An epididymectomy is the surgical removal of the epididymis, a single, tightly coiled tube situated along the back of each testicle. This organ stores and matures sperm cells after they leave the testicle. The epididymis connects the testicle to the vas deferens, which transports sperm.
Reasons for the Operation
The primary reason for an epididymectomy is to alleviate chronic pain that has not responded to less invasive medical treatments. This discomfort is often caused by chronic epididymitis, which is persistent inflammation of the epididymis that standard medications cannot resolve. This inflammation causes severe, ongoing scrotal pain that interferes with daily life.
The procedure is also used to manage painful, large epididymal cysts, known as spermatoceles. These fluid-filled sacs can cause localized discomfort or swelling requiring surgical relief. Additionally, an epididymectomy may be recommended for localized trauma, severe abscesses, or to treat certain benign or malignant tumors affecting the epididymis.
The operation may also treat chronic scrotal pain developing after a vasectomy, known as post-vasectomy pain syndrome. Since the surgery destroys the sperm-transporting mechanism, it is considered a last resort when conservative pain management has failed over an extended period.
How the Procedure is Performed
The surgery is typically performed under general anesthesia, ensuring the patient is asleep and pain-free. A combination of sedation and a spinal anesthetic may also be used, depending on the surgeon and the patient’s health. The operation usually takes about 30 minutes and is often done in an outpatient setting, allowing the patient to return home the same day.
The surgeon makes a small incision, usually on the midline of the scrotum (scrotal raphe), to access the area. The testicle is carefully delivered through this opening, and the epididymis is exposed. The goal is to isolate the epididymis while preserving the blood supply to the testicle to ensure its viability.
The affected portion or the entire epididymis is then separated from the testicle using precise dissection and sometimes electrocautery to manage bleeding. The surgeon must take care not to damage the testicular artery, as this could compromise testicular function. Once the epididymis is removed, the incision is closed with dissolvable sutures or surgical glue, and a dressing is applied.
Recovery and Aftercare
Recovery begins immediately with pain management, involving prescribed oral medication and over-the-counter anti-inflammatories. Applying ice packs to the scrotum for the first 48 hours is recommended to minimize swelling and provide relief. Ice should typically be applied for 15 minutes at a time, followed by a 15-minute break.
Patients are advised to wear tight-fitting supportive underpants or a scrotal supporter continuously to immobilize the area and reduce swelling. Mild to moderate swelling and bruising are expected and should gradually resolve over the first few weeks. The incision site must be kept clean and dry, and dissolvable sutures typically disappear within one to two weeks.
Physical activity must be restricted, requiring avoidance of strenuous exercise, heavy lifting, and straining activities for up to two weeks. Most individuals can return to light work and driving within a few days. Full return to normal activity, including sexual activity, is usually cleared by the surgeon after the initial recovery period. Any significant increase in pain or swelling should be reported to a healthcare provider.
Potential Surgical Risks
As with any surgery, general risks include reaction to anesthesia, bleeding, and wound infection. A specific complication is the potential for a hematoma, a collection of blood in the scrotum that may require a second procedure to drain if it is large.
A localized risk is damage to the testicle’s blood supply, which can lead to testicular atrophy (shrinkage). Preserving blood flow is a major focus during the operation, though this complication is rare. Furthermore, the chronic pain the surgery intended to treat may persist, as pain relief is not guaranteed for all patients.
If the epididymectomy is performed on both sides, the removal of both epididymides results in the loss of the sperm transport pathway, leading to permanent infertility. If only one side is removed, fertility is usually maintained by the remaining side. Patients are counseled about these specific risks, especially the impact on pain relief and reproductive function.