Testicular appendage removal

Anatomically, the epididymis is an independent organ that ensures the "maturation" of spermatozoa. Under certain conditions (injuries, inflammatory and tumor processes), the question of removing the epididymis may arise: this is a rare operation that is prescribed when long-term conservative treatment is ineffective.

Indications for the procedure

Removal of the epididymis is performed only for strict indications and in extreme cases, when conventional conservative treatment does not show visible improvements. Most often, the operation is prescribed for tuberculosis of the appendages, less often - for chronic inflammatory processes, cysts and tumors. In general, specialists highlight the following clear indications:

• chronic epididymitis with frequent exacerbations;
• tuberculous epididymitis;
• the presence of tight, painful and persistent infiltrates that do not respond to resorption;
• high probability of necrotizing orchitis, development of abscess, death of the testicle;
• structural disorders of the testicle that are not amenable to drug treatment and are accompanied by pain, fever, etc.

Removal of the epididymis cyst is most often performed by excision, preserving the testicle itself. Complete removal - epididymectomy - is performed only in complex cases, for example, when complications develop, when all tissues of the organ are involved in the pathological process.

Preparation

When performing a planned operation to remove the epididymis, an examination is carried out in advance:

• urological examination with palpation of the left and right testicles;
• ultrasound examination of the scrotal organs, Dopplerography;
• standard set of preoperative laboratory tests.

A few days before the intervention, alcohol intake is excluded, as well as any medications not prescribed by the attending physician. The day before the operation, a "light" diet is followed, consuming foods that do not weigh down the digestive tract. Meat, lard, fatty foods, mushrooms, nuts, and legumes are excluded from the diet. Dinner is canceled. On the day of the operation, do not eat or drink.

If the patient suffers from diabetes, the doctor will individually correct his preoperative nutrition.

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

If the removal of the epididymis is performed urgently, then the entire list of preparatory measures is carried out in a hospital setting.

Technique testicular appendage removal

The patient is placed on his back, an anesthetic is administered depending on the type of pain relief. The standard procedure for removing the epididymis is done in stages:

• stretch the skin above the testicle, make an incision in the transverse direction;
• the edges of the incision and other underlying tissues are fixed with special clamps;
• open the serous membrane;
• If the removal of the epididymis is performed due to tuberculous lesions, the incision area is extended to the external inguinal ring, including the sinus openings;
• from the upper part of the head of the appendage they begin to excise, dividing and ligating the vas deferens;
• They try to carry out the manipulation as close to the appendage as possible, avoiding damage to the testicular vessels that run along the medial border;
• the appendage is exposed and lifted, the vas deferens is ligated and cut with chromic catgut 3.0;
• the wound is sutured with a nodal suture using 3.0 catgut;
• the testicle is moved to the scrotum area and the tissues are sutured;
• the testicle is sewn to the scrotum to prevent it from twisting;
• drainage is usually not required, or it is installed for up to 24 hours;
• The removal is completed by putting on a suspensory.

The removed material must be sent for histological examination.

In general, there are several techniques for removing the epididymis. The surgeon who will perform the operation selects the most suitable option.

Contraindications to the procedure

Contraindications to epididymectomy can be absolute and relative:

• Absolute contraindications are when the intervention may lead to a deterioration in the patient's health or even death. This includes: recent myocardial infarction, acute cerebral circulatory failure, etc.
• Relative contraindications are diseases that may worsen under the influence of surgery, such as hypertension, diabetes, bronchial asthma, etc.

In addition, the removal of the epididymis is postponed if the patient is found to have a clear violation of blood coagulation. The operation is prescribed again after the correction of the blood coagulation picture.

Consequences after the procedure

As a rule, no functional or organic consequences are observed after removal of the epididymis. Spermatogenesis ceases, but this does not affect the functional capacity of the organ.

Swelling and pain after surgery usually go away on their own or with the help of additional restorative treatment. With improper care, suppurations rarely develop, which are opened and drained.

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

Complications after the procedure

The most common complications after removal of the epididymis are those caused by bleeding from damaged and poorly ligated vessels. In this case, an interstitial or subarachnoid hematoma may form. The hemorrhage itself does not pose any threat to health and life, but it raises many questions, causing 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 epididymis may be the addition of an infection, with the development of infectious and inflammatory foci. In this case, intensive anti-inflammatory treatment is carried out using non-steroidal drugs and antibiotics.

Care after the procedure

The operation to remove the epididymis may proceed differently in different patients. However, the main goal of rehabilitation measures is always the elimination of pain, acceleration of tissue restoration and wound healing, maintaining normal blood flow in the affected area, and preventing postoperative complications. Of great importance is both compliance with asepsis and antisepsis, care of the wound surface, and psychological support for the patient.

Most often, the recovery period after removal of the epididymis 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 the following:

• Physiotherapy – electrophoresis, magnetic therapy, ultrasound and balneotherapy – improve blood circulation, optimize muscle tone, and quickly eliminate swelling and inflammation.
• Diet therapy – involves recommendations for maintaining a balanced diet, enriched with vitamins and microelements. Sweets, hot spices, and alcohol are excluded. The menu is selected individually.
• Psychotherapy is very important for men who are worried about their future sexual abilities. Often, patients find it morally difficult to cope with the problem, and depressive and depressed mood slows down recovery. To avoid this, patients sometimes need not only the support of their relatives, but also the help of a specialist psychotherapist.

Psychologists advise, if possible, to start a special recovery diary, in which you need to write down all the nuances of your 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 epididymis

The period after the operation to remove the epididymis is always accompanied by antibiotic therapy: the drugs are prescribed for an average of 7-10 days. If the intervention was carried out due to a tuberculous inflammatory process, then anti-tuberculosis treatment is prescribed, and if the reason was a tumor, then chemotherapy is possible.

The stitches are usually removed on the eighth day after the epididymis is removed. If self-absorbing materials were used, they do not need to be removed.

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

Masturbation after epididymectomy, as well as sexual intercourse or any physical activity, should be excluded for 2-3 weeks after surgery.

Epididymide Removal Reviews

The majority of reviews about epididymectomy are positive. Patients note an improvement in their well-being, getting rid of regular exacerbations and unpleasant painful symptoms. Remote consequences develop extremely rarely, so almost no one talks about them. One of the main points is a careful choice of the clinic and the operating doctor. Although many operations are performed on an emergency basis, and choosing a specialist in such a situation is sometimes impossible.

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