You are on page 1of 21

Fadhilla Rakhmatiar

Definitions

TORSION OF TESTIS
Testicular torsion is a twist of the spermatic cord,
resulting in strangulation
(Oxford American Handbook of Urology 1st edition, 2011)

ORCHIDECTOMY
Surgical removal of one or both testis.
(Oxford Medical Dictionary, third edition, 2004)

ORCHIDOPEXY
Surgical fixation of a testis.
(Oxford Medical Dictionary, third edition, 2004)

Anatomy and Phsiology

Grays Anatomy XI sec


3c

Indications

Tools

Equipment
Sterile drapping Sterile gauze Sterile gown Hand gloves Povidone iodine
10%

Sponge
forceps
Kocher Blade no
forceps Metzenbau 15 Pinset
Needle
m Holder

Plain catgut 3.0 Silk 1.0 Polyprolene 3-0


Procedure

Preparation and
Disinfection

Incision

Identification
and Evaluation
Preparations and Desinfections
Patient in general anesthesia or
spinal block.

Patient in supine position, a right-handed
surgeon stands on the right side of the
table.

Evaluate the SSC (Surgical Safety


Checklist).
Incisions
Grasp the scrotum with the thumb

and index finger, and press the
testis forward. The scrotum maybe
edematous

Make a short transverse


incision

Alternatively para raphe


incision (SOP RSU dr Saiful Anwar
Malang) (Hinmans Atlas of Urologic Surgery,
third edition, 2012)
Continue the incision to the
tunica vaginalis, which may
appear darkened from
contained bloody serum.
Identification and
evaluation
Open the tunica vaginalis,
evacuate the accumulated
hydrocele fluid, and extrude the
testis

Observe its color after untwisting


it clockwise on the right,
counterclockwise on the left.
Wrap it in warm saline sponges
and observe it for 10 or 15
minutes
(Hinmans Atlas of Urologic Surgery,
third edition, 2012)
If the testis become red and
sanguinous, proceed with
orchidopexy. If the testis remains
dark, proceed with orchidectomy
Viable
Orchidopexy
Bilateral

Orchidectomy
ipsilateral
Non
Viable Orchidopexy
contralateral
Orchidopexy
If the testis is to remain,
trim the excess tunica
vaginalis

Obtain hemostasis
along the edge with
thorough fulguration

Place three interrupted


suture in the cut edges
of the tunica vaginalis
to approximate the
edges behind the testis

(Hinmans Atlas of Urologic


Surgery, third edition, 2012)
Orchidopexy

Invert the scrotal septum
into the wound with a finger
inserted from the opposite
side, and fix the tunica
albuginea to the septum in
three places.

Use interrupted
mattress 3-0 non-
absorbable sutures
(Hinmans Atlas of Urologic Surgery,
(polyprolene) and tie
third edition, 2012)
them after all have
been inserted.
Orchidectomy
Push the scrotal layers away with
sponge dissection, and deliver the
testis within the tunica vaginalis
into the wound.

Alternatively, open the tunica


vaginalis before delivering the
testis. Draw the testis down to
expose the epididymis and cord.

Doubly clamp each part, and


(Hinmans Atlas of Urologic Surgery, ligate them with a 1-0 non-
third edition, 2012) absorbable sutures (Silk).
Closure

Before closing, electrocoagulate any bleeders
in the dartos and subcutaneous tissue to avoid
a distressing scrotal hematoma.
Close the dartos layer with a running
absorbable sutures, and close the skin,
together with the subcutaneous tissue, with
interrupted 3-0 sutures (plain catgut).
Add sterile fluff sheld in place with a snug-
fitting scrotal supporter.
Complications
Intra Operatives Post-operative
Early :
Bleeding Hematome
Wound infection
Epididymitis and/or
orchitis
Injury of Excessive pain
testicular vessels
Late :
and nerves Congestive
epididymitis and/or
orchitis
Persistent pain
syndrome
Testicular atrophy
Post Surgical Care

Rest and avoidance of vigorous
activity help minimize discomfort.
Scrotal support for 3 5
days.
Oral antibiotics and
analgetics

TERIMA KASIH