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

 

Gray’s Anatomy XI sec 3c


Indications

Torsion of testis

In doubt wether
torsion or infection
 Tools

Sterile Sterile Metzenbau Needle
gauze linen m scissor holder

Povidone Blade and

iodine blade
10% holder Iodine cup Silk 3-0

Kocher
Pincets
forceps Plain catgut Polypropile
3-0 ne 3-0
Sponge Towel
forceps clamp
 Equipment
Sterile drapping Sterile gauze Sterile gown Hand gloves Povidone iodine
10%

Sponge forceps
Blade no
Kocher forceps Metzenbaum 15 Pinset
Needle
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).

Desinfects the abdomen, penis, scrotum, and both inner

thigh with Povidone Iodine 10% then cover it with
sterile towel.
 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)
(Hinman’s 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
(Hinman’s 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

(Hinman’s 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
(Hinman’s Atlas of Urologic Surgery, (polyprolene) and tie them
third edition, 2012) 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 ligate

(Hinman’s Atlas of Urologic Surgery, them with a 1-0 non-absorbable
third edition, 2012) 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 testicular  Excessive pain
vessels and nerves
Late :
• 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