Testicular surgeries

Surgical interventions on the testicles – operations on the testicles – are performed to eliminate defects in their development and the consequences of injuries, as well as a method of getting rid of other pathologies of the male reproductive glands.

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Indications for the procedure

Reasons for performing testicular surgery include:

• undescended testicles – absence of one or both testicles in the scrotum, defined as cryptorchidism or ectopia testis. The pathology is detected in 3-4% of newborn boys and is more common in premature infants. In 80% of cases, only one testicle is undescended (unilateral cryptorchidism), that is, surgery is performed on the left or right testicle;
• testicular torsion – twisting of the spermatic cord with blood vessels and nerve fibers passing through it, which occurs due to rotation of the testicle in the scrotum (usually occurs in boys, adolescents and young men). This surgical intervention is urgent and must 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 saved, a delay of six or more hours almost always leads to tissue necrosis, requiring removal of the testicle;
• the inability of hormone therapy to cure testicular atrophy, in which the testicles shrink and both their germ cells (which produce sperm) and their testosterone-producing Leydig cells cease to function;
• testicular cysts, including a fluid-filled epididymal cyst (forming in the epididymis, where the spermatic cord attaches), which can be large enough to cause discomfort; or a spermatocele, a cyst filled with sperm;
• accumulation of fluid in the scrotum, around the testicle - testicular hydrocele;
• abnormal expansion of the network of veins of the testicles - varicocele, which can cause pain, testicular atrophy and be the cause of male infertility;
• testicular cancer (seminoma, choriocarcinoma, teratoma, embryonal carcinoma, sarcoma, etc.), which accounts for 1-2% of all types of oncology in men.

Surgeries are also performed to replace the removed testicle, 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 of examination of the scrotum, pelvic organs and abdominal cavity using X-rays, ultrasound and other visualization methods.

Blood tests (general clinical, coagulation, STD, HIV and hepatitis) and urine tests are taken, an ECG and a lung X-ray are done.

6-8 hours before the scheduled surgery, the patient stops eating solid food, and 2-3 hours before the scheduled surgery, stops drinking liquids.

Technique testicular surgery

Testicular descent surgery

Usually, within the first three to six months of a boy's life, the undescended testicles move into the scrotum naturally, but if this does not happen and cryptorchidism is diagnosed, an operation to lower the testicle into the scrotum is required - testicular descent or orchiopexy, which must be performed before the child is 12 months old. Thus, this operation is performed on the testicles of children.

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

For more information on what preparation for orchiopexy involves, how it is performed, and what the possible consequences and complications may be, read the extensive article – Testicular descent

Testicular cyst surgery in men

Epididymal cysts (spermatoceles) are removed through an incision in the scrotum – to the testicle and its epididymis, with the testicle removed from the incision and the cyst separated from the epididymis (sometimes part of the epididymis has to be removed). The wound is then sutured, and drainage is placed to prevent fluid accumulation in the scrotum.

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

The operation is completed by applying a sterile bandage and an ice pack to prevent a hematoma from forming on the testicle after the operation.

Testicular Varicocele Surgery or Testicular Vein Removal Surgery

Enlargement and/or widening of veins in the scrotum (varicocele) can cause pain and swelling, and the goal of surgical treatment of this pathology is to stop the backflow of blood from the renal vein to the scrotum. Laparoscopy and microsurgical techniques are currently used to perform this intervention; anesthesia is local or general. And the results of both types of surgery are similar, because the incisions are minimal.

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

The technique of laparoscopic clipping of the testicular vein is used. To block the blood flow to the varicocele,

Hydrocele surgery

Hydrocele is most common in infants when there is an opening between the abdominal cavity and the scrotum, and in men, dropsy is formed due to trauma, infectious inflammation of the testicles or their appendages (epididymitis).

Hydrocele removal surgery is performed using the Winkelmann, Bergman or Lord methods, and the surgeon chooses the most appropriate one in each specific case.

