Testicular surgery

There are situations in which a patient may need to have a testicle removed. This is a surgical procedure that is considered relatively simple in urology. Nevertheless, it requires a serious approach and preliminary preparation. Like all operations, it has its own indications, contraindications. Most often, pathology is observed in elderly men. Let's talk about it in more detail.

Indications for the procedure

The reasons for testicular removal in men are quite serious. The procedure has its own indications for behavior. So, the main indication is benign and malignant tumors of the testicle, prostate, prostate gland. The operation is indicated in severe inflammatory and infectious processes, sepsis. Sometimes the procedure is carried out with hydrocele, or hydrocele of the testicle. But it must be complicated forms of this disease, in which there is not only an intense accumulation of fluid in the testicle, but also suppuration, the development of purulent-septic processes. Indications are various neoplasms, tumors, seals that develop as a result of trauma to the testicle, as a result of the inflammatory process. If you do not pay attention to this pathology in time, and do not take the necessary measures, an inflammatory process develops, which can later develop into a tumor disease. Spermatocele is a complication of hydrocele, trauma and tumor processes, which is also considered as an indication for surgery.

As the main indications for surgery are considered the main symptoms: hyperthermia (increase in body temperature), discomfort in the perineal area, rupture of the testicular walls. If the scrotal skin is strongly stretched, there is pain in the testicle, scrotum, back, surgery is also performed. Also indications are necrosis, atrophic processes, degenerative age-related changes leading to progression of infection and inflammation, necrotic phenomena, erosions, ulcers. Sometimes testicular removal is performed in the case of intentional castration, when a man wants to become infertile, which is observed very rarely (however, there are such cases). The operation is also performed during sex reassignment, which is also not often observed. [1]

Surgery should be performed if there are indications for it. The main indication is the development of inflammatory and infectious processes, tumors, necrosis in adult men and sexually mature boys. This is characterized by pathological transformation of tissues, edema, inflammation. If there is soreness, swelling, redness, inflammation, discomfort, surgery is also performed. In the presence of any complications of testicular disease, pathology, surgery is performed at any age. Also to the indications include the following diseases: balanitis, alanopostitis, condylomatosis, the presence of any neoplasms, foreign bodies, infections under the foreskin and in the testicle itself. It should be borne in mind that the removal of the testicle is possible in case of its torsion with pronounced signs of necrosis, with damage to mucous membranes, tissues. [2]

Testicular removal - castration

Testicular removal is essentially castration. Castration refers to the removal of the reproductive organs of mature adult males. This is exactly what happens when the testicles, which are the main reproductive organs of men, are removed. There must be a valid reason for the surgery. The operation is also called orchiectomy. The essence consists in the excision and complete removal of the testicles. It is most often performed on older men. Adult men and young men whose reproductive function has not yet faded, it is necessary to perform this operation only as a last resort, if there are absolute indications, and if other treatment options are not possible. Also, this procedure can be performed in an emergency, in the presence of serious health risks. These are most often progressive infectious, inflammatory, necrotic, tumor and degenerative processes.

Removal of testicles for prostate cancer

Cancer, or malignant neoplasm is a serious cancer problem that requires serious radical treatment. Due to the fact that there is a risk of developing metastases and progression of the disease, radical treatment is performed. Often the removal of testicles is performed in prostate cancer, other similar conditions. In this case, not only the tumor itself is excised, but also the very organ in which the tumor is localized (testicle).

It should also be taken into account that a cancerous tumor can grow, blocking natural biological openings, including the urethra. The accumulation of exudate can lead to the development of purulent, septic inflammatory process. Often there is a tendency to further development of suppuration, accumulation of purulent contents.

Removing a testicle from a child

The main indications for testicular surgery in a child are benign and malignant neoplasms, including cancer, carcinoma, testicular cysts. In the presence of any tumor in the testicles of the child, in any case, surgery is indicated. Children undergo surgery if the size of the neoplasm exceeds 1 centimeter. With a smaller size of the pathological neoplasm, surgery can be prevented, while using conservative treatment. But if it is a malignant neoplasm, it will not be possible to avoid surgery. It is also necessary to monitor the patient's condition with ultrasound. [3]

Preparation

Preparation for testicular removal surgery is standard and does not differ from the process of preparation for other types of surgical intervention. It includes a set of necessary examinations, including blood tests, urine, feces, platelet index, ECG, fluorography. In addition, bacteriological and virological studies are carried out bacteriological and virological studies, studies for infections, including HIV, syphilis. Obligatory consultations of specialists are needed, and it is necessary to obtain a conclusion from a therapist or pediatrician, or a therapist, which will indicate the conclusion on whether the patient can be operated.

