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Dr. D. Love
Dr. D. Love, Doctor
Category: Urology
Satisfied Customers: 18550
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have a few inquiries about my current issue involving

Customer Question

I have a few inquiries about my current issue involving small epididymal cysts (bilateral) and a varicocele.
After doing a lot of Googling about things, it seems microsurgery is the best way to go with lowest risks. I was hoping for something less invasive, but I suppose I gotta do what I gotta do.
1- How bad will pain be afterward? Can they inject local anaesthesia so that when I wake up I won't be in horrible pain? How long does the pain tend to last?
2- Can both the cystectomy and varicocelectomy be done at once? If so, how long will this take?
3- Am I able to have anxiety medication before the procedure? This is very scary for me.
4- Is recovery time usually quicker with the microsurgical approach? For that matter, is pain usually also lessened with it?
5- Will I have a hole in my bandages/dressing/support I can easily pee from?
6- My cysts are very small but causing mild pain, so I'd imagine dissection of the epididymis would be needed. If dissection is necessary, will it hurt more?
7- What are the odds of stitches coming apart prematurely?
8- I read you can shower after 24 hours but they say to leave dressings on for 48. Does this mean wearing the dressing while showering?
9- What are the odds I'll need a scrotal drainage tube after surgery? Both the epididymal cysts and varicocele are quite small still.
10- I'm pretty sure I'll have to go through with the surgery, but do any less invasive, less painful techniques exist nowadays? Or should I just get the microsurgery done?
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

1. There is usually only mild pain after removal of epididymal cysts or variciceles. Yes, the doctor can inject long-acting numbing medicines to help ease post-operative pain.

2. Yes, both the cysts and the varicocele can be removed during the same surgical encounter. Surgery duration would depend upon the number of structures to be removed, but are generally a relatively short surgery, generally lasting about 1-2 hours.

3. Yes, the surgeon can prescribe anxiety medicines prior to the procedure. It is up to the professional discretion of the surgeon whether the medicine is justified. There also should be coordination with the Anesthesiologist, so that there is no interference with the anticipated anesthesia.

4. Recovery time is slightly quicker with the microscurgery, but actually either surgery method usually recovers relatively quickly.

5. The bandage will leave the penis free for urination.

6. Since the epididymal cysts arise off the epididymis, there is some dissection needed in all cases, not just for small ones.

7. The odds of stitches coming loose prematurely is very low.

8. The surgeons at our facility instruct patient to remove the bandage at 24 hours and allow cleaning of the wound. If the bandage needs to be continued, then you will be instructed to replace the bandage after the wound is clean and dry.

9. A drainage tube is generally not needed, particularly for small cysts and varicoceles.

10. It may be an alternative to drain the cysts with a needle and syringe. This will not get rid of the cyst, but may be able to relieve enough pressure that they are no longer causing any symptoms. The doctor may also consider injecting a medicine that may induce scarring of the cyst, to try to prevent recurrence. Injection may not be well tolerated, but would be more of a consideration in someone that is trying to avoid surgery. Of course, if the cysts are not causing symptoms, it would be an option to do nothing except monitor the cyst and varicocele over time.

Customer: replied 1 year ago.
Thank you for getting back to me so promptly.
In my own way, I almost WANT to have the surgery just to be sure I'm rid of these ailments, I just don't like the idea of being "cut open" down there. It ends up being a double edged sword of being scared to have the surgery but wanting to get rid of what's been bothering me. Plus the idea of showering with an incision sounds rather painful.Is there a trick to cleaning the wound properly? Or is it just kinda "let the water flow and bite the bullet for pain"
How can I get past this surgical anxiety? Any advice would be appreciated.
Expert:  Dr. D. Love replied 1 year ago.

For cleansing the wound, the most important issue is to be gentle. Do not let the full force of the shower water strike directly on the wound. Instead, let the water land on the skin of the abdomen and use the hands to direct the water to flow gently over the wound. Similarly, be gentle when applying soap and water over the wound with the hands or a soft wash cloth. It also may help to support the scrotum with one hand, while using the other hand to direct the water and clean the wound.

