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Medical Forum / General / General / February 2007Remember The Hydrocele Surgery Thread--It Was
A HEMATOCELE when the uro got in there. He did not seem unduly concerned but he did seem a bit surprised. Original transilluminations were clear ( they became more complex/cloudy in past 18 months) and though 3 scrotal Ultrasounds had revealed blood and other debris the word hematocele was never considered (by the uro) to be a possibility until during today's "hydrocele" surgery. Not looking to blame anyone--heck I'm home feel pretty good so far-- but uro never even asked for the most recent US--I requested it to compare with last year's US--and though he reviewed the US report he never asked to see to "film" of the US (again until after the surgery-- I brought the film "just in case").Wouldn't a hematocele mass look much different on US film than a suspected hydrocele? As I said he never looked at the film until after the surgery. Obviously I'm (again) in intense data gathering mode and you folks (esp. Dr/Mr. McCollister )provided invaluable information in getting me ready for my "otherwise routine" "hydrocele" surgery. [Note too: urologist did not mention any histology or pathology tests done while I was on the table, or ordered after the procedure. Should any of this be a concern? I'm going back to him Monday to have dressing changed and drain removed] Thanks to all (Part 24). Michael >A HEMATOCELE when the uro got in there. He did not seem unduly > concerned but he did seem a bit surprised. Original transilluminations [quoted text clipped - 19 lines] > any of this be a concern? I'm going back to him Monday to have > dressing changed and drain removed] Transillumination is a rather blunt diagnostic tool. As to the ultrasound, the blood in a hematocele is likely to have had much of its cellular elements absorbed and the contents pretty liquified, so the ultrasound may very well have not been able to tell the difference. The biggest issue for the ultrasound is determining a fluid filled mass vs a solid mass, or perhaps a fluid-fill cyst with internal solid elements - this is an attempt to determine the potential for a malignancy as source for the fluid, which would in turn require a different surgical approach. The ability to determine the nature of what the fluid actually is is marginal with ultrasound. It's pretty routine, in fact generally required, that any tissue removed be sent to pathology. However, an experienced surgeon would very likely be able to ascertain the mass's general nature and draw a conclusion from that. Surprises can happen, but if he didn't come to you aftward and express concern, it's likely because he wasn't at all suspicious and awaiting the final pathology report without particular concern. HMc > >AHEMATOCELEwhen the uro got in there. He did not seem unduly > > concerned but he did seem a bit surprised. Original transilluminations [quoted text clipped - 39 lines] > > HMc Howard: I want you to be my urologist whether or not you have a medical degree (my very strong suspicion is that you do but "my profession" can certainly understand why you do not identify yourself as a doc on thesr Boards). Your feedback has been state-of- the art and invaluable to me. Still feeling pretty good 30 hours after but my complaint of the day is that neither the hospital (Surgical Department) nor the urologist has even called today to check on my well-being. And my complaint is not generic: I really needed detailed help from them in dealing with the rather bulky "surgical dressing" and wound care. The dressing is getting funkier by the hour (I'll spare EVERYONE further details of course) and I'd love to know how to change it before Monday's appointment with my uro. As stated the dressing is bulky, complex to me (including a "scrotal support"--viz., a mini jockstrap) and the dressing is holding the drain in place (not that I have a clue where the drain is, what it even looks like, where exactly the incision is or what the consequences would be of me trying to change the dressing without nursing/medical supervision). I hope the toxic waste dump that it is becoming will not put me at risk but I can't see how this is "good" in any way. One call from even the Surgical Nurses would have helped. OK, rant over, ongoing thanks not over!!! > Howard: > [quoted text clipped - 21 lines] > becoming will not put me at risk but I can't see how this is "good" in > any way. One call from even the Surgical Nurses would have helped. No, I doubt that you're at any risk from your dressing, but I'm sure it's getting unpleasant and you deserve better than to have to endure it. Dressings are simple. The concept of using a standard penrose drain in a hydrocele repair is kind of old fashioned, so I'm a little surprised that that's what happened. Even so, I recommend you go get some cotton gauze and change the dressing. If necessary, throw the scrotal support in the washing machine, wash the wound with some soap and water, redress with clean dry gauze in the scrotal support. A tight pair of briefs or an athletic supporter will work fine too. You won't hurt anything. HMc > > Howard: > [quoted text clipped - 34 lines] > > HMc Howard: TYVM......(Part 48). Michael PS- I'll fly you to my area, put you up at the Hyatt Regency and take you to Le Bec Fin if you'll become my urologist (med degree or not!!). The use of the drain and the uro's thought to wait 4 days (instead of the next day) to remove it was the focal point of his post-op approach (so I'm less than thrilled to hear the penrose drain is kind of old fashioned). What is used in its place if anything (OK no more questions in this post, I promise)? > The use of the drain and the uro's thought to wait 4 days (instead of > the next day) to remove it was the focal point of his post-op approach > (so I'm less than thrilled to hear the penrose drain is kind of old > fashioned). What is used in its place if anything (OK no more > questions in this post, I promise)? Accurate dissection and meticulous hemostasis. Most surgeons that I know, including myself, would rarely use a drain, and if it was deemed necessary, would use a closed suction drain like a Blake or Jackson-Pratt. HMc > > The use of the drain and the uro's thought to wait 4 days (instead of > > the next day) to remove it was the focal point of his post-op approach [quoted text clipped - 9 lines] > > HMc Unexpected post-drain removal complications. The drain was removed on Monday. I had to ask about any histopathology--it was not brought up--and uro said he's awaiting results. He did not seem concerned.I am (and will be until official findings are received). It has now been one week since hydrocele surgery turned into hematocyle surgery. Drain removed, surgical dressing changed. But now a very large front part of my scrotum--skin now exposed since drain was removed/dressing made less bulky--is very irritated/burning/painful especially when anything comes into contact with it (like my pants). Slightly more painful near the area of the still covered incision. I cannot walk 10 feet without experiencing intense irritation. I pull the waistband of the pants out to minimize scrotal skin/pants rubbing. I can get comfortable when sitting or lying down. Any idea of cause(s) or more importantly some 100% non-burning topical medication that will alleviate this intense discomfort while moving? The thought of showering (I'm way overdue) where water or soap hits that area is intimidating. Anything that will "cool this area off" without burning or risking complications to incision greatly (as usual) appreciated. Otherwise I feel fine!!! Thanks in Advance. Michael > Unexpected post-drain removal complications. > [quoted text clipped - 19 lines] > without burning or risking complications to incision greatly (as > usual) appreciated. The question in my mind would be local skin irritation from a fungal infection vs neuroma from the incision. If it were the former, I'd treat it with some topical anti-fungal cream like Lotrimin. This is not an uncommon finding in skin that's been moist, such as the scrotum, and which has had wet dressings from constant drainage from, say, a penrose drain. If it's a neuroma, there's not much that can be done in the short run. Intense, burning, stinging pain is common with a neuroma. HMc |
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