When planning general anesthesia, it is absolutely necessary to consult with an anesthesiologist, to choose the optimal method of anesthesia. As a rule, the allergist finds out the allergy history, selects the optimal and most effective and safe means for anesthesia, calculates their dosage.

The main preparation is carried out about a month before the planned date of the operation. If the operation is allowed, about 2-3 weeks in advance you should switch to a rational diet (exclude all fatty, fried, smoked). Also, you can not use marinades, spices, spices. Confectionery and alcohol for 14 days should also be completely excluded, cancel the intake of anticoagulants and other drugs.

On the day of surgery:

• you can't eat or drink anything.
• wash the genitals thoroughly using water and mild soapy lather.
• In the pubic and groin area, hair must be removed.

Before admission to the hospital, all necessary documents are drawn up, a written consent for the procedure is signed.

Anesthesia is required for the operation. Anesthesia is mandatory, but the method of anesthesia is determined by the doctor. The choice of method depends on the age of the patient, on the condition, severity, volume and duration of the surgical intervention. It also depends on the peculiarities of the psycho-emotional state of the patient. [4]

Technique of the testicular removal

When a testicle is removed, it is completely surgically removed (excision).There are several techniques for performing the operation. Classical removal involves the traditional removal of the organ using a surgical scalpel. There is an incision of tissues, their subsequent excision, suturing of tissues.

As a rule, there are no complications after the procedure. The duration of the procedure does not exceed 30 minutes.

The behavioral technique of the operation is as follows:

1. The surgical site is treated with a special antiseptic.
2. The organ is excised and removed from the wound.
3. The wound edges are sutured, antiseptic treatment is performed.

If the procedure is performed for cancer or other neoplasm, laser removal of the neoplasm itself is possible. With the laser beam, the movements can be finely controlled to minimize the risk of complications.

There are several variations of the operation. The testicle may be completely removed, along with the protein sheath that surrounds it and the appendage. In some cases, the appendage may be saved. In the simplest and most gentle method, only the testicular tissue is removed and the appendages and testicular sheath are preserved. [5]

Unilateral orchiectomy

A unilateral orchiectomy is a surgical procedure to remove one of the testicles. There may be many reasons for this: damage to the testicle, necrosis or atrophy of the tissue, development of a tumor.

Preparation for surgery is standard, performed in advance. It is carried out according to the same principles that are used for all surgical manipulations. To plan methods of anesthesia, anesthesia, anesthesia, it is necessary to consult with a specialist anesthesiologist.

The main preparation for the operation begins 2-3 days before the operation. The doctor will tell you how to prepare. Usually anticoagulants and other medications are canceled, a special diet is observed. For 2-3 weeks you can start drinking 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. The last meal should be 7-8 hours before the operation.

The essence of the operation consists of making an incision, cutting off the testicle, suturing the tissues. After surgery, it is necessary to follow the regime, rehabilitation.

Testicular appendage removal

In some cases, such as inflammation, cancer, infection, it may be necessary to remove the testicular appendage. Preparation is standard: medical examination, dietary recommendations, withdrawal of medications. On the day of surgery, it is necessary to thoroughly wash the genitals, waxing, without damaging the skin. The operation is done under general anesthesia, lasts several hours. After the operation, it is necessary to follow the postoperative regimen, undergo rehabilitation, be observed by a urologist and surgeon.

Testicular tumor removal

In benign or malignant neoplasms, removal of the testicular tumor is necessary. Preparation for surgery is carried out. Immediately before the operation is carried out examination (diaphanoscopy, ultrasound). In diaphanoscopy through the enlarged testicle shine a flashlight. According to the refractive indexes of light judge the nature and location of the tumor, plan the further course of the operation. If there is a tumor, or other thickening, neoplasm, the light does not pass.

Ultrasound is used if diaphanoscopy fails to make a diagnosis. Ultrasound clearly shows the structure of the pathology and can clearly differentiate the tumor.

There are several methods of surgical treatment. In particular, there are minimally invasive and radical treatments. Minimally invasive treatment is most often puncture and sclerosing. Radical methods - complete removal of the testicle along with the tumor. The choice of method depends on many factors.

Removal of left testicle, right testicle

Sometimes unilateral orchiectomy is performed - surgery to remove one testicle (left or right). Indications may vary, but most often it is irreversible inflammatory, infectious processes, tumors, necrosis, sepsis. On average, the duration of surgery ranges from 30-40 minutes in the simplest cases, to 2-3 hours in more severe cases. Of course, complex anesthesia is used. It is necessary to prepare in advance and strictly observe the rehabilitation period.

