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Urology (Expert Forum)
Local anesthesia for spermatocele surgery?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Local anesthesia for spermatocele surgery?
by Bill1, Oct 06, 2005 12:00AM
I have a spermatocele or epididymal cyst that measures about 6.7 cm at it's longest. It is about twice the size of the testicle and attached to the right testicle. I had an ultrasound and everything is normal/benign. I want to have it surgically removed as I dont like it, though it doesn't cause much pain. I just dont like it "flopping around" and whatnot. It is an optional surgery, but I greatly desire to have it.
The problem is I am terrified of "going under" general anesthesia. So far the one doc I talked to said it is a simple surgery, but that they only perform it under general anesthesia. He said it is difficult to anesthetize the area fully using local and there is too much pain or chance I might kick or rise up due to a sudden burst of pain under local, so he refused to do the surgery with local. He mentioned spinal anesthesia might be a possibility but for the most part no. He also said a few urologists "might" do it under local, but not he.
He also said elderly patients that are poor surgical risks they sometimes do under local, apparantly. Yet he refused to do me with local only.
On the internet I found a description of spermatocele surgery under local anesthesia (cord block). That link is here: http://www.emedicine.com/med/topic2880.htm and I qoute: "Spermatocelectomy is typically performed on an outpatient basis. A variety of anesthetic agents may be used. The choice is determined primarily from the preference of the anesthesiologist. This author's preferred form of anesthesia for most scrotal procedures is infiltration with local anesthesia and IV sedation because it produces excellent patient comfort without delaying the postoperative recovery."
I have also found studies of this (scrotal surgery under cord block/local/awake) on pubmed. It seems entirely possible.
So basically long story short, I guess I am wondering what you think I should do. Remember I desire the operation, but refuse to "go under" general anesthesia for it. It seems a pretty simple operation, I am 30 and healthy and can tolerate some pain during the operation should it arise no problem.
Should I continue to "shop" around for a doc that will do the operation I desire under cord block/local anesthesia/awake? (I am already seeing two docs on it, and they dont seem to mind) Or do you think basically no urologists will do this? What is your opinion?
The problem is I am terrified of "going under" general anesthesia. So far the one doc I talked to said it is a simple surgery, but that they only perform it under general anesthesia. He said it is difficult to anesthetize the area fully using local and there is too much pain or chance I might kick or rise up due to a sudden burst of pain under local, so he refused to do the surgery with local. He mentioned spinal anesthesia might be a possibility but for the most part no. He also said a few urologists "might" do it under local, but not he.
He also said elderly patients that are poor surgical risks they sometimes do under local, apparantly. Yet he refused to do me with local only.
On the internet I found a description of spermatocele surgery under local anesthesia (cord block). That link is here: http://www.emedicine.com/med/topic2880.htm and I qoute: "Spermatocelectomy is typically performed on an outpatient basis. A variety of anesthetic agents may be used. The choice is determined primarily from the preference of the anesthesiologist. This author's preferred form of anesthesia for most scrotal procedures is infiltration with local anesthesia and IV sedation because it produces excellent patient comfort without delaying the postoperative recovery."
I have also found studies of this (scrotal surgery under cord block/local/awake) on pubmed. It seems entirely possible.
So basically long story short, I guess I am wondering what you think I should do. Remember I desire the operation, but refuse to "go under" general anesthesia for it. It seems a pretty simple operation, I am 30 and healthy and can tolerate some pain during the operation should it arise no problem.
Should I continue to "shop" around for a doc that will do the operation I desire under cord block/local anesthesia/awake? (I am already seeing two docs on it, and they dont seem to mind) Or do you think basically no urologists will do this? What is your opinion?
Doctor's Answer
by Kevin Pho, MD, Oct 06, 2005 12:00AM
, Oct 06, 2005 12:00AM
The type of anesthesia will be influenced on the size, location, and the severity of the cyst being removed. If it is anticipated that the procedure is extensive, then doctors may be hesitant to use local anesthesia.
That being said, you can continue to ask for additional anesthesia opinions to see if one is willing to do your case without general anesthesia.
I cannot give a specfic opinion