General anesthetic is usually used for adults and children. Spinal anesthesia may be used on occasions. The aim is to dilate the closed urethral opening, and often a small incision is necessary. Rarely, a transposition skin/mucosal flap repair is required, often as a secondary procedure after simple surgery has failed.

The associated anatomy is relatively constant, but the degree of stenosis can vary considerably from mild narrowing altering the urine stream to complete closure. The presence of the foreskin can make the procedure more difficult, especially if phimosis is present.

See Table 5.2. Complications are generally minor and/or infrequent; however, some may be more significant on occasions. These include infection, skin necrosis, cosmetic deformity, meatal ulceration, meatal restenosis, and bleeding. Urinary retention is not uncommon and occasionally requires catheterization. Acute dysuria is a typical feature until the skin and mucosa heal.

Pain may be significant and may require loosening of dressings and pain relief. Acute dysuria is a consequence of surgery and expected; if prolonged beyond 72 h, it is abnormal. Bleeding is rarely severe. Infection usually responds to local dressings and oral antibiotics, if required. Infection may increase scarring and create poor cosmesis. Meatal ulceration may lead to recurrent meatal stenosis on occasions, which may require further surgery.

General anesthetic is almost always used; however, spinal anesthesia may be used. The aim is to explore the scrotal contents in particular the testes, as the usual indication for bilateral fixation is proven or suspected torsion of one testis. A separate transverse scrotal incision for each side, or a single midline incision, through the layers of the scrotum, may be used to expose each testis and deliver it outside the scrotum for adequate inspection. The color of the testis is noted and any evidence of torsion. If the testis is black or dark, then a period of time is spent waiting for any color change. Most testes will gain a pink coloration; however, if established necrosis has occurred (~ >6 h ischemia time), then removal of the testis may be required. The procedure objective of detorsion and fixation to prevent future torsion is achieved by one of several methods, all of which fixate each testis to the scrotal median raphe or to the lateral scrotal tissues or both and sometimes to each other. Either absorbable or nonabsorbable sutures can be used.

The main cause for testicular torsion is high investment of the processus vaginalis around the testis and posterior epididymis, allowing the testis and epididymis to rotate around the spermatic cord superiorly. This often produces the clinical “bell clapper” testis phenomenon, with a classical horizontal lie of the testis. Tenderness over the upper epididymis may signify torsion of an appendix of the testis; however, surgical exploration is usually warranted to confirm this, although duplex ultrasound can be very reliable in determining blood supply to each testis and the correct diagnosis.

See Table 5.3. Complications are generally minor; however, on occasions some may be more significant. These include bleeding, hematoma formation, infection, skin necrosis, wound dehiscence, cosmetic deformity, acute and chronic pain, and rarely recurrent torsion. Urinary retention is not uncommon and occasionally requires catheterization. Large scrotal hematomas or infection can significantly increase hospitalization and delay recovery.

Pain may be significant and may require support dressings and pain relief. Chronic pain occasionally occurs and is a major problem. Bleeding is rarely severe but can produce a large scrotal hematoma requiring surgical evacuation. Infection usually responds to local dressings and oral antibiotics. Infection may cause wound dehiscence, increase scarring, and create poor cosmesis.

General anesthesia is almost always used; however, spinal anesthesia may be used. The aim is to explore the scrotal contents on the side of the hydrocele, confirm the diagnosis, and incise, drain, and repair the hydrocele. A separate transverse scrotal incision on the affected side, or a single midline incision, through the layers of the scrotum, is used, to expose the hydrocele. Several methods can be used to drain the hydrocele and prevent recurrence. A standard method excises some of the anterior part of the hydrocele sac and folds the lateral part of the hydrocele wall back against the epididymis where it is sutured with a continuous absorbable suture (Jaboulay method), on each side of the testis. This effectively obliterates the tunica vaginalis preventing reformation of the hydrocele. The scrotum is closed in layers. The procedure is usually unilateral, unless both sides are affected. Needle aspiration or tapping of the hydrocele is usually associated with recurrence.

The main cause for hydrocele is collection of excessive fluid in the tunica vaginalis, the remnant of the embryological processus vaginalis around the testis and posterior epididymis. A hydrocele invests the testis, predominantly anteriorly as a uniform swelling, with the epididymis usually being palpable at the back. Duplex ultrasound can be very reliable in determining the correct diagnosis.

See Table 5.4. Complications are generally minor; however, on occasions some may be more significant. These include bleeding, hematoma formation, infection, skin necrosis, wound dehiscence, cosmetic deformity, acute and chronic pain, and rarely recurrent hydrocele. Urinary retention is not uncommon and occasionally requires catheterization. Needle aspiration or tapping of the hydrocele is usually associated with recurrence, bleeding, and infection.

Pain may be significant and may require support dressings and pain relief. Chronic pain occasionally occurs and is a major problem. Bleeding is rarely severe but can produce a large hematoma requiring surgical evacuation. Infection usually responds to local dressings and oral antibiotics. Infection may cause wound dehiscence, increase scarring, and create poor cosmesis. Recurrence of the hydrocele may also occur, perhaps necessitating further surgery.