Contraindications to the procedure

In general, contraindications to testicular removal are standard, as with any surgical procedure. There are no specific contraindications in this case, with the exception of preserved reproductive function. In this case, if there are no urgent and absolute indications, it is better to consult a reproductologist beforehand. It may be possible to preserve the reproductive function.

Otherwise, the operation is not performed in acute inflammatory processes in the pelvic organs, with active colds and infectious diseases, with viruses in active form. Strictly contraindicated operation in various serious pathologies of the kidneys, liver, with insufficiency and violation of the functional state of the cardiovascular system, respiratory function, hypertension. It is better not to perform the operation in case of vascular tone disorders, heart rhythm, in the presence of a pacemaker, COPD, CHF, immunodeficiencies, autoimmune pathologies.

As contraindications to the operation of testicular removal are considered severe decompensated pathology of internal organs, at least until the disease is stabilized.

Surgery is not performed in acute infectious and inflammatory processes, hemostasis disorders, blood coagulation disorders, taking anticoagulants. In this case, it will be necessary to cancel anticoagulants, if possible, and consultation with a hematologist. The procedure is contraindicated in intolerance to anesthesia, pronounced and moderate allergic reactions, especially immediate type (anaphylactic shock, choking, Quincke's edema). Do not perform the procedure in case of increased sensitization of the body, acute inflammatory and infectious pathologies, exacerbations of asthma.

It is also not necessary to perform the operation in the presence of pustular infections, in the presence of pus and exudate in the area of the operation, in the progression of inflammatory and infectious process, in the presence of sexually transmitted diseases. However, this contraindication is temporary, it is necessary to undergo appropriate treatment, and after recovery, the operation can be performed.

Surgery is not performed in severe forms of diabetes mellitus, blood clotting disorders, hemophilia, taking anticoagulants, varicose veins, thrombophlebitis and other vascular and blood diseases.

Consequences after the procedure

Certainly, after surgery, the condition of the body changes. The main consequence is infertility. But there are cases in which the reproductive function can still be preserved. In this case, treatment is carried out individually, you need to consult a reproductologist and further observation, compliance with his recommendations. It is worth noting that often the operation entails a number of mental problems: the patient is depressed, feels depression, apathy, depression. To overcome the condition will help to consult a psychologist.

Another unfavorable consequence is that after surgery, immunity is drastically reduced, which favors the development of hospital strains of microorganisms.

Postoperative period

As after any surgical intervention, the postoperative period will have to be observed. Immediately after surgery, the patient is transferred to a postoperative ward. There he is under the supervision of doctors from a few hours to a few days. Then the patient is transferred to the ward of general therapy. In the absence of complaints and complications, the patient is discharged after a few days.

Recommendations and appointments are made at home. Further treatment in the outpatient clinic is possible. In general, the rehabilitation period does not exceed 1 month. For the first 2-3 days, bed rest will be required. Later it will be necessary to wear a special bandage (bandage). This allows you to avoid the development of complications: edema, hyperemia.

Pain after testicular removal

For some time after surgery to remove the testicle, there may be pain in the genitourinary tract, perineum, pelvis. This is due to tissue damage that is inevitable during surgery. It is not necessary to tolerate pain. It is better to contact a doctor who will prescribe treatment: painkillers. Usually the doctor immediately tells the patient what means to take, conducts the appropriate analgesic treatment. At first, strong painkillers are used, in the form of injections and drips. But after a few days, you can switch to lighter ones: analgin, aspirin, paracetamol, spasmolgon, no-shpa, citramone. If these drugs are ineffective, prescribe stronger ones: ketanol, ketolorac, ketoferil (prescription). 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.

Complications after the procedure

Complications after the procedure are rare, however, they are possible. After surgery, a temperature increase is possible, which may be due to the natural recovery processes in the body (this entails a number of transformations, tissue and cellular reactions, in connection with which there is a slight increase in temperature). In the normal course of the recovery period, the temperature does not exceed 37.0-37.2 degrees. Another reason for an increase in temperature is a natural reaction in response to mechanical tissue damage. This is not dangerous, often does not require special treatment. You can take an antipyretic or anti-inflammatory drug.

However, if the temperature rises above 37.5, it can already be considered as an unfavorable sign, and indicates the development of complications and pathological conditions. This can be inflammatory, infectious process, suppuration in the area of the wound, sutures, and even necrosis and atrophy of tissues.

