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Medical Forum / General / General / April 2007Pinging (Dr.) McCollister (and others): Hydrocele/Hematocele Complications
I'm almost embarrassed to continue this reach-out. Background: what was supposed to be "simple" testicular hydrocele surgery--though I found nothing simple or "routine" about it--turned out to be AFTER I was on the table surgery to remove a hematocyle. In basic terms the fluid causing the testicular swelling was blood not "clear". Supposedly this was not detectible pre-op and my urologist said at the time that to him it did not present any exceptional surgical complications (pathology was benign thank G-d). One week after the surgery, I felt much better but while scraping ice off my car I slipped and "ripped open" most if not all of the healing incision area. Yes "ewww" and "ouch" indeed. Since that time my uro has taken a conservative approach ("wait for it to heal" keep clean watch for infection--there has thus far been none). Last week I went to him for the 4th time since my fall and he was clearly dismayed at the "unhealed" state of the incision area. Without much discussion he proceeded to "cauterize" the area to, as he explained, intentionally inflame it to speed-up the healing process. As a final bit of background though unhealed, in the week before this 4th post-slip monitoring appointment with the uro, I started feeling better and any "dischagted fluid" on the gauze pad I used to cover the area had dropped to almost nothing (but the wound had still not healed, obviously). At this appointment for the FIRST TIME he mentioned the possibility of an "abcess" which he said (again for the first time) might drain forever unless surgically addressed even if the skin on the outside heals. He said the damage the hematocyle had caused to the testicle on which it had impacted might have created the abcess in or near the testicle possibly requiring ( or warranting) ultimate removal of the testicle (again, hearing this for the first time). He seemed to be saying my slip on the ice/damage to the incision was almost irrelevant to his current evaluation. Since the cauterization the discharge has become more prevalent and the wound does not seem to have healed.. He wants to see me again (5th time since my slip on the ice) in three weeks and if the healing is not obvious he will be ready to discuss clean-up//redo surgical procedures. Don't even know where to begin except to say anyone's reaction including ewww and ouch greatly appreciated. Was cauterization called-for under the facts discussed? Did/does it have the chance to promote healing within the next three weeks? Should I consult a medical wound specialist and/or seek a second opinion from a urologist? And why o why did he spring this "abcess" problem on me so late in the game (or not address the abcess surgically at the time he discovered the hematocyle while I was on the table on Feb 8th; he said "it was too messy with the blood he discovered" to do so at that time). Ugh. Otherwise I feel great (really). Thanks to anyone who can provide ANY feedback Michael > I'm almost embarrassed to continue this reach-out. Background: what > was supposed to be "simple" testicular hydrocele surgery--though I [quoted text clipped - 54 lines] > "it was too messy with the blood he discovered" to do so at that > time). I wish I could be of help, but your situation exceeds the liklihood of accurate clinical evaluation over the internet. I'm not clear on how we got from excision of a simple hematocele to an abscess and possible loss of the testicle. The scrotum has many layers. I'm not clear on exactly where this infection is - skin? spermatic fascia? dartos? vaginalis? I can see cauterizing exuberant granulation tissue, but that certainly doesn't have to imply an infection. And where does this talk of abscess come from? Is the scrotum infected? Is there cellulitis? Fever? Elevated white count? I'm sorry, the internet isn't going to be able to help you with this. Certainly, given the questions above, you don't have confidence in your urologist, in which case I definitely think you should consider seeing a different urologist for another opinion. Don't waste you time with a "wound healer", you need someone who is very familiar with the layers of the scrotum. HMc > > I'm almost embarrassed to continue this reach-out. Background: what > > was supposed to be "simple" testicular hydrocele surgery--though I [quoted text clipped - 72 lines] > > HMc Thanks again for your reaction and of course I do not use the Internet as the final guide to what should be done medically. But your feedback has always been considered and state-of-the-art whether under Internet or "real world" standards. I too am/was mystified about where the abcess (sp?)//infection talk came from (I think he's saying there is no external infection from the still- healing wound but that the hematocele was caused/exacerbated by a so far unaddressed abcess either in the testicle OR somewhere between the outer layer of the scrotum and the testicle itself). I'm very unclear about had I not slipped would this "smoldering abcess" (the uro's words) still have presented a significant ongoing medical problem to me ... > But your feedback has always been considered and state-of-the-art > whether under Internet or "real world" standards. I too am/was [quoted text clipped - 7 lines] > abcess" (the uro's words) still have presented a significant ongoing > medical problem to me I could see where the sudden strain from slipping on the ice could cause a little bleeding in the tunica vaginalis space, but in that case we're talking maybe a hematoma. This "smoldering abscess" talk by your urologist smacks of obfuscation. As to the hematocele. They are almost always due to trauma if they're not cause by cancer (as yours apparently was not). So I put this together as a chronic hematocele from remote testicular trauma which was removed via a scrotal incision and a penrose drain left in (ick). You subsequently slipped on the ice, developed some recurrent swelling. In addition, you have some exuberant granulation tissue at the wound edges or drain exit sites which your urologist cauterized with something. Do see someone for another opinion. HMc > > But your feedback has always been considered and state-of-the-art > > whether under Internet or "real world" standards. I too am/was [quoted text clipped - 22 lines] > > HMc HmC: Words cannot express--though I continue typing--my appreciation for your thoughts from Day One (actually you began discussing this more than one year before I had the surgery) about this relatively simple (compared to the millions of other legitmately ill//injured folks) matter. Since words cannot express my thanks I'll use symbols ^&+!!!! =TYVM!!!! I will indeed seek a second opinion and only wish you were in the Philadelphia area!!! |
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