Why is it done?

• To remove a symptomatic painful epididymis post vasectomy.

How is it done?

• This procedure is performed under general anesthetic.
• A single incision is made on the midline raphe of the scrotum.
• The affected testis and vas deference is then extracted through this incision.
• The epididymis is exposed.
• The epididymis is carefully removed off the testis without disrupting the blood supply to the testis.
• The cord is checked for hemorrhaging.
• A drain may be placed.
• A catheter may be left over night.
• A dressing is then applied, which should be removed after 72 hours.
• No strenuous movements are permitted for at least 14 days.

NB! You are required to bring 2 pairs of tight new undies for post-operative scrotal support.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain all such risks.
• The drain will be removed the next morning.
• The catheter will be removed 6-8 hours after the procedure.
• A hematoma (blood collection under the skin or in the scrotal cavity) may form and needs to be reviewed by Dr Schoeman as soon as possible. This may require drainage. Bruising is normal.
• An infection of the wound can occur and requires immediate attention.
• Owing to the nature of the surgery and the soft skin of the scrotum, bruising may appear to be much worse than it actually is and is no cause for alarm.
• DANGER SIGNS: A scrotum that swells immediately to size of a football, fever, puss. Contact Dr Schoeman or the hospital immediately as this may occur in up to 15% of all cases.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until the dressing comes off with ease.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• Do not tug at the sutures!
• Sutures will dissolve after 10-14 days
• On discharge a prescription may be issued for patients to collect.
• Please direct all further queries to Dr Schoeman’s rooms.
• PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Epididymectomy

Why is it done?

• Enlarged scrotum.
• Could be uncomfortable.
• Usually large and uncomfortable.
• Can become so big that it buries the penis making usual functions difficult, ie urination and sexual function.
• May contribute to Infertility.

How is it done?

• This procedure is done under general anaesthetic.
• Supine position.
• A midline scrotal incision is done.
• The intact hydrocele is delivered through the skin incision.
• The sac (tunica vaginalis) is opened and surgically removed.
• A hemostatic running suture is placed around the raw edge of the Tunica Vaginalis.
• Hemostasis is actively chased.
• A drain is left overnight.
• An Indwelling catheter is left for 6-8 hours to prevent acute urinary retention.
• The scrotum is closed in 2 layers with dissolvable sutures.
• You would be required to bring 2 pairs of tight new undies for post-operative scrotal support; these will be placed post-operatively.

NB! You are required to bring 2 pairs of tight new undies for post-operative scrotal support.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain such risks.
• Bleeding is a possible complication therefore the scrotal drain/s overnight.
• Your catheter will be removed the next.
• You will have scrotal swelling and bruising for the next 2-6 weeks.
• Any sudden increased swelling needs urgent attention!
• Any symptoms of fever and signs of infection, requires urgent attention!

What next?

• Dressings should be kept for the initial 72 hours after surgery and soaked off in a bath thereafter.
• The catheter will be removed the morning after surgery.
• Patients should schedule a follow-up appointment with Dr Schoeman 4-6 weeks after the procedure.
• There will be signs of bruising for at least 2-6 weeks.
• PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Hydrocelectomy

Who is susceptible?

• Newborn babies: Often missed diagnosis.
• 12–16-year-old boys as their testes increase in size with puberty.

Why is it done?

• To reverse a twisted spermatic cord compromising blood supply to the testis.
• This should be done within 4-6 hours of the first presenting symptoms.
• A failed manual detorting of the testis.

How is it done?

• This procedure is performed under general anesthetic.
• A single incision is made on the midline raphe of the scrotum.
• The affected testis and vas deference is then extracted through this incision.
• The testis is then un-twisted.
• The testis is then covered with a warm wet swab, encouraging blood supply in the testis by means of Vaso-dilatation.
• Once the dusky blue grey colour is replaced by a pink colour, the testis is pexed to the dartos muscle.
• If the testis is black on opening the scrotum and no change occurs with the revival process, the testis is removed.
• The contra-lateral testis is pexed to the dartos muscle.
• A dressing is then applied, which should be removed after 72 hours.
• No strenuous movements are permitted for at least 14 days.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain all such risks.
• A hematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
• An infection of the wound can occur and requires immediate attention.
• Owing to the nature of the surgery and the soft skin of the scrotum, bruising may appear to be much worse than it actually is and is no cause for alarm.
• DANGER SIGNS: A scrotum that swells immediately to size of a football, fever, puss. Contact Dr Schoeman or the hospital immediately as this may occur in up to 5% of all cases.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until the dressing comes off with ease.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal.
• Do not tug at the sutures!
• PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Testicular Tortion

Why is it done?

• For sterilization
• For completed family numbers
• For legal reasons such as sterilization of a mentally handicapped adult or minor. In such instances a court order needs to be obtained prior to the consultation.

How is it done?

• This procedure is done under general anesthetic.

• A single, 5mm cut is made on the midline raphe (line in the middle of scrotum).
• The 2 vas deferii (rubbery cord) are then individually extracted through this incision.
• A 0.5 cm piece of each vas is then removed and sent to pathology for confirmation.
• The edges of the cords are then coagulated, tied off with a suture and then buried at different levels of the scrotal wall.
• A dressing is then applied, which should be removed after 72 hours.
• A local anesthetic is injected around the vas deferii and into the wound, thus giving post-operative pain relief for the next 4-6 hours.

NB! You are required to bring 2 pairs of tight new undies for post-operative scrotal support.

What to expect after the procedure

• Any anesthetic has its risks, and the anesthetist will explain such risks.
• Bleeding is a common complication.
• A hematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible.
• An infection of the wound can occur and requires immediate review.
• Owing to the nature of the surgery and the soft skin of the scrotum, bruising may appear to be much worse than it is and is no cause for alarm.
• DANGER SIGNS: A scrotum that swells immediately to the size of a football, fever, or puss. Contact Dr Schoeman or the hospital immediately as this may occur in up to 5 % of all cases.

What next?

• The dressing should be removed 72 hours after the procedure by soaking in a bath until it comes off with ease.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• Condoms (protected intercourse) must be used for the next 3 months, as viable sperm are still present in the seminal vesicles (behind the prostate).
• A semen analysis will be requested 3 months after the procedure. Only if there are no viable sperm in the collection, may one proceed with unprotected intercourse.
• Patients will be informed of the semen analysis results by Dr Schoeman’s rooms.
• Should you have a persist sperm count, you should continue with contraceptive.
• If after 6 months you still have immotile sperm cells, you may get special clearance to drop your contraceptives, speak to Jo
• PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Vasectomy