Surgery for testicular hydrocele

Surgery for testicular hydrocele is perhaps the only effective way to treat this disease. Traditional methods are often ineffective. However, they are also used mainly in the early stages of the disease, or if necessary to delay surgery, delay and stop the disease.

Indications for the procedure

A hydrocele is also called hydrocele. This is the main indication for the operation. A hydrocele is a pathological process, accompanied by the accumulation of a large amount of fluid in the space between the testicular membranes. There can be many reasons, but most often in children it is a congenital pathology, and in adults it is an injury, or an inflammatory process. In case of an acute inflammatory and infectious process, trauma, an operation may be required. In children, a hydrocele often develops if the child's peritoneum is not overgrown. This is often an indication for surgery. It is also worth noting that against the background of dropsy, pain, pressure, a feeling of heaviness, discomfort, and difficulty urinating can develop.

Preparation

Preparation for the operation to remove the hydrocele of the testicle is standard, carried out in advance. It is carried out according to the same principles by which all surgical procedures are carried out. At the first stage, it is necessary to pass a set of necessary examinations (clinical and biochemical blood tests, urine tests, blood clotting tests). At the second stage, instrumental studies are carried out (ECG, fluorography, ultrasound). Be sure to conduct research on infections, including HIV infection, the Wasserman reaction. At the third stage, consultations of specialists are held, including an anesthesiologist, a surgeon, a cardiologist, and a urologist. At the fourth stage, you need to get the conclusion of a pediatrician, or a therapist, which will indicate the conclusion about whether the patient can undergo surgery.

To plan the methods of anesthesia, anesthesia, anesthesia, it is necessary to consult with a specialist anesthetist. The anesthetist needs a complete medical history.

If surgery is not contraindicated, careful preparation is necessary. The first thing to do is to switch to a balanced diet in about 2-3 weeks. From the diet you need to exclude all fatty, fried, smoked, marinades, pickles, spices, spices, alcohol. Confectionery, coffee, strong tea should be completely excluded. Reception of anticoagulants and other medicines is cancelled. For 2-3 weeks, instead of tea, you can start drinking a decoction of anti-inflammatory herbs, in particular, chamomile, or calendula. You can also drink rosehip broth - this is a huge source of vitamins and minerals. This will allow you to transfer the operation well and quickly recover after it. The last meal should be 7-8 hours before the start of the operation. Also on the day of the operation, it is necessary to thoroughly wash the genitals, conduct epilation without damaging the skin.

An additional examination is carried out immediately before the operation. Methods such as diaphanoscopy, ultrasound are used. The essence of diaphanoscopy is that a flashlight shines through an enlarged testicle. According to the refractive indices of light, the state and severity of the pathology, the amount of liquid are judged. So, water freely transmits light unchanged. If there is a tumor, or another seal, neoplasm, the light does not pass. You also need to consider that in the presence of a scar, or after a recent operation in the scrotum, with inflammation of the testicles. In this case, during diaphanoscopy, blood will accumulate between the membranes of the testicle. It also doesn't transmit light very well.

Ultrasound is used if diaphanoscopy fails to make a diagnosis. On ultrasound, the structure of the pathology is clearly visible, it is possible to clearly differentiate a tumor, hernia, hydrocele and other similar conditions.

Another important feature of the preparation for the operation is that immediately before the operation it is necessary to cure all inflammatory and infectious processes, including colds, caries. In case of acute inflammatory, infectious diseases, exacerbation of chronic pathologies, the operation should be postponed.

Technique of the surgery for testicular hydrocele

Let us consider in more detail the technique of the operation to remove the hydrocele of the testicle. There are several methods of surgical treatment. In particular, there are minimally invasive and radical treatments. Minimally invasive treatment is most often puncture and sclerotherapy. The main methods of radical intervention are suturing the testicular membranes. It's just that the operation will be ineffective if the main causes that call for the development of dropsy are not fully eliminated. If the causes are not eliminated, the effect of the procedure will be temporary.

