Urology

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Testicle removal + eventual prosthesis insertion

What does this procedure entail?

The essence of this procedure is the removal of the testicle through a cut in the scrotum, exceptionally in the groin. The procedure is performed for other reasons than suspected testicular cancer.

If you have problems with the cosmetic result after testicle removal, it is possible to insert a silicone prosthesis into the scrotum (in any case, this procedure must be agreed in advance).

What are the alternatives to this procedure?

Follow-up

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
pacemaker
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 procedure is usually performed under general anaesthesia (you will be asleep during the procedure), but it can also be performed under local anaesthesia. The testicle is removed via an incision in the scrotum or groin (depending on its location). If agreed, a prosthesis may be inserted into the scrotum and fixed with a suture inside the scrotum. The wound is then closed with absorbable sutures. A shield is usually created to prevent bleeding into the scrotum – the skin of the scrotum is sewn to the skin of the lower abdomen via a tampon (it is not performed when the prosthesis is inserted). The drain is not normally inserted into the wound. The procedure takes approximately 30 minutes (about twice the time in bilateral procedures).

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 and drink and eat. 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.

You may feel discomfort in the scrotum for a few days – you can use common painkillers. The stitches are absorbable – there is no need to remove them.

The shield (sewn-in skin of the scrotum with tampon) is removed on day 1 after the surgery. The total duration of hospitalisation is 2 to 3 days, necessary work leave is 2 to 3 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)

Oedema of the scrotum for several days
Leaking of yellowish liquid from the wound for several days

Occasional (2-10% of procedures of this type)

Infection or bleeding at the incision site requiring further treatment (possibly removal of the implant).
Impossibility to guarantee fertility in the future (when 1 testicle is removed)

Rare (may occur in 2% of procedures of this type)

An unexpected finding in the histological examination that requires further treatment
Minimal possibility of uncertain histological diagnosis
Pain, infection, or foreign body reaction requiring implant removal (if inserted)
Cosmetic expectations of the patient, which may not be fully met by the implant
The implant may be located higher in the scrotum than common in a normal testicle
A palpable suture at one end of the implant that you can feel
Long-term risks arising from the use of silicone products are unknown

Hospital infections

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.

What else should I watch out for?

In case more problems occur, unusual bleeding, etc., see your attending physician. You may feel discomfort in your groin and scrotum for one to two weeks. This discomfort is often alleviated by commonly available pain medications. Small bruises often occur in the groin and scrotum. You may feel more comfortable in firm underwear (instead of boxers) – loose underwear is more suitable in case of implant insertion. You can shower 24 hours after the procedure, but palpate the area gently and make sure it is really dry. You can return to work about 2 weeks after the procedure, but it is advisable to avoid strength training and sports for at least 6 weeks.

You can engage in sexual activity after 2 weeks; the procedure may temporarily reduce sexual desire in some men.

Important information?

Results of histological analysis (if required) will be routinely available after 7-21 days. The result will eventually be communicated to you during the subsequent outpatient examination.