A sharp rise in temperature to high values (up to 38.5 - 39 and higher) is observed when a hospital infection joins. This dangerous infection, which causes severe complications, is the most dangerous form of infection. Sometimes there is a sharp rise in temperature up to 40 degrees, and even higher. Hospital strains of microorganisms are dangerous in that they are practically untreatable, since they are resistant to most antibacterial agents and disinfectants. They have developed resistance and increased survivability as a result of adaptation to the conditions of existence in the hospital. They survive well in the environment and multiply rapidly when ingested. Once in the human body, cause severe complications, generalized infections that progress very rapidly and are not amenable to treatment. Such conditions often lead to rapid development of bacteremia and sepsis (a person can die from blood poisoning). Timely treatment can prevent lethal outcome. Therefore, any rise in temperature should be a reason to contact a doctor or call an ambulance. [6]

Care after the procedure

For some time after the procedure, the patient will need special care and rehabilitation. After surgery, in the first few days there is a feeling of discomfort, pain. But these sensations, as a rule, disappear within a few days. It is also worth noting that the pain is quite easily managed with the help of conventional painkillers. After surgery, it is extremely important to observe the correct rehabilitation period, the duration of which ranges from several weeks to several days, depending on the severity of the condition, the chosen technique of surgery. It is important to provide proper skin care, to carry out genital hygiene. It is necessary to use sterile dressings (dry, clean). Shower for some time it is better not to take a shower, or put on a condom while taking a shower. Children are not recommended to take a shower. For them, ordinary rubdowns are quite enough. They should be carried out in such a way as not to wet the bandage.

You also need to consider that men may experience nocturnal spontaneous erections that cause pain and discomfort. It can also lead to blood flow disorders. Sometimes, with a strong erection, it is possible that the sutures may diverge, but this is extremely rare. With a pronounced blood flow disorder, the bandage should be removed for a while. As a rule, in this case, the penis will be swollen, slightly increased in size. But this should not cause concern, as this is a normal reaction to tissue damage. Usually, the removal of sutures is not required, since in the process of surgery self-absorbing threads are used. They do not need to be removed unless they have not dissolved within 10 days.

After the procedure, special care and rehabilitation are required. At the initial stages, the patient is transferred to a postoperative ward. There he is monitored, the person comes out of anesthesia. Then the person can be transferred to a regular ward. In the normal course of the postoperative period, the patient is released home.

In the first days, you need to take care of the stitches (go to the clinic for dressings, visit the surgeon). Initially, it is necessary to observe bed rest, drink a lot. The patient's activity is sharply limited, but this is only for a few days. In the first 2-3 days, bed rest will be required (reduces the swelling of the genitals). During the entire rehabilitation period, it is necessary to wear sweaty fitting underwear, a special bandage (bandage). After a few days, the bandage is removed. It can be removed by a doctor, or the patient himself. It is also necessary to be constantly monitored by a surgeon.

Life after testicular removal

Some patients say their life changes after testicular removal. Others do not feel any change. Undoubtedly, testicular removal entails some psychological discomfort. Some patients experience this condition severely, others bear it easily. It all depends on the mental state and mood. As a rule, young patients with preserved reproductive function tolerate this condition more severely than older people. This is primarily due to the fact that after the operation the reproductive function is lost, a person becomes infertile. Nevertheless, modern medicine and reproductive technologies in some cases make it possible to preserve even the reproductive function. Some patients have postcancer syndrome - patients are accompanied by fear of sexual life, psychological problems associated with the feeling of defect and inferiority. There may also be hormonal disorders, which are accompanied by rapid weight gain and muscle mass. But this can be controlled. The achievements of modern andrology and reproductology make it possible to restore sexual function.

Sexual activity after testicular removal

After the operation, sex is contraindicated for 2-3 weeks. Otherwise, sexual life after testicular removal is not limited in any way, there are no contraindications to having sex. But the problem is that some patients experience psychological problems that prevent them from having sexual intercourse, experiencing erection and orgasm. Many experience failures in sexual intercourse, but they have no physiological basis. It is purely a psychological problem.

If the postoperative wound heals well, there are no complications and painful sensations, after this time, you can resume intimate life. However, 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. During this time it is necessary to observe sexual rest. Otherwise, complications may develop.

Testimonials

We have analyzed the reviews about the operation. Removal of the testicle for a man is a serious problem, which is rather psychological in nature. In most cases, reviews are written by mothers of children who have had this operation. Adult men prefer not to discuss this topic, considering it delicate. As reviews show, the operation significantly alleviates the condition of patients suffering from infectious, inflammatory diseases, necrosis, tumors. Relief comes at the level of physiology. But instead there are a number of psychological problems - a sense of inferiority, inferiority, fear of sexual life, further family life, doom, the inability to become a father. Children tolerate the operation more easily. As a rule, more stress is experienced by the child's parents. The child himself quite quickly forgets about the operation, carry it easily, without complications. The earlier such an operation is performed, the less psychological problems will arise in the future in men. Adult men usually leave reviews only if the result is unfavorable, or there were complications. The main complications are inflammation, infection, prostatitis.