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Water hernia / spermatocele surgery
What does this procedure entail?
Spermatocele is a cystic enlargement of parts of the epididymis filled with fluid and sperm.
Hydrocele is body fluid that accumulates in the testicle capsules.
Both spermatocele and hydrocele are manifested by enlargement of the scrotum, which usually does not initially cause problems. Bulky spermatocele/hydrocele is annoying due to its size or it causes cosmetic problems.
What are the alternatives to this procedure?
- Aspiration of the fluid using a needle inserted through the skin – usually only with a transient effect. Gradually, the filling will be restored
- Removal of the epididymis (in spermatocele) or, in exceptional cases, it may be recommended to remove the testicles on the affected side at the same time
What should I expect before this procedure?
If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.
At the request of the referring physician, you will have to schedule preoperative examinations to assess your overall condition, including laboratory and instrumental tests. If the report does not preclude the indicated procedure, you will be admitted to the hospital. If you don’t undergo a preoperative examination or it is incomplete, you will not be able to have the surgery as scheduled. You will be admitted by a nurse and a member of the medical team will complete your examination and assess your fitness for the surgery.
You will be asked not to eat or drink for at least 6 hours before the surgery!
In the evening before the surgery, you will receive medication from an anaesthesiologist to calm you down so that you sleep well.
Remember to inform your physician about the following possible facts before the surgery:
- artificial heart valve
- coronary artery stent
- artificial joint
- artificial vascular graft
- neurosurgical bypass
- other implanted foreign body
- use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
- drug and other allergies
- any abnormalities or eventualities
It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.
What will happen during the surgery?
You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first. The scrotum must be completely shaved before the procedure.
The procedure is performed under general anaesthesia.
The surgery is performed by cutting the side of the scrotum – after releasing the testicle and epididymis from the scrotum, a hydrocele bag is prepared (sometimes more smaller bags in the case of spermatocele). In the case of hydrocele, the sac is opened and "turned upside down". In the case of spermatocele, the stem at the epididymis is cut and closed, and the entire sac is removed. A drain (plastic drainage tube) is inserted into the wound.
In very exceptional cases, it is necessary to remove the epididymis even with the testicle (e.g. in case of repeated surgeries, in case of complicated inflammation, scarred terrain) – if this risk can be expected, you will be informed about it separately before the surgery.
The surgery takes about 30-45 minutes.
What will happen immediately after the procedure?
You will wake up at the intensive care unit equipped for the continued monitoring of patients immediately after the procedure. The surgeon will inform you about the course of the procedure. You will still have high levels of anaesthetics in your blood at that time, so you may not remember this conversation.
As soon as your medical condition allows, you will be allowed to sit down and then stand up. After that, you will be able to walk slowly and carefully around the room, initially accompanied by medical staff. Pay close attention to eventual dizziness, uncontrollable weakness, and to gait stability. Otherwise immediately inform medical personnel or anyone in the vicinity.
The wound is closed with absorbable sutures, so there is no need to remove them. The drain is removed on day 1-2 after the surgery. The total length of hospitalisation is 3 to 5 days. Duration of sick leave is 2 to 3 weeks. Oedema of the soft tissues of the scrotum is quite common in the postoperative course, it will gradually disappear within a few days or weeks.
Once you are fully conscious, you should:
- ask if the planned outcome was achieved
- inform the medical staff about any problems
- ask what you can and cannot do
- ask all the questions you have for the healthcare professionals and members of the medical team.
- remember (and understand) why the surgery was performed, how it turned out, and what will follow
What are the postoperative risks or complications?
Common (10% of procedures of this type)
- Scrotal oedema, which may last for several days
- Serous (wound) secretion up to a few days after the surgery
Occasional (2-10% of procedures of this type)
- Incision site infections requiring additional surgical or antibiotic treatment
- Bleeding requiring further surgery
Rare (may occur in 2% of procedures of this type)
- Chronic scrotal pain
- Repeated fluid collection
- MRSA colonisation (0.9% – 1 of 110)
- Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
- MRSA blood infection (0.02% – 1 of 5,000)
Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.
What should I expect when I return home?
When you are discharged from the hospital, you should:
- Get recommendations on recovery at home
- Ask when you can return to normal activities such as work, exercise, driving, housework
- Get a contact number for further questions after returning home or in case of trouble
- Ask about the date and place of subsequent check-ups (hospital or your doctor)
- Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs
At your departure from the hospital (sometimes several days later), you will receive a hospitalisation report. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.
The wound should be clean and dry for a full 24 hours. If clothes stick to it, they can be removed after a short bath or shower. You should not bathe or shower until the area has healed, as this could lead to quick dissolution of the sutures and infection and poor healing.
It is recommended to wear tight underwear or a suspender until the swelling subsides or until any problems disappear.
You should stay at home for 10-14 days and avoid any strenuous exercises to enable the wound to heal. You should avoid sexual intercourse for about 14 days, or until all eventual problems improve.
What else should I watch out for?
If you experience more frequent problems, fever, redness, pulsation or discharge from the wound, see your attending physician.
Some stiffness or numbness above or behind the testicles is common after this procedure and is often permanent.