As for surgery anxiety, that is usually something that needs to be faced. Anxiety medicines can help to a certain extent, but somewhere along the line the anxiety needs to be directly faced. This should not enter into the decision of whether to perform surgery and we would not want to do surgery partly so that a patient can face their anxiety. But once a surgery is otherwise indicated, that would be the proper time to face the anxiety.

Customer: replied 1 year ago.
I wonder, would it be easier to just bathe in clean water?
Expert:  Dr. D. Love replied 1 year ago.

That is personal preference. Either would be fine.

Customer: replied 1 year ago.
If I'm getting a bilateral spermatocelectomy along with a varicocelectomy, how many incisions can I expect and where will they be likely to be? Again , these things are very small. Small enough you can't see them with the naked eye.Another curiosity is how common is it to have urination trouble after surgery? What would cause this? What can be done to help this problem? The idea of a catheter scares the hell out of me.
Expert:  Dr. D. Love replied 1 year ago.

Usually only two incisions,one on each side, but if the cysts on a side are far from each other, the surgeon may need to make rwo incisions on that side. When the surgeon examines you, the number of excisions can be stated.

Surgery in the scrotum will typically not cause urination difficulty. This surgery is far from the flow of urine.

Customer: replied 1 year ago.
the surgeon will also be able to access the varococele that way too? I understood it as a higher, non-scrotal incision (based on the image of incision sights for techniques)
Expert:  Dr. D. Love replied 1 year ago.

They can usually make one incision on each side to address both issues, but the surgeon will be able to say when the examination is done.

Customer: replied 1 year ago.
I've read a couple of things online about the use of a scrotoscope for excision of epididymal cysts. How effective is this? How many incisions would need to be made then?
Again, I'm aiming to treat varicoceles AND bilateral epididymal cysts and looking for as LITTLE discomfort as humanly possible. I know there will have to be some discomfort no matter what route I go, but I've honestly never been more freaked out in my life. I don't even know what the urologist is gonna say yet, but if these things don't go away on their own and only get worse over time, I'm gonna need the procedure(s) eventually right?Meantime I'm going in for an ultrasound on my abdomen in a couple of days to figure out this odd pressure feeling I've been having over the last couple of weeks in the liver/gallbladder area. I dunno if its just anxiety about my testicles causing it, or if I now have a whole new set of problems to worry about. Gallstones are my big worry because I have lost significant weight in the last 3 months (about 30lbs) due to dieting. On the other hand it could be that I'm just sitting all the time these days. I've seen my family doctor about it, and he poked and prodded me but didn't seem like he noticed anything. To be clear I have no real symptoms other than this odd pressure. Urine has been foamy sometimes, but also normal and pale yellow most of the time. Stools MAY have some mucus, but its kinda hard to tell. As far as I can tell things seem relatively normal looking.Any recommendations to get my head in the right state of mind? I'm not entirely sure what a panic attack feels like, but over the past few weeks I have had my fair share of breakdowns (crying pretty heavily, anger, wishing life could go back to the way it was, intense fear of surgical procedures that might be in my future, not QUITE suicidal thoughts, but wishing I was dead so my suffering can end, and honestly just overall emotional. Even as I write this I'm on the verse of tears)You have been great in answering my questions so far, and I thank you for your patience. My family doctor has told me that if the ultrasound comes back negative, he will talk to my mother (with my permission) about anxiety issues (I guess he wants another person's perspective outside of my own, which I understand, for all he knows I'm just after drugs)Meanwhile I have been seeing a hypnotherapist for my fears, but I can't really tell if it's working. I feel pretty good upon leaving the office, but it doesn't take long for my fears to set in again.
Expert:  Dr. D. Love replied 1 year ago.

I have already answered the 10 original questions, as well as several additional questions. If you want to have additional questions answered, then you will need to accept the Offer for Additional Service.

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