Consent: Scrotal Exploration +/- Orchidopexy +/- Orchidectomy - Podcast Version TeachMeSurgery 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure Scrotal exploration is performed for cases of suspected testicular torsion, i.e. patients presenting with acute testicular pain. The most common access is via a vertical midline scrotal incision to gain access to both hemiscrotum. The findings of the exploration often determine if subsequent fixation or orchidopexy will be performed. It is imperative when consenting to ensure detailed informed consent is gained for the scrotal exploration +/- bilateral orchidopexy +/- suspected side orchidectomy. Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage Damage to the vessels of the spermatic cord Damage to surrounding structures The vas deferens or associated neurovascular structures can be damaged; especially important to avoid if the testicle is viable Careful dissection and identification of avascular plane, and ensure the identification of key structures throughout the procedure Anaesthetic Risk Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential Ways to Reduce Risk Pain Pain from the incisions and internal handling of scrotal structures Regular analgesia post-operatively and the use local anaesthesia at the incision site Infection Surgical site infections can develop at the incision site Maintain an aseptic technique throughout the procedure Haematoma formation Accumulation of blood around the testes, however this will usually gradually resolve spontaneously Adequate haemostasis intra-operatively Late Complication Description of Complication Potential Ways to Reduce Risk Testicular atrophy If the testis are damaged and non-viable, they will atrophy over time, reducing fertility Anti-sperm antibody production Detorting an ischaemic testicle can lead to the production of anti-sperm antibodies in some cases Tie off the testis proximally around cord if non-viable before performing orchidectomy Chronic pain Patients can develop chronic testicular pain due to fixation if an orchidopexy also performed Frequent questions What is scrotal exploration and when is it performed? Scrotal exploration is a surgical procedure conducted to investigate suspected testicular torsion, typically in patients experiencing acute testicular pain. This procedure often involves a vertical midline incision to access both sides of the scrotum. What are the potential complications of scrotal exploration? Complications can arise during or after scrotal exploration, including haemorrhage, infection, and testicular atrophy. These risks can be mitigated through careful surgical technique and postoperative management. What is the role of orchidopexy in scrotal exploration? Orchidopexy is often performed during scrotal exploration if the findings indicate that the testicle is viable but requires fixation to prevent recurrence of torsion. This procedure aims to secure the testicle in place to maintain its blood supply and function. How can the risk of infection be reduced during scrotal exploration? To minimise the risk of infection during scrotal exploration, it is essential to maintain an aseptic technique throughout the procedure. This includes proper sterilisation of instruments and the surgical site. What long-term complications may arise from scrotal exploration? Long-term complications from scrotal exploration can include chronic testicular pain and testicular atrophy if the testicle is found to be non-viable. These issues may affect fertility and overall testicular health, making careful assessment crucial during the procedure. Rate This Article