Operations on the testes

Surgical intervention on testicles - operations on testicles (testes) - are carried out to eliminate defects in their development and the consequences of injuries, as well as as a method of getting rid of other pathologies of the male sex glands.

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Indications for the procedure

The reasons for the operation on the testicles include:

• Undescended testicles - lack of one or both testes in the srotenum, defined as  cryptorchidism  or ectopia of testicles. Pathology is detected in 3-4% of newborn boys and is more common in preterm infants. In 80% of cases, only one testicle (unilateral cryptorchidism) is omitted, that is, surgery is performed on the left testicle or on the right;
• torsion of the testicle  - the twisting of the spermatic cord with the blood vessels and nerve fibers passing through it, which occurs due to the twisting of the testicles in the scrotum (as is usually the case in boys, adolescents and young men). This surgical procedure is urgent and should be performed within four hours after the onset of symptoms (pain, swelling of the scrotum, nausea). Although the operation does not guarantee that the testicle will be preserved, but a delay of six hours or more almost always leads to necrosis of the tissues, requiring removal of the testicle;
• the inability, with the help of hormone therapy, to cure  atrophy of the testicles, in which they decrease and cease to function as their germ cells (producing sperm), and testosterone-producing Leydig cells;
• a testicle cyst, including a fluid-filled epididymal cyst (formed in the epididymis, at the point of attachment of the spermatic cord), which may be large enough to cause discomfort; or  spermatocele  - cyst, filled with sperm;
• accumulation of fluid in the scrotum, around the testicles - hydrocele of the testicle;
• abnormal enlargement of the network of testicle veins -  varicocele, which can cause pain, testicular atrophy and cause male infertility;
• testicular cancer  (seminoma, choriocarcinoma, teratoma, embryonic carcinoma, sarcoma, etc.), which accounts for 1-2% of all types of oncology in men.

Also, operations on prosthetics of the removed testicle are performed, helping to give the scrotum a normal anatomical appearance. This operation can be performed simultaneously with the removal of the testicle or later.

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Preparation

Preparation for any surgical intervention on the testicles consists in examining the scrotum, pelvic organs and abdominal cavity with the help of radiography, ultrasound and other imaging techniques.

Blood tests (general clinical, coagulation, STD, HIV and hepatitis) and urine are given, ECG and X-ray of the lungs are done.

6-8 hours before the scheduled operation, the patient stops taking solid food, and for 2-3 hours - the use of liquid.

Technique of the operations on the testicles

Operation to lower the testicle

Usually, during the first three to six months of the boys' life, untreated testicles move to the scrotum naturally, but if this does not happen and the cryptorchidism is diagnosed, an operation will be required to lower the testicle into the scrotum-a testicle or orchipexis that must be performed before the child turns 12 months. Thus, this operation is performed on testicles in children.

The type of operation - open surgery or laparoscopic, and also how long the operation lasts on the testicle - depends on the location of the undescended testicle; all manipulations are performed under general anesthesia. When the testicle is in the groin, simple orchidectomy can be performed, and the duration of such an operation does not exceed 40-45 minutes. But with a high retroperitoneal location of the testicle, a two-step operation using the Fowler-Stevens technique may be required: the second stage follows a few months after the first intervention.

More details about what is the preparation for orchitis, how it is carried out and what the consequences and complications may be, read the extensive article -  Testicular Ejaculation

Operation on the testicle cyst in men

Epididymal cysts (spermatoceles) are removed through the incision of the scrotum - to the testicle and its appendage, with the extraction of the testicle from the incision and the separation of the cyst from the epididymis (sometimes the part of the appendage must be removed). Then the wound is sutured, and to prevent the accumulation of fluid in the scrotum, drainage is put.

It is also possible to perform laparoscopic surgery (through three small incisions).

The operation is completed by applying a sterile bandage and applying a bladder with ice - so that there is no hematoma on the testicle after the operation.

Surgery to remove varicocele on the testicle or surgery to remove veins on the testicles

The enlargement and / or expansion of veins in the scrotum (varicocele) can cause pain and swelling, and the goal of surgical treatment of this pathology is to stop the reverse blood flow of renal veins to the scrotum. Now laparoscopy and microsurgical technique of this intervention are applied; anesthesia - local or general. And the results of both types of operation are similar, because the cuts are minimal.

The procedure begins with a skin incision of 2-2.5 cm near the inguinal fold and the upper part of the scrotum. The spermatic cord is released, its dissection is made and ligature is applied to hypertrophied venous vessels. Then the seed cord returns to its place, and the incision is closed in two layers.

Apply the technique of laparoscopic clipping of the testicle vein. For blocking the blood flow to the varicocele,

Operation to remove the dropsy (hydrocele)

The hydrocele is most commonly found in infants when there is an opening between the abdominal cavity and the scrotum, and in men hydrocele is formed due to trauma, infectious inflammation of the testicles or their epididymitis.

