620 CHAPTER 16 Urological surgery and equipment

Hydrocele and epididymal cyst removal

Hydrocele repair (removal)

Indications include primary (idiopathic) hydrocele repair; this is not indicated for secondary hydrocele repair.

Anesthesia: local or general

Techniques

•Lord’s plication technique—for small to medium-sized hydroceles (minimal interference with surrounding scrotal tissues, which minimizes risk of postoperative hematoma)

•Jaboulay procedure—for large hydroceles. Excision of hydrocele sac

Hydrocele aspiration

Strict attention to asepsis is vital, since introduction of infection into a closed space could lead to abscess formation. Avoid superficial blood vessels (if you hit them, a large hematoma can result).

Postoperative care involves nothing specific.

Postoperative complications and their management

•Scrotal swelling, which resolves spontaneously

•Hematoma formation. If it is large, surgical drainage is best performed, as spontaneous resolution may take many weeks. It can be difficult

to identify the bleeding vessel. Leave a small drain to prevent reaccumulation of the hematoma.

•Hydrocele recurrence

Epididymal cyst removal (spermatocelectomy)

•Avoid in young men who wish to maintain fertility, since epididymal obstruction can occur.

•An alternative to surgical removal is aspiration, though recurrence is usual.

Procedure-specific consent form—recommended discussion of adverse events

Hydrocele removal

Occasional

•Recurrence of fluid collection can occur.

•Collection of blood around the testes which resolves slowly or requires surgical removal

•Possible infection of incision or testis requiring further treatment

Alternative therapy

•Observation

•Removal of fluid with a needle

HYDROCELE AND EPIDIDYMAL CYST REMOVAL 621

Epididymal cyst removal

Occasional

•Recurrence of fluid collection can occur

•Collection of blood around the testes which resolves slowly or requires surgical removal

•Possible infection of incision or testis requiring further treatment.

Rare

• Scarring can damage the epididymis, causing infertility

Alternative therapy includes observation; removal of fluid with a needle.

622 CHAPTER 16 Urological surgery and equipment

Nesbit procedure

This is a penile straightening procedure for correcting penile curvature. Wait for at least 6 months after the patient has experienced no more pain, and wait for the penile curvature to stabilize (there is no point in repairing the curvature if it is still progressing).

Indications

This procedure can used in Peyronie’s disease for men with deformity who still obtain rigid erections.

Anesthesia

Local or general anesthetic can be used.

Postoperative care

The patient should avoid intercourse for 2 months. Edema can be managed with cold compresses.

Procedure-specific consent form—recommended discussion of adverse events

Serious or frequently occurring complications

Common

•Some mild shortening of the penis

•Possible dissatisfaction with the cosmetic or functional result

•Temporary swelling and bruising of the penis and scrotum

Occasional

•Circumcision is sometimes required as part of the procedure.

•There is no guarantee of total correction of the bend.

•Bleeding or infection may require further treatment.

Rare

•Impotence or difficulty maintaining an erection

•Nerve injury with temporary or permanent numbness of penis

Alternative treatment includes observation, drugs, and other surgical procedures plication and graft procedures.

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