Name of the Procedure:

Epididymectomy; bilateral
Common names: Bilateral epididymectomy
Technical terms: Bilateral removal of the epididymis

Summary

A bilateral epididymectomy is a surgical procedure where both epididymides (the coiled tubes at the back of the testicles that store and carry sperm) are removed. This procedure is typically done to alleviate chronic pain or treat disorders related to the epididymis.

Purpose

Medical Conditions Addressed:

• Chronic epididymitis (recurrent inflammation of the epididymis)
• Persistent pain in the epididymis not responsive to other treatments
• Spermatocele (cyst in the epididymis causing discomfort)

Goals/Expected Outcomes:

• Relief from chronic pain or discomfort in the scrotal area
• Resolution of symptoms caused by chronic or recurrent epididymitis
• Improved quality of life by eliminating the source of pain or infection

Indications

Symptoms/Conditions:

• Chronic scrotal pain that significantly affects quality of life
• Recurrent infections or inflammation of the epididymis
• Spermatocele causing discomfort or complications

Patient Criteria:

• Failed conservative treatments (e.g., antibiotics, anti-inflammatory medications)
• No desire for future fertility, as the procedure can impact sperm transport

Preparation

Pre-procedure Instructions:

• Fasting for at least 6-8 hours before the surgery
• Avoiding blood-thinning medications and certain supplements as directed by your healthcare provider
• Arranging for transportation home

Diagnostic Tests:

• Scrotal ultrasound to examine the epididymis and surrounding structures
• Blood tests to assess overall health and readiness for surgery

Procedure Description

1. Anesthesia: General or regional anesthesia is administered to ensure patient comfort.
2. Incision: A small incision is made in the scrotum for each epididymis.
3. Exposing the Epididymis: The epididymis is carefully separated from the testicle.
4. Removal: Both epididymides are surgically removed.
5. Closure: The incisions are closed using absorbable sutures, and a dressing is applied.

Tools/Equipment Used:

• Surgical scalpel
• Forceps and scissors
• Absorbable sutures

Duration

The procedure typically takes about 1-2 hours, including anesthesia and preparation time.

Setting

Performed at:

• Hospital
• Outpatient surgical center

Personnel

Healthcare Professionals Involved:

• Urologist or surgeon
• Anesthesiologist
• Surgical nurses

Risks and Complications

Common Risks:

• Infection at the incision site
• Scrotal swelling or bruising

Rare Risks:

• Persistent pain
• Hematoma formation
• Impact on fertility

Possible Complications Management:

• Antibiotics for infections
• Pain medication for post-operative discomfort

Benefits

• Relief from chronic pain in the scrotal area
• Resolution of recurrent infections or inflammation
• Improved overall quality of life

Recovery

Post-procedure Care:

• Ice packs to reduce swelling
• Pain management medications
• Avoiding heavy lifting or strenuous activities for several weeks

Expected Recovery Time:

• Most patients can return to light activities within a week
• Full recovery typically takes 4-6 weeks

Restrictions/Follow-ups:

• Follow-up appointments to monitor healing
• Avoiding sexual activity for a few weeks as advised by the surgeon

Alternatives

Other Treatment Options:

• Medications (e.g., antibiotics, anti-inflammatories)
• Conservative measures (e.g., scrotal support, physical therapy)
• Spermatic cord block (injection to reduce pain)

Pros and Cons of Alternatives:

• Medications: Non-invasive, but may not be effective for chronic conditions.
• Conservative Measures: Less invasive, but may not provide long-term relief.
• Spermatic Cord Block: Temporary relief, minimally invasive, but may need repeated treatments.

Patient Experience

During the Procedure:

• Under anesthesia; no pain or awareness of the procedure.

After the Procedure:

• Some discomfort or pain managed with medications
• Swelling and bruising in the scrotal area
• Instructions on wound care, activity restrictions, and follow-up appointments

Pain Management and Comfort Measures:

• Application of ice packs
• Oral pain medications or anti-inflammatory drugs