Testicular cancer: fast diagnosis, high chance of cure

Testicular cancer

Testicular cancer is a relatively rare disease, accounting for only 1% of all cancer cases in men. However, it is the leading cancer in men aged 15 to 35.

Risk factors for testicular cancer include being born with undescended testicles (cryptorchidism), having a family history of testicular cancer and having Klinefelter syndrome (a genetic disorder that affects hormone production).

The most common symptoms of testicular cancer include pain or swelling in the testicle, tenderness or heaviness in the scrotum, and changes in the appearance or size of the testicle. However, it is important to remember that there are often no obvious symptoms early in the disease.

The diagnosis of testicular cancer usually starts with a physical examination, followed by a blood test to measure levels of hormones produced by the testicles (tumor markers). If the doctor suspects cancer, a biopsy may be needed to confirm the diagnosis.

Treatment of testicular cancer usually includes surgery to remove the affected testicle, followed by chemotherapy or radiation therapy. The surgery is usually performed as an outpatient procedure and is considered very safe. Chemotherapy and radiation therapy are used to kill any remaining cancer cells.

The prognosis for testicular cancer is generally very good, with cure rates above 95% when detected and treated early. Men should watch for any change in the size or shape of their testicles and see a doctor if they have concerns. Regular self-examination can also help detect testicular cancer in its earliest stages. (1–7)

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018: Cancer Statistics, 2018. CA Cancer J Clin. January 2018;68(1):7–30.

2. Lv ZJ, Wu S, Dong P, Yao K, He YY, Gui YT, et al. Clinical outcomes in patients with stage I non-seminomatous germ cell cancer. Asian J Androl. July 2013;15(4):558–63.

3. Hajdum S, Whitmorjer W. Distribution of retroperitoneal lymph node metastases in testicular germinal tumors. 1974;(2):9.

4. Weissbach L, Boedefeld EA, for the Testicular Tumor Study Group. Localization of Solitary and Multiple Metastases in Stage II Nonseminomatous Testis Tumor as Basis for a Modified Staging Lymph Node Dissection in Stage I. J Urol. July 1987;138(1):77–82.

5. Fung C, Sesso HD, Williams AM, Kerns SL, Monahan P, Abu Zaid M, et al. Multi-Institutional Assessment of Adverse Health Outcomes Among North American Testicular Cancer Survivors After Modern Cisplatin-Based Chemotherapy. J Clin Oncol. April 10, 2017;35(11):1211–22.

6. Large MC, Sheinfeld J, Eggener SE. Retroperitoneal lymph node dissection: reassessment of modified templates. BJU Int. November 2009;104(9b):1369–75.

7. Masterson TA, Cary C. The Use of Modified Templates in Early and Advanced Stage Nonseminomatous Germ Cell Tumor. Adv Urol. 2018;2018:1–5.

Vasectomy

Vasectomy is a surgical procedure designed to prevent sperm from fertilizing the egg — in other words, it is a contraceptive method for men. It is performed through a small incision in the scrotum, where the vasa deferentia, the ducts that carry sperm to the urethra during ejaculation, are cut.

Any man over 18 years of age can choose to have a vasectomy, provided he understands the risks and benefits of the procedure and is certain that he does not want to have more children in the future. Keep in mind that vasectomy does not protect against sexually transmitted diseases, so it is important to keep using other methods of protection, such as condoms.

Before a vasectomy, the patient should have a consultation with a specialist, such as Dr. Bruno Benigno, to assess whether he is a suitable candidate for the procedure and to discuss the best type of anesthesia for his case. Vasectomy can be performed under local anesthesia, sedation or general anesthesia, depending on the patient’s preference and health status.

Recovery after vasectomy is usually quick and can take place at home. The patient should avoid strenuous exercise for a few days and may feel pain and discomfort in the operated area, but these symptoms are usually mild and can be controlled with pain medication.

Vasectomy is a highly effective contraceptive method, with a failure rate of less than 1%. However, keep in mind that it is a reversible option and, if the patient decides to have more children in the future, it may be necessary to reconnect the ducts using microsurgery.

After a vasectomy, a man still produces sperm, but it is absorbed by the body and is not expelled during ejaculation. Therefore, there is no change in sexual desire or in the quality of the semen after vasectomy.(1–4)

10 benefits of vasectomy

Vasectomy is a highly effective and safe contraceptive method that offers several benefits for men who want to control their fertility and have a healthier and safer sex life. Some of the main benefits of vasectomy are:

1. It is a highly effective contraceptive method, with a very low failure rate of less than 1%.
2. It does not affect sexual desire or semen quality.
3. It does not require the use of other contraceptive methods, such as condoms or pills.
4. It is a simple and quick procedure, usually performed in a single session.
5. Recovery is usually quick and can take place at home.
6. It does not require a hospital stay.
7. It has no hormonal side effects or other effects on the body.
8. It is a reversible option, although this may require additional procedures, such as in vitro fertilization.
9. It can be performed under local anesthesia, sedation or general anesthesia, depending on the patient’s preference and health status.
10. It helps protect the woman’s health, as it does not require her to use contraceptive methods that may cause side effects or interfere with other health conditions.