The first two methods involve cutting or excising the testicular membrane with subsequent eversion and suturing from the back of the testicle. This operation on the testicles in children requires general anesthesia, in adults local anesthesia is sufficient.

Also, removal of hydrocele is performed using a laser (on an outpatient basis under local anesthesia).

Surgery for testicular torsion

If testicular torsion occurs, surgery is needed immediately to relieve pain and swelling and prevent loss of the testicle.

An incision is made in the scrotum - with exposure and removal of the testicle, untwisting of the spermatic cord and fixation of the testicle to the tissues of the internal septum of the scrotum using sutures. Drainage of the postoperative wound is installed.

In a situation where the ischemic condition of the testicle has been long-term and it is not possible to restore blood flow, the surgeon decides to remove the testicle.

Surgery to remove the testicles - orchiectomy

Removal of the testicles (orchiectomy) is the first treatment for testicular cancer and also helps control prostate cancer (since prostate cancer requires testosterone to grow, and testosterone levels in the blood drop rapidly after testicle removal).

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

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

In all types of orchiectomy, the operation is performed by direct access - through dissection of the scrotum tissue with the removal of the testicle and spermatic cord. In case of radical removal, the spermatic cord is first ligated, and then the testicle itself is excised.

Contraindications to the procedure

Surgery on the testicles for congenital hydrocele is not performed on boys under the age of one and a half years.

Contraindications to the procedure also include:

• decreased blood clotting, in particular thrombocytopenia and hemophilia;
• general infectious diseases and acute inflammatory processes;
• infectious genital lesion;
• cardiovascular failure;
• severe renal and/or hepatic insufficiency;
• severe pulmonary pathologies with respiratory failure.

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Consequences after the procedure

With unilateral testicular removal, erectile function is usually not affected, but the consequences of a bilateral orchiectomy procedure include the cessation of sperm production and the loss of the man's ability to fertilize.

In addition, without testicles, the male body lacks testosterone, which reduces libido and the ability to have an erection. Other consequences include increased fatigue, hot flashes to the head and upper body, and loss of muscle and bone mass. To correct these side effects, patients are prescribed drugs that replace the endogenous sex hormone.

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Complications after the procedure

In addition to pain of varying intensity and swelling of the scrotum, surgery on the testicles may have complications in the form of: adverse reactions to general anesthesia; bleeding (including internal); secondary infection of the postoperative wound; a hematoma on the testicle is possible after surgery.

The main complications after testicular descent surgery are: the testicle returns to the groin area, and if there is insufficient blood supply after moving it 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 make it difficult for sperm to pass.

In case of removal of a cyst, hydrocele or varicocele, damage to the testicle and its atrophy are possible. In addition, the operation to remove veins on the testicles can be complicated by bilateral hydrocele of the testicles (due to poor lymph drainage).

And when performing an orchiectomy, injury to blood vessels and nearby anatomical structures, including the urethra, cannot be ruled out.

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Care after the procedure

It is necessary to take care after surgery on the testicles and follow all the doctor's recommendations. So, to reduce pain, analgesics and NSAIDs are prescribed, to prevent inflammation - antibiotics, and to reduce swelling, an ice pack should be placed on the scrotum (no longer than a quarter of an hour - several times a day).

After surgery for testicular torsion, patients may be prescribed heparin and novocaine (intramuscular injections).

For at least a week, you need to give up fatty foods, which take longer to digest and overload the gastrointestinal tract, but you need to drink enough water.

Until the suture is completely healed (the sutures are removed approximately one week after the procedure), physical activity and water procedures are prohibited; sexual intercourse is prohibited for a month. The doctor may allow sports activities one to two months after the operation.

If surgery was performed on a testicular cyst in men or on varicocele/hydrocele, then it is mandatory to wear a suspensory.

Regardless of the reviews about the surgery on the testicles, patients should understand that there are pathologies and conditions in which this surgical intervention is inevitable.

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