Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section v: operations on the scrotum, penis, and urethra
3-31
Section V. OPERATIONS ON THE SCROTUM, PENIS, AND URETHRA
3-31. HYDROCELECTOMY
a. General. This operation (see figure 3-10) involves the excision of the tunica vaginalis of the testis in order to remove a hydrocele. This is abnormal accumulation of fluid within the scrotum around the capsule of the testis and within the tunica vaginalism. Excessive secretion or accumulation may be due to infection or trauma.
Figure 3-10. Hydrocelectomy.
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A-Incision through anterior scrotum, exposing hydrocele sac. Characteristic dark blue shiny appearance of tunica vaginalis (which is sac wall) is due to deep shadow within sac.
B-Hydrocele sac enucleated and removed from scrotum. It is left attached to groin by spermatic cord.
C-Sac opened and excised from testis.
D-Skin edges and subcuticular tissues approximated with single mattress sutures of no. 3-0 plain catgut. |
b. Patient Preparation. The patient is placed in supine position and draped with fenestrated sheet.
c. Operative Procedure.
(1) An anterolateral incision is made in the skin of the scrotum over the hydrocele mass, using a scalpel with a number 2-0 blade. Bleeding is controlled with Crile hemostats and vessels ligated with number 2-0 plain gut ligatures.
(2) Small retractors may be placed (see figure 3-10 A), and then the fascial layers are incised to expose the testis and tunica vaginalis. With fine scissors and forceps, the sac is delivered and dissected free (see figures 3-10 B and C). The hydrocele may be aspirated. The adherent tunica vaginalis is separated from the internal fascia layers and the sac opened. When the tunica vaginalis has been trimmed as desired, the testis is returned to the scrotal sac.
(3) A Penrose drain is placed, and the wound is closed (see figure 3-10 D) in layers with Atraumatic sutures plain gut number 2-0 on curved cutting needles. The wound is dressed, and a supportive sling dressing or suspensory is usually applied.
