescribed, and if the cause was a tumor neoplasm, chemotherapy is possible.

Sutures are usually removed on the eighth day after removal of the testicular appendage. If self-absorbable materials were used, they do not need to be removed.

Additionally, depending on the symptoms, the doctor may prescribe painkillers, non-steroidal anti-inflammatory drugs, antihistamines. The period of stay in hospital is determined individually, but on average it is 3-4 days.

Masturbation after removal of the testicular appendage, as well as sexual intercourse or any physical activity should be avoided for 2-3 weeks after surgery.

Testicular appendage removal reviews

The predominant feedback about testicular appendage removal is positive. Patients note the improvement of well-being, getting rid of regular exacerbations and unpleasant painful symptoms. Distant consequences develop very rarely, so almost no one talks about them. One of the main points is a careful choice of clinic and operating doctor. Although many operations are performed in an emergency, and the choice of a specialist in such a situation can be impossible.

Doctors themselves consider the prognosis of such surgical intervention favorable. The patient after a month can live a normal and full sexual life. After removal of the testicular appendage, it is important to immediately conduct a course of therapy of the underlying pathology - for example, urethritis, inflammation of the prostate gland, adenoma, vesiculitis and so on. During the year, the patient is recommended to visit the urologist several times for observation. In the future, this should be done once a year.