A puncture is one of the types of surgical intervention in which the patient's condition can be temporarily alleviated. The puncture gives only a temporary effect, and is used if a full-fledged operation is contraindicated. As a rule, the effect of this procedure lasts for 5-6 months. The operation is performed under local anesthesia by injecting an anesthetic into the puncture site. The puncture is made with a thin needle. The liquid is pumped out, then the puncture must be sealed with a sterile plaster.

The Ross operation is a surgical technique that is indicated for patients under the age of 2 years. The operation is performed for congenital testicular pathologies. Preparation for the procedure is standard. During the operation, the patient lies on his back, legs apart. The doctor injects anesthesia. After the anesthesia takes effect, the doctor disinfects the skin. Then an incision is made in the lower abdomen. This allows you to visualize the spermatic cord, and separate it so as not to damage during the operation. Then it is necessary to isolate the process of the peritoneum, due to which the development of the hydrocele occurs. The formation is crossed, the stump is bandaged. As a result, a hole is formed on the inner surface of the testicle, in its shell, through which the outflow of fluid occurs. After performing all the necessary manipulations, the doctor sutures the operation site and applies an antiseptic bandage.

How long does testicular hydrocele surgery take?

In order to answer the question of how long the testicular hydrocele operation lasts, it is necessary to take into account the severity of the pathology, the age of the patient, and other individual characteristics. On average, the duration of the operation ranges from 30-40 minutes in the simplest cases, up to 2-3 hours in more severe cases. In this case, the simplest procedure is considered to be a puncture, in which the doctor makes punctures with a needle, after which he pumps out the liquid with a special syringe. This is the least dangerous and least traumatic procedure.

Lord's operation for hydrocele

The most effective way to treat hydrocele is considered to be a procedure such as plication of the membranes. This procedure was developed by the Lord, which is why it was called the Lord's operation. The advantage of this technique is that with this procedure, the risk of complications and injury to surrounding tissues is minimized. During the operation, the patient is in the supine position. In this case, an antiseptic treatment of the scrotum with an antiseptic is performed. Lubricates the lower abdomen, loose and connective tissue. After treatment, the affected testicle is pulled down. This allows you to relax the muscle responsible for lifting. Then the spermatic cord is clamped, lidocaine is injected directly into the cord. This drug has an analgesic effect. After that, the doctor makes an incision along the inner lining of the testicle. External tissues are moved apart, they are fixed with clamps. This prevents bleeding. Coagulation of affected and damaged blood vessels is performed. Next, a deeper incision is made in the inner lining of the testicle. Again, the expansion and fixation of tissues is carried out. [1]

During the operation, the wound has a rounded appearance. Along the edges of the wound, you can find the skin, subcutaneous tissue, external (fleshy membrane). After the main incision, the doctor makes a puncture of the vaginal membrane, which allows the liquid to be eliminated. An incision is made in the vaginal membrane and its further extrusion into the wound. A detailed study is being carried out in order to identify other comorbidities and take timely measures. After that, the testicle rises, the doctor assembles the testicle (plitting is performed). This is a specific feature that distinguishes Lord's operation from other similar operations. It is then sutured with absorbable sutures. The threads are pulled, which allows you to return the testicle to the desired position. If necessary, the doctor applies additional stitches. [2]

Bergman's operation for hydrocele

Bergman's operation is performed with dropsy, or testicular hydrocele. As the main indications for the operation, the main symptoms are considered: hyperthermia, fluid accumulation between the testicular membranes, discomfort in the perineum, inguinal zone. An indication for emergency surgery is a rupture of the testicular wall, which leads to severe pain and inflammation.

The Bergman operation is performed under general or local anesthesia. The operation allows you to completely cure the disease and avoid impotence. The operation is aimed at removing the accumulated fluid. The Bergman operation is based on excision of tissues and pumping out fluid.

Before the operation, it is necessary to pass a set of examinations: clinical and biochemical blood tests, urine tests, blood clotting tests, ECG, fluorography. If necessary, bacteriological studies, studies for infections, including HIV infection, for a complex of viral and bacterial infections are carried out. After passing all the examinations, you need to get a conclusion from a pediatrician or therapist, which will indicate whether the patient can undergo surgery.

