Surgery for Scrotal Disorders

The three most common scrotal disorders are:

• • Hydroceles, the collection of fluid within a section of the scrotum;

• • Varicoceles, enlarged veins that are similar to varicose veins; and

• • Spermatoceles, sperm-filled cysts located at the head of the epididymis.

A varicocele is the most serious of the three conditions, because it can lead to infertility.

WHEN IS IT INDICATED?

Hydrocelectomy. When hydroceles cause the scrotum to enlarge and ache or are cosmetically unacceptable, physicians will recommend a surgical procedure called hydrocelectomy to remove the fluid.

Varicocelectomy. Varicocelectomy is considered when it causes pain or when a fertility problem exists.

Spermatocele treatment. Spermatocelectomy and sclerotherapy are indicated if the cyst has enlarged enough to cause pain or discomfort.

PRE-PROCEDURE GUIDELINES

Guidelines for all three procedures are minimal, such as not eating or drinking prior to the surgery, and depend on the physician or the facility where the procedure is being performed. A physician should provide a patient with any necessary pre-procedure instructions.

WHAT TO EXPECT

Hydrocelectomy. Performed on an outpatient basis under general or spinal anesthesia, hydrocelectomy usually lasts between 30 and 90 minutes. The physician locates the hydrocele and removes it. The hydrocele fluid must be drained and the hydrocele sac edges partially stitched or removed and cauterized to prevent recurrence.

Needle aspiration of the fluid, with or without an injection of medication that hardens tissue, also treats hydroceles. However, surgery is usually preferred over aspiration.

Varicocelectomy. There are several different methods of varicocelectomy, all of which involve tying off the affected veins, including:

• • Microsurgical subinguinal varicocelectomy;

• • Inguinal varicocelectomy;

• • Laparoscopic varicocelectomy;

• • Retroperitoneal varicocelectomy; and

• • Radiographic occlusion.

The incidence of the varicocele recurrence following surgery varies widely, with an average rate of 9 percent. In cases of recurrence, the surgery is usually repeated.

It takes at least 4 months to see any significant improvement in sperm quality. Surgery may cause men who have low testosterone levels to experience increased muscle mass, body hair, and sexual interest.

Spermatocelectomy. Spermatocelectomy is a type of outpatient surgery. The physician makes an incision in the skin of the scrotum and gently pulls the testicles and the epididymis through the incision. A suture (thread) is tied around the spermatocele, separating it from the epididymis.

Sclerotherapy for spermatocele. This procedure is usually performed on a man past his reproductive years because of the risk of complications. A needle is inserted into the cyst and the fluid is drained. The physician then injects the cyst with a chemical agent, called a sclerosant solution. The chemical hardens or closes the cyst and prevents it from collecting more sperm.

POST-PROCEDURE GUIDELINES

Hydrocelectomy. After surgery, the physician implants a catheter (a small flexible tube) to drain the surgical area. The patient should arrange for a ride home following the procedure. Patients are required to apply ice to the scrotal region for the first 24 hours and wear scrotal support for approximately 7 to 10 days.

Patients can resume normal activities within 2 weeks.

Varicocelectomy. The physician will instruct the patient to:

• • Avoid bathing or showering for 24 to 48 hours;

• • Avoid weightlifting or jogging for 2 weeks;

• • Abstain from sexual activity for 1 week;

• • Take pain medication as directed; and

• • Remove the outer dressing after 48 hours.

Spermatocelectomy and sclerotherapy. After undergoing a spermatocelectomy, patients are instructed not to shower for 24 to 48 hours, not to lift more than 10 pounds, and to avoid strenuous activity. Patients are monitored for 7 to 10 days afterward.

Patients who have had sclerotherapy should not apply pressure to the scrotum. The physician will schedule a follow-up visit 1 month after sclerotherapy, and again at 4 to 6 months.

POSSIBLE COMPLICATIONS

Hydrocelectomy. Possible complications from hydrocelectomy may include:

• • Bleeding, pain, and infection;

• • Injury to the epididymis or vas deferens;

• • Hematoma; and

• • Recurrence of the hydrocele.

Varicocelectomy. Possible complications from varicocelectomy can include hydrocele formation and damage to the testicular artery. If the testicular artery is damaged during surgery, it can cause the testicle to shrink or stop producing sperm. Although rare, complications from radiographic occlusion can include:

• • The balloon moving into the renal vein, resulting in loss of a kidney;

• • Blood clots developing in larger veins; and

• • Allergic reactions to the radiographic dye.

Spermatocelectomy. Possible complications resulting from spermatocelectomy include:

• • Hematoma;

• • Infection; and

• • Low sperm activity.

Sclerotherapy. Possible complications from sclerotherapy include infection of the epididymis caused by the sclerosing agent and recurrence of the spermatocele.