Most testicular masses (those needed to be removed by testicular mass removal surgery) are benign and the majority of them prove to be a hydrocele, a spermatocele, a varicocele, an inguinal hernia, or epididymitis. However, testicular cancer is another possibility. When a mass is detected, physical examination, imaging studies, and biopsy or testicle mass removal can provide diagnosis and treatment.
Dr. Elist treats a hydrocele by removing the abnormal fluid filled sac in the scrotum or in the inguinal canal. After injecting an area with local anesthetic and using aseptic techniques, Dr. Elist makes an incision in the scrotum or in the inguinal area.
Care is taken to keep the hydrocele intact while it is dissected free of its attachments to the testis and other structures. The sac is opened high along its front surface and the testis is pushed up through the sac and out through the incision. This inverts the hydrocele sac which is tacked by suturing to the spermatic cord structures behind the testis. The testis is returned to the scrotum and is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting of the testis. A rubber drain may be left in the scrotum and the incision closed in layers by suturing.
Dr. Elist treats a hydrocele of the spermatic cord by removing from the spermatic cord above the testis in the scrotum or in the inguinal canal. After injecting the area with local anesthetic, Dr. Elist makes an incision in the scrotum or in the inguinal area. The hydrocele is kept intact while it is freed of its attachments to the spermatic cord. The sac is opened, drained, and excised all the way to the internal inguinal ring in the upper groin area. The remaining tissues are repaired and closed by suturing. The testis is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting of the testis. A drain may be placed in the scrotum and the incision closed in layers by suturing.
Dr. Elist removes a lesion of the spermatic cord by dissection and excision. After injecting the area with local anesthetic, Dr. Elist makes an incision in the scrotum or in the inguinal area and dissects the tissues to expose the lesion.
Care is taken to keep the lesion intact while it is dissected free of its attachments to the spermatic cord. This may involve mobilization of the testis. The lesion is removed by cutting all of its attachments. The tissues damaged during the dissection are repaired and closed by suturing. If the testis has been mobilized, it is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting. A drain may be placed in the scrotum and the incision is closed in layers by suturing.
An infection, acute or chronic, of the epididymis may warrant a surgical intervention if conservative drug therapy is of no help.
Important: your doctor needs to distinguish between acute epididymitis and testicular torsion in order to provide the right treatment
Treatment: antibiotics, cold compresses, anti-inflammatory medication, surgical testicular mass removal (rarely necessary).
Dr. Elist ligates the spermatic veins and/or excises a varicocele. An abdominal approach is performed by an incision made in the pubic area just medial to the bony prominence of the pelvic bone on the affected side and carried down through the abdominal musculature to the spermatic vein and artery. The cord is brought up into the incision and the structures of the cord are dissected, the veins identified, and ligated with suture material. Alternately, an incision is made in the scrotum and the dilated veins ligated separately may be removed. The operative incision is closed in layers by suturing. If an inguinal hernia is present at the same time, Dr. Elist repairs it by folding and suturing of tissues to strengthen the abdominal wall and correct the weakness responsible for to hernia. In very rare cases in Beverly Hills testicular mass removal may be necessary.
Inguinal hernias are caused by a weakness in the abdominal wall allowing its contents to protrude between the muscle (direct hernia) or through the inguinal canal (indirect hernia). An indirect inguinal hernia can descent into the scrotum causing a swelling, especially prominent when coughing or pressing.
Diagnosis: History and physical, ultrasound, further imaging studies is required
Treatment: Asymptomatic small hernias do not need a repair. Bigger hernias should be evaluated on individual basis and surgically repaired if warranted, testicular mass removal may be needed.
Testicular cancer is the most common cancer in men aged 20-39 years. It can present with or without pain. The mass usually feels firm and arises from the testicle. Testicular cancer has one of the highest rates of cure, over 90%, and even 100% if it has not spread. Occasionally, testicular cancer may appear with symptoms of metastasis, which could include cough, shortness of breath, or weight loss. Even in case of metastasis, modern chemotherapy can achieve a cure rate of over 80%. Monthly testicular self-exams are recommended for every man between the ages of 18-40 years old.
If testicular cancer spreads, the following symptoms may be present:
Diagnosis: Self-examination, physical and history, imaging studies, biopsy, or a removal of affected testicle (orchiectomy) for diagnosis and treatment purposes. Treatment: Treatment of testicular cancer is depending on the pathology and may include surgery, radiation therapy, and chemotherapy, testicular mass removal may be necessary.
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