Be sure to consult with an anesthesiologist, who should choose the best method of anesthesia.

The technique of the Bergman operation is quite simple. During Bergman's operation, the membranes are excised. After making an incision and gaining access to the testicles, the surgeon selects the optimal technique for performing the operation, removes excess fluid. Then it is necessary to turn the testicle into the wound, remove the liquid. After the liquid is completely eliminated, the vaginal membrane is dissected, and excess tissues are excised. The remnants of the tissues are sutured with catgut, as a result of which the testicle returns to its place, the membranes and skin are sutured. There is a complete resorption of the sutures. The stitches usually dissolve after about 2 weeks. [3]

There are no specific contraindications for the operation. All of them are standard, they are no different from contraindications in any surgical intervention. After surgery, adverse effects are rare. On the contrary, the condition improves significantly, pain and discomfort cease to bother a person. It should be borne in mind that in the first few days after the operation, soreness and swelling may persist at the site of surgical intervention. I will have to give up driving a car for several days, as the surgical wound prevents this. The pressure on the scrotum and testicles is also significantly reduced, reproductive function is restored, after a few weeks you can restore intimate life, return to your usual lifestyle.

Complications rarely occur. The most common complications such as inflammatory and infectious processes, pain. They, as a rule, are observed with the wrong technique of the operation, or with non-compliance with the sanitary and hygienic regime. Possible suppuration of the wound, the formation of pus or exudate in the suture area. A hernia is also possible, a divergence of the seams in the event that it is especially often observed if a person lifts weights, walks a lot in the first days after the operation. With a severe postoperative period, the temperature may rise, edema, hyperemia, irritation, itching may develop.

After the operation, special postoperative care is required. In most patients, there is a significant improvement in the condition within 3-4 days after surgery. During the rehabilitation period, the patient must strictly take all the medicines prescribed by the doctor, follow all the recommendations, and treat the wound. If during the postoperative period pain, swelling, discomfort bother you, you need to consult a doctor who will prescribe painkillers. [4]

Winckelmann operation for hydrocele

A fairly common procedure for hydrocele is the Winckelmann operation. During this operation, the doctor makes a series of gradual incisions. First, an incision is made in the skin and outer membranes of the testicle (5-6 cm). After that, a continuous incision is made through several layers, to the inner vaginal membrane. Then the accumulated liquid is pumped out. The doctor twists the edges of the wound, examines them, then the organs are sutured from behind. As a result, the shell area is sharply reduced. Accordingly, there is no further accumulation of fluid, which will facilitate further absorption of the fluid. Sutures are applied, using various threads, including absorbable and non-absorbable. Stitches made of non-absorbable threads are removed after about 12-14 hours.

Surgery for a hydrocele in a child

With a hydrocele in a child, the operation is performed according to the same indications and principles as for an adult. First of all, it is necessary to pass a set of necessary examinations. First of all, clinical and biochemical tests will be required: blood, scraping, smears, urine, blood clotting test, ECG. On the day of the operation, you need to arrive at the hospital in advance. All necessary preparatory measures are carried out by medical personnel. During the operation, the child requires mandatory anesthesia. Anesthesia is mandatory, but the method of its implementation is determined by the doctor.

Often, Lord's surgery is performed on children, which is a relatively simple, yet extremely effective procedure. It is possible with dropsy of small size, or with a disease in a child. The advantage of the operation is that it rarely recurs. The doctor makes a dissection of the bag with serous lubrication, after which special channels are created through which excess fluid is eliminated. This prevents further accumulation.

In the first few days after surgery, soreness and swelling may persist at the site of surgery. But, as a rule, these symptoms pass rather quickly.

After surgery, the child needs special postoperative care. It takes about 3-4 hours to get out of anesthesia. During this time, you can not drink. After coming out of anesthesia, you can start drinking, in small sips. It is recommended to drink a decoction of wild rose. It is a rich source of vitamin C, and the substances that make up rose hips have a softening effect on the gastrointestinal tract, which prevents inflammation, pain, and spasm.