The operation to remove the hydrocele is carried out according to the methods of Winckelmann, Bergman or Lord, and the surgeon chooses the most suitable in each specific case.

The first two methods involve dissection or excision of the testicle of the testis, followed by its reversal and stitching on the back side of the testicle. This operation on the testicles in children requires general anesthesia, in adults enough local anesthesia.

Also, the removal of the dropsy of the testicles is performed with a laser (on an outpatient basis under local anesthesia).

Surgery for torsion of the testis

If there is a torsion of the testicle, surgical intervention is necessary immediately to alleviate the pain and swelling and prevent the loss of the testicle.

The incision is made in the scrotum - with the exposure and extraction of the testicle, the untwisting of the spermatic cord and the fixation of the testicle to the tissues of the internal septum of the scrotum using seams. Drainage of the postoperative wound is established.

In a situation where the ischemic condition of the testicle was prolonged and the blood flow can not be restored, the surgeon decides to remove the testis.

Surgery to remove testicles - orchiectomy

The removal of the testicles (orchiectomy) is the first method of treatment for testicular cancer, and also helps to control prostate cancer (because testosterone is needed to grow a prostate tumor, and testosterone levels drop rapidly after removal of the testes).

This is a complex and lengthy operation. With oncology, the technique of radical inguinal orchiectomy (assumes removal of the testis together with the spermatic cord, as well as simultaneous retroperitoneal dissection of nearby lymph nodes).

In other cases, a subcapsular orchiectomy is used: the glandular tissue of the testicle is removed, and its shell is left. Partial removal can also be performed - excision of the testicle part or  resection of the testicle.

With all types of orchiectomy, the operation is performed by direct access - through the dissection of the tissues of the scrotum with the excretion of the testis and the spermatic cord. With a radical removal, the ligation of the spermatic cord is first performed, and then the testicle itself is excised.

Contraindications to the procedure

Operation on testicles with congenital dropsy of testicles is not carried out to boys under the age of one and a half years.

Contraindications to the holding also concern:

• reduced blood clotting, in particular, thrombocytopenia and hemophilia;
• common infectious diseases and acute inflammatory processes;
• infection of the genitals;
• cardiovascular insufficiency;
• severe renal and / or liver failure;
• severe pulmonary pathologies with respiratory failure.

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Consequences after the procedure

With unilateral removal of the testicles, erectile function usually does not suffer, but the consequences after the procedure of bilateral orchiectomy are manifested in the cessation of sperm production and the loss of a man's ability to fertilize.

In addition, without testicles, the male body lacks testosterone, which reduces libido and erectile ability. Other consequences are manifested by increased fatigue, hot "tides" to the head and upper body, loss of muscle and bone mass. To correct these side effects, patients are prescribed the use of drugs that replace the endogenous sex hormone.

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Complications after the procedure

In addition to pain of varying intensity and edema of the scrotum, the operation on the testicles can have complications in the form of: an adverse reaction to general anesthesia; bleeding (including internal); secondary infection of the postoperative wound; Possible hematoma on the testicle after surgery.

The main complications after the operation to ovulate the testicle: the return of the testis to the groin area, and with insufficient blood supply after moving to the scrotum, there is a risk of atrophy of its glandular tissue (leading to the need for orchiectomy). There is a risk of damage to the vas deferens, which will subsequently complicate the passage of sperm.

In the case of removal of a cyst, dropsy or varicocele, testicular damage and atrophy are possible. In addition, surgery to remove veins on the testicles can be complicated by a bilateral hydrocele of testes (due to a poor outflow of lymph).

And when carrying out an orchiectomy, injury to blood vessels and nearby anatomical structures, including the urethra, is possible.

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Care after the procedure

It is necessary to care after the operation on the testicles and follow all the recommendations of the doctor. So, analgesics and NSAIDs are prescribed to reduce pain, so that there is no inflammation - antibiotics, and to reduce the swelling it is necessary to put a package on the scrotum with ice (no more than a quarter of an hour - several times a day).

After the operation, when twisting the testicle, patients can be prescribed heparin and novocaine (IM injections).

At least a week you need to give up fatty foods, which are digested longer and overload the digestive tract, but you need to drink enough water.

Until the seam is fully healed (seams are removed about a week after the intervention) physical activities and water procedures are prohibited; during the month you can not have sex. Sports doctor can solve the problem in one to two months after the operation.

If an operation was performed on the testicle of the testicle in men or in varicocele / dropsy, then the suspensions should be worn without fail.

Whatever the testimony about the transplanted operation on the testicles, patients should understand that there are pathologies and conditions in which this surgical intervention is inevitable.

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