![]() ![]() ![]() It is imperative that the sac is not violated prior, as it makes dissection exceedingly difficult. #Webbed scrotum freeOnce encountered, we use blunt dissection around the tunica to free it from overlying fascia before we deliver it from the incision. ![]() A small median raphe incision is made and dissected to the level of the hydrocele sac. At our institution, we prefer the Jaboulay procedure. Although there are numerous techniques for repairing hydrocele ( 6- 8), the two most common procedures are the Jaboulay hydrocelectomy and the Lord procedure ( 9). Hydrocelectomy is one of the most ubiquitous surgical procedures in urologic practice. At our institution, sclerotherapy is a seldom-used modality, but remains an option for patients with numerus comorbid conditions that may preclude surgical management. A Cochrane review of aspiration and sclerotherapy versus hydrocelectomy revealed surgical management resulted in fewer long-term recurrences, despite higher rates of complications ( 5). The cure rates of sclerotherapy are variable, with most studies reporting anywhere between 50–95% cure ( 2- 4). Sclerotherapy of hydroceles, commonly performed with concomitant aspiration, involves the injection of a sclerosing agent, such as phenol or tetracycline, into the hydrocele sac. Management of hydrocele may involve watchful waiting, sclerotherapy, or hydrocelectomy. Ultrasonography can be used to confirm the diagnosis (hydrocele, spermatocele), its volume, and its complexity. Classically, the scrotal transillumination test has been used to describe the presence of hydrocele or a solid testicular mass. On physical exam, hydroceles are manifested by a variable, fluid-filled sac which contains the testis. The diagnosis is most commonly made by physical examination and ultrasonography. In adults, hydroceles tend to be non-communicating, and have a variety of causes: idiopathic and reactive (infection, malignancy, trauma). Hydroceles have been classified into communicating or non-communicating types-dependent on whether the processus vaginalis remains patent. Hydroceles are a commonly encountered urologic condition with an incidence of nearly 1% of adult men ( 1). #Webbed scrotum skinHowever, it is our hope that we can provide our indications, surgical techniques, and our complications for more complex scrotal procedures, such as scrotoplasty and split-thickness skin grafting, to provide confidence for the urologist who may not routinely perform these surgeries. In this review, we briefly discuss hydrocelectomy, which is amongst the most commonly performed procedures by the general urologist. These range from simple hydrocelectomy to complex scrotal reconstruction. Urologists encounter a wide-variety of conditions affecting the scrotum that require surgical management. Keywords: Fournier’s gangrene (FG) hydrocele prosthesis implantation scrotum skin grafting trauma Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Abstract: Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. ![]()
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