You can feed the baby after 4-5 hours. A postoperative diet is shown (table No. 0). Most patients experience improvement within 3-4 days after surgery. For a complete recovery of the body, it takes from one to several months.

After the operation, you must observe the postoperative period. For some time it is necessary to wear a special bandage, which will help relieve swelling and inflammation. Do not wear tight, tight or tight underwear. Pants must be made of cotton fabric. You will have to give up diapers and diapers for a while. Physical activity should be limited for at least a week. If during the postoperative period pain, swelling, discomfort bother you, you need to see a doctor. The doctor may prescribe painkillers. After 10 days, a follow-up examination by a doctor is required. [5]

Contraindications to the procedure

All medical procedures, especially surgical ones, have certain contraindications. As for the operation for a hydrocele, there are no specific contraindications in this case. The operation is not performed in case of acute inflammatory processes in the pelvic organs, with colds and infectious diseases. It is strictly contraindicated in various serious pathologies of the kidneys, liver, cardiovascular system, in violation of respiratory function, hypertension, impaired vascular tone, in COPD, CHF, immunodeficiencies, autoimmune pathologies. Also, the procedure is contraindicated in case of intolerance to anesthesia, severe allergic reactions, especially of the immediate type (anaphylactic shock, suffocation, Quincke's edema), with increased sensitization of the body, with acute inflammatory and infectious pathologies. The operation is not performed in severe forms of diabetes mellitus, with blood clotting disorders, with hemophilia, when taking anticoagulants. Caution requires varicose veins, a history of oncological pathology.

Consequences after the procedure

The procedure can have certain consequences, both negative and positive. For example, a hematoma, which is an internal hemorrhage, may occur. As a rule, this is a temporary condition that does not require special treatment. Hematoma occurs for various reasons: hemorrhage, vascular damage, loose suturing. Also, one of the adverse consequences of the procedure may be a relapse of the disease. Most often, relapses develop with a minimally invasive procedure, such as a puncture. Also, relapses are possible if the cause of the development of the pathology could not be eliminated. In this case, a serous fluid is again formed between the membranes of the testis. In the event that the cause of the development of recurrence could not be eliminated, relapse develops in almost 100% of cases. Also, relapses are often observed during the suturing procedure, especially if a pocket of connective tissue forms around the testicle.

One of the consequences after the operation can be called a cosmetic defect, in which a nodule is formed. This is a phenomenon that is observed with a strong hydrocele. At the same time, gathered tissue forms at the site of the operation, and an unpleasant appearance occurs. Similar cosmetic defects also occur when suturing large volumes of tissue, large shells.

In some cases, swelling of the scrotum develops. It can be observed for several months after the procedure. As a rule, passes by itself, no additional measures are required. In order to speed up the removal of edema, you need to follow all the recommendations of the doctor, periodically apply cold compresses to the area of the operation. It is necessary to check that the testicles remain soft. [6]

Complications after the procedure

One of the complications after surgery can be excision of the spermatic cord. This is a rather dangerous injury, which often leads to even more serious complications and consequences, in particular, to infertility. It is worth noting that the spermatic cord, as a rule, is not restored. In the event of damage, you need to see a doctor as soon as possible. The effectiveness of treatment depends on how quickly the appropriate measures were taken.

One of the most dangerous complications of the procedure is testicular atrophy, in which there is a gradual death of testicular cells and tissues. As a rule, this is an irreversible process. In this case, the testicle gradually decreases in size, until the process of sperm formation stops completely. If the testicle is sharply reddened, or turned blue, increased, or vice versa, decreased in size, you need to see a doctor as soon as possible.

Pain after hydrocele surgery

For some time after hydrocele surgery, pain may occur. You don't need to endure it. It is worth consulting a doctor who will prescribe the most appropriate treatment: painkillers. As a rule, light analgesics are prescribed: analgin, aspirin, paracetamol, spasmolgon, no-shpu, citramon. With the ineffectiveness of these drugs, stronger ones are prescribed: ketanol, ketolorac, ketoferil. Also, special postoperative bandages, frequent change of dressings, treatment of the postoperative wound with special ointments, medicines will help relieve pain and alleviate the condition.