1. Yang F, Li J, Dong L, Tan K, Huang X, Zhang P, et al. Review of Vasectomy Complications and Safety Concerns. World J Mens Health. July 2021;39(3):406–18.

2. Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril. May 2000;73(5):923–36.

3. Stormont G, Deibert CM. Vasectomy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited December 20, 2022]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK549904/

4. Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician. December 15, 2006;74(12):2069–74.

Varicocele: what it is, symptoms, diagnosis and treatment:

Varicocele is a common condition in men that occurs when the veins in the scrotum — the sac of skin that holds the testicles — become dilated. This can raise the temperature of the testicles and affect sperm production, which may lead to fertility problems.

Symptoms of varicocele include pain or discomfort in the scrotum, swelling or a feeling of heaviness in the scrotum, and enlargement of the testicles. However, there are often no visible symptoms, and varicocele is detected during a physical examination or during infertility treatment.

Risk factors for varicocele include:

• Family history of varicocele
• Age (it is more common in young men)
• Intense physical activity
• Obesity

Varicocele is usually diagnosed by physical examination, but other tests, such as ultrasound and Doppler, may be performed to confirm the diagnosis.

Treatment of varicocele is usually recommended if symptoms are severe or if the condition is affecting fertility. Treatment may include surgery to correct the problem or medication to relieve symptoms. Dr. Bruno Benigno is a specialist in varicocele and infertility and can help determine the best treatment for each patient.(1–5)

1. Masson P, Brannigan RE. The varicocele. Urol Clin North Am. February 2014;41(1):129–44.

2. Zavattaro M, Ceruti C, Motta G, Allasia S, Marinelli L, Di Bisceglie C, et al. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest. December 2018;41(12):1365–75.

3. Leslie SW, Sajjad H, Siref LE. Varicocele. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited December 20, 2022]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448113/

4. Pryor JL, Howards SS. Varicocele. Urol Clin North Am. August 1987;14(3):499–513.

5. Baigorri BF, Dixon RG. Varicocele: A Review. Semin Interv Radiol. September 2016;33(3):170–6.

Vasectomy Reversal

Vasectomy is a male sterilization procedure that blocks the passage of sperm during ejaculation. Vasectomy reversal, also called vasovasostomy, is a surgical procedure that aims to restore male fertility — that is, a man’s ability to father children.

Indications

Vasectomy reversal is indicated for men who want to have more children after having a vasectomy. However, vasectomy reversal is not a viable option for every man, as it depends on the quantity and quality of sperm in the testicles, the man’s age and the time elapsed since the vasectomy.

Preparation

Before vasectomy reversal, the man should undergo a preoperative evaluation that includes blood and urine tests and a semen analysis to assess sperm quantity and quality. The doctor may also order other tests, such as an MRI or a testicular biopsy, to assess the condition of the testicles and check for any obstacles to vasectomy reversal.

Techniques

There are two main techniques for vasectomy reversal: microscopic vasovasostomy and open vasovasostomy. Microscopic vasovasostomy is the most commonly used technique and involves reconnecting the vasa deferentia (the ducts that carry sperm produced in the testicles to the urethra) through a microscopic incision in the scrotal skin. Open vasovasostomy is performed through a larger incision in the scrotal skin and is indicated when the vasa deferentia are severely damaged or too far apart.

Chance of success

The chance of success of vasectomy reversal depends on several factors, such as sperm quantity and quality, the time elapsed since the vasectomy and the technique used. According to the medical literature, the success rate of microscopic vasovasostomy is about 55% to 95%, while the success rate of open vasovasostomy is about 35%(1–6)

Anesthesia used in vasectomy reversal surgery:

It is usually a combination of local and general anesthesia. Local anesthesia is given at the surgical site to numb the area and keep the patient comfortable during the procedure. General anesthesia is given by injection or inhalation and blocks the sensation of pain throughout the body, keeping the patient unconscious during surgery. Vasectomy reversal usually takes 3 to 6 hours, depending on the complexity of the case. It is important to note that anesthesia is an important part of the surgical procedure and must be administered by a trained and qualified professional.

Recovery after vasectomy reversal surgery varies from patient to patient, but a period of rest and care is usually needed to ensure a quick, complication-free recovery.

