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Health

Removal of the epididymis

, medical expert
Last reviewed: 01.11.2022
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Anatomically, the epididymis is an independent organ that provides "ripening" of spermatozoa. Under certain factors (injuries, inflammatory and tumor processes), the question of removing the epididymis may arise: this is a rare operation, which is prescribed when prolonged conservative treatment is ineffective.

Indications for the procedure

Removal of the epididymis is performed only under 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, experts distinguish such clear indications:

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

Removal of an epididymal cyst is most often carried out by excision, while preserving the testicle itself. Complete removal - epididymectomy - is carried out only in difficult cases, for example, with the development of complications, when all tissues of the organ are involved in the pathological process.

Preparation

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

  • urological examination with palpation assessment 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, as well as any medications not prescribed by the attending physician, are excluded. The day before the operation, they adhere to a “light” diet, eating foods that do not weigh down the digestive tract. Exclude from the diet meat, lard, fatty foods, mushrooms, nuts, legumes. Dinner is cancelled. Do not eat or drink on the day of the operation.

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

On the morning before the removal of the epididymis, the patient washes thoroughly in 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 epididymis is carried out urgently, then the entire list of preparatory measures is performed in stationary conditions.

Technique of the removal of the epididymis

The patient is laid on his back, an anesthetic is injected depending on the type of anesthesia. As a standard, the operation to remove 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 carried out due to a tuberculous lesion, then the incision area is extended to the outer inguinal ring, including the sinus openings;
  • from the upper part of the head of the appendage, they begin to excise, dividing and bandaging the vas deferens;
  • they try to carry out the manipulation as close as possible to the epididymis, avoiding damage to the testicular vessels that lie along the medial border;
  • the epididymis is exposed and lifted, the vas deferens is pulled and cut with chrome-plated catgut 3.0;
  • the wound is sutured with an interrupted suture using catgut 3.0;
  • the testicle is moved to the scrotum area, tissues are sutured;
  • the testicle is sutured to the scrotum to prevent it from twisting;
  • drainage is usually not required, or it is installed for up to 24 hours;
  • complete the removal by putting on a suspensor.

The seized material is mandatory sent for histological examination.

In general, several techniques for removing the epididymis are known. The most suitable option is selected by the surgeon who will perform the operation.

Contraindications to the procedure

Contraindications to the removal of the epididymis can be absolute and relative:

  • They say about absolute contraindications if the intervention can lead to a deterioration in well-being or even to the death of the patient. This refers to: a fresh myocardial infarction, an acute form of cerebrovascular insufficiency, etc.
  • Relative contraindications are diseases, the course of which may be aggravated under the influence of surgery - for example, hypertension, diabetes, bronchial asthma, etc.

In addition, the removal of the epididymis is postponed if the patient has a clear bleeding disorder. The operation is prescribed again after the correction of the coagulation picture of the blood.

Consequences after the procedure

As a rule, no functional and organic consequences are observed after removal of the epididymis. Spermatogenesis stops, but this does not affect the functional ability of the organ.

Swelling and pain after surgery usually go away on their own or with supportive restorative treatment. With improper care, suppuration rarely develops, which is opened and drained.

In some cases, the removal of the epididymis is accompanied by the formation of a pronounced scar, or atrophy of the testicles. However, these effects are rare.

Complications after the procedure

Most often, after removal of the epididymis, complications occur due to bleeding from damaged and poorly bandaged vessels. In this case, the formation of a hematoma of the interstitial or intrathecal type is possible. The hemorrhage itself does not pose any threat to health and life, however, it raises many questions, being a cause for concern for the patient. When a hematoma appears, the doctor may insist on a longer hospital stay of the patient.

A serious complication after removal of the epididymis can be the attachment of an infection, with the development of infectious and inflammatory foci. In this case, intensive anti-inflammatory treatment is carried out with the use of nonsteroidal drugs and antibiotics.

Care after the procedure

The operation to remove the epididymis in different patients can proceed in different ways. However, the main goal of rehabilitation measures is always to eliminate pain, accelerate tissue repair and wound healing, maintain normal blood flow in the affected area, and prevent postoperative complications. Of great importance is the observance of asepsis and antiseptics, 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 recovery methods, the doctor may recommend the following:

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

Psychologists advise, if possible, to start a special recovery diary in which you need to record all the nuances of well-being, noticing the progress of recovery. Such a simple measure sets up 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: drugs are prescribed for an average of 7-10 days. If the intervention was carried out for a tuberculous inflammatory process, then anti-tuberculosis treatment is prescribed, and if the cause was a tumor neoplasm, then chemotherapy is possible.

Removal of sutures is usually carried out on the eighth day after removal of the epididymis. If self-absorbable materials were used, then 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 the hospital is determined individually, but on average it is 3-4 days.

Masturbation after removal of the epididymis, as well as sexual intercourse or any physical activity should be excluded for 2-3 weeks after the operation.

Reviews about the removal of the epididymis

The dominant part of the reviews about the removal of the epididymis is positive. Patients note an improvement in well-being, getting rid of regular exacerbations and unpleasant painful symptoms. Long-term consequences develop extremely rarely, so almost no one talks about them. One of the main points is the careful choice of the clinic and the operating doctor. Although many operations are performed on an emergency basis, and the choice of a specialist in such a situation is not possible.

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

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