Temperature after hydrocele surgery

Temperature is possible after hydrocele surgery. An increase in temperature may be associated with natural recovery processes in the body. Any regeneration entails a number of biochemical transformations, tissue and cellular reactions, in connection with which there is a slight increase in temperature. As a rule, during the normal course of the recovery period, the temperature does not exceed 37.0-37.2 degrees. Also, the temperature can rise as a natural reaction in response to mechanical tissue damage. However, if the temperature rises above the indicated values, this is an unfavorable sign. As a rule, an increase in temperature above 37.5 indicates the development of complications. It can be an inflammatory, infectious process, suppuration in the area of the wound, sutures. With the addition of a hospital infection, which is the most dangerous form of infection, there is a sharp increase in temperature up to 39-40 degrees, and even higher. Hospital strains of microorganisms are resistant to most antibacterial agents and disinfectants. At the same time, they live in a hospital, operating room, and are quite well adapted to life in the external environment, outside the human body. They are not killed by normal disinfection and sanitation. Once in the human body, they cause severe complications, generalized inflammatory and infectious processes that progress, are not treatable, often lead to the rapid development of bacteremia and sepsis. A person can die for several days or even hours from blood poisoning. The sooner treatment is started, the more effective it will be. Therefore, any increase in temperature should be a reason for going to the doctor, taking serious measures. The situation is complicated by the fact that after the operation, immunity is sharply reduced, which creates favorable ground for the unhindered development and reproduction of hospital strains of microorganisms.

Hard testicle after hydrocele surgery

There may be a hard testicle for a few days after surgery, a hydrocele. This is often associated with the development of hematomas, subcutaneous hemorrhages, and inflammatory processes. In some cases, caked blood can accumulate in the testicular membranes, which can also cause hardness. The development of edema, swelling, can cause hardness. Swelling of tissues, as a rule, disappears within 2-3 days. You also need to make sure that there is no tumor, neoplasm. Usually, in doubtful cases, an ultrasound is performed to make a diagnosis.

Testicular induration appeared one year after hydrocele surgery

If a year after the operation, the hydrocele sometimes appears induration of the testicle. In this case, you need to seek help from a urologist as soon as possible. You need to undergo an examination prescribed by a doctor. Most often, to make a diagnosis and determine the cause of the pathology, you need to conduct an ultrasound scan. The reason may be a relapse of the disease, accumulation of fluid and blood, purulent exudate, tumor development, inflammatory or infectious process. It is necessary to exclude trauma, hypothermia.

Hydrocele recurrence after surgery

After hydrocele surgery, a relapse is possible in cases where the cause of the pathology has not been determined. It is possible to eliminate the hydrocele only if the cause that causes the accumulation of fluid is completely eliminated. Otherwise, it will gradually accumulate again. Also, a relapse is possible if the operation was performed incorrectly, the technique was not followed, asepsis was not followed, if after the operation there were pockets in which liquid could accumulate. Also, a relapse is possible after a puncture, which does not eliminate the cause of the development of the pathology, but is aimed only at removing fluid from the place of its accumulation.

Care after the procedure

After hydrocele surgery, the postoperative period and recovery last 2-3 months. During the recovery period, loose clothing must be worn. You should not wear briefs, other tight underwear, you must definitely choose cotton underwear, soft, not pressing. The ideal option is family shorts. Small children are not recommended to wear diapers, diapers. This is important, because in a diaper, the testicle can overheat, undergo evaporation. The exception is the case when the operation was performed by puncture, since during this procedure, on the contrary, it is necessary that the testicle be tightly pressed. Therefore, after the puncture, on the contrary, it is recommended to wear tight, tight-fitting underwear. There are even special postoperative underwear. In other cases, both clothing and underwear should be loose, not tight.