Here are some things patients can expect during recovery:

• Strict rest for 48 hours: the patient should rest and avoid physical activity or excessive exertion during this period to allow the body to recover from surgery.
• Avoid high-impact physical activity for 45 days: the patient should avoid high-impact activities, such as running or jumping, for at least 45 days after surgery. This helps minimize the risk of injury and allows the body to recover fully.
• Use an ice pack: applying an ice pack to the surgical area can help reduce pain and swelling.
• Take medication: the doctor may prescribe medication to help control pain and prevent infection.
• Apply cold compresses: cold-water compresses can help reduce swelling and pain.
• Use a compression garment: the doctor may recommend a compression device, such as a scrotal support or a compression band, to help reduce swelling and promote blood circulation.
• Follow the doctor’s instructions: it is important to follow the doctor’s instructions and any additional guidance to ensure a quick, complication-free recovery.

1. Namekawa T, Imamoto T, Kato M, Komiya A, Ichikawa T. Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade. Reprod Med Biol. October 2018;17(4):343–55.

2. Lopushnyan NA, Walsh TJ. Surgical techniques for the management of male infertility. Asian J Androl. January 2012;14(1):94–102.

3. Shridharani A, Sandlow JI. Vasectomy reversal versus IVF with sperm retrieval: which is better? Curr Opin Urol. November 2010;20(6):503–9.

4. Belker AM, Thomas AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. March 1991;145(3):505–11.

5. Silber SJ. Microscopic vasectomy reversal. Fertil Steril. November 1977;28(11):1191–202.

6. Silber SJ. Perfect anatomical reconstruction of vas deferens with a new microscopic surgical technique. Fertil Steril. January 1977;28(1):72–7.

What is a hydrocele?

A hydrocele is a condition in which fluid builds up in the scrotum, the sac that holds the testicles. This can cause swelling and discomfort in the area. A hydrocele is usually benign and can be treated with surgery. However, in some cases it may be a symptom of other medical conditions, such as a tumor or inflammation of the testicles. If you are concerned that you may have a hydrocele, it is important to talk to a doctor for proper diagnosis and treatment.

Symptoms of a hydrocele include:

• Swelling of the scrotum
• A feeling of heaviness or pressure in the scrotum
• Pain or discomfort in the scrotum (rarely)
• Scrotal swelling that may look more pronounced when the patient is standing and decrease when he is lying down

It is important to note that a hydrocele often causes no symptoms and is discovered incidentally during a physical examination. If you are concerned that you may have a hydrocele, it is important to talk to a doctor to obtain an accurate diagnosis and appropriate treatment.(1–4)

What is the difference between a hydrocele and an inguinal hernia?

A hydrocele is a collection of fluid in the scrotum, whereas an inguinal hernia is the displacement of internal organs, such as the intestine, into the scrotal region. A hydrocele does not always require surgery, whereas hernias do.

The symptoms of these two conditions can be similar, since both can cause scrotal swelling. However, an inguinal hernia can also cause pain or discomfort in the groin or scrotum. In addition, an inguinal hernia may be reducible or irreducible, meaning that the displaced tissue or organ either can or cannot be easily pushed back into place.

What can happen if a hydrocele is not treated?

An untreated hydrocele can grow and cause discomfort or pressure in the scrotum, affecting blood circulation and, in severe cases, damaging the testicles. It may also be a sign of more serious conditions, such as tumors or inflammation, that require medical attention. Although many hydroceles are asymptomatic and need no intervention, it is essential to see a doctor to assess the risks and determine the best treatment.

How is hydrocele repair surgery performed?

Surgery to repair a hydrocele is called a hydrocelectomy. It is usually performed under local or general anesthesia and takes about 30 to 60 minutes.

During surgery, the doctor makes an incision in the skin of the scrotum and removes the excess fluid. The doctor then closes the incision with stitches and applies a dressing. The surgery is generally well tolerated, and patients can usually go home the same day.

After surgery, it is common to have some swelling and discomfort at the incision site. The doctor may prescribe pain medication and recommend rest and avoiding strenuous physical activity for a few days. Full recovery usually takes one to two weeks.

If you have been diagnosed with a hydrocele and are considering surgery, it is important to discuss all the details and possible risks with your doctor so you can make an informed decision.

1. Huzaifa M, Moreno MA. Hydrocele. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited January 6, 2023]. Available at: http://www.ncbi.nlm.nih.gov/books/NBK559125/

2. Doudt AD, Kehoe JE, Ignacio RC, Christman MS. Abdominoscrotal hydrocele: A systematic review. J Pediatr Surg. September 2016;51(9):1561–4.

3. Cimador M, Castagnetti M, De Grazia E. Management of hydrocele in adolescent patients. Nat Rev Urol. July 2010;7(7):379–85.

4.Arslan M, Kilinç M, Yilmaz K, Oztürk A. A new approach in the management of the hydrocele with a silicone catheter. Urology. January 2004;63(1):170–3.