Hygiene procedures depend on which method of operation was performed. As a rule, you should not take a hot bath or hot shower. In the first few days, you need to observe a hygienic regimen: use sanitary napkins, or special treatment products. After a few days, you can take a warm shower. It is better to use a soft washcloth and soap suds, but not shower gel, or other products. Cosmetics must be natural. You will also have to refrain from sexual intercourse for at least 2-3 weeks. Sometimes drainage is installed. In this case, you need to see a doctor in 2-3 days to remove it. The seam is smeared with a solution of brilliant green, or other anti-inflammatory drugs that the doctor will prescribe.

After the operation, the patient needs care and rehabilitation. The patient is transferred to the postoperative ward. There he is under the supervision of doctors for several hours. In the absence of complaints and complications, the patient is discharged. If there is a risk of complications, the wound is bleeding, the patient does not tolerate the effects of anesthesia, the patient will not be discharged. The patient will need to follow a number of recommendations at home. In general, the rehabilitation period does not exceed 2-3 weeks. For the first time, bed rest will be required for 2-3 days. It is necessary to wear a special bandage (bandage). This avoids the development of edema, provides a secure fixation. After a few days, the bandage is removed.

How long does it take for stitches to be removed after hydrocele surgery?

Patients often ask how many days the sutures are removed after hydrocele surgery. It all depends on what technique of the operation was used, what threads were used. It is also worth noting that this largely depends on the age, individual characteristics of the body, the speed of wound healing. If we take the average, then usually the stitches are removed on the 12-14th day. If special absorbable threads are used, they do not need to be removed at all, they dissolve on their own.

Bandages after hydrocele surgery

After hydrocele surgery, bandages are needed. This is due to the fact that in the first few days after the operation, soreness and swelling may persist at the site of surgical intervention. The bandage fixes the testicle in the desired position, and therefore, the load is reduced, the likelihood of injury. Also, under the influence of the bandage, the pressure on the scrotum and testicles is significantly reduced, and reproductive function is restored. Additionally, the bandage will help relieve swelling and inflammation. Also, instead of the usual tight-fitting underwear, you need to wear a jockstrap. This is a special supportive clothing that relieves excess tension in the groin area. If necessary, drainage is applied.

Sex after hydrocele surgery

After hydrocele surgery, sex is contraindicated for 2-3 weeks. If the postoperative wound heals well, there are no complications and pain, after this time, you can resume intimate life. It should be noted that even if the patient feels satisfactory, there is no pain and discomfort in the area of the operation, it is still necessary to endure the full rehabilitation period of 2-3 weeks, unless otherwise indicated by the doctor. Otherwise, complications or recurrence of the disease may develop.

Hydrocele treatment without surgery

As practice shows, a full-fledged treatment of hydrocele without surgery is impossible. Surgical treatment is the only effective means of eliminating this pathology.

Reviews

We analyzed reviews of the operation for testicular hydrocele. In most cases, reviews are written by mothers of children who have undergone this operation. Adult men prefer not to discuss this topic. As the reviews show, the operation greatly alleviates the condition of patients suffering from congenital dropsy. At the same time, the paradox is that the parents of the child experience much more stress. While the child himself quickly forgets about the operation, it is easily tolerated, mostly without complications. As noted by some experts, dropsy in children can be cured conservatively. Therefore, not all specialists immediately prescribe the operation. Others believe that the sooner the operation is performed, the more effective it will be, and they try to prescribe it as early as possible, when the first signs appear.

As practice shows, the postoperative period is much more difficult. It is quite difficult to get out of anesthesia: children are naughty, demand to drink, experience thirst, headache, increased aggressiveness, irritability, or, conversely, tearfulness. It is also quite difficult for children to endure bed rest. However, it is not recommended to get out of bed for some time. You also need to take into account that the catheter remains in the child’s hand, so you need to carefully monitor that he does not remove it. There are also negative reviews. In particular, some children require a second procedure due to a recurrence of the disease.

Adult men usually leave feedback only if the result is unfavorable, or complications have occurred. The main complications are inflammation, relapse, infection, varicocele, prostatitis. However, in most cases, the prognosis is usually good. Surgery for testicular hydrocele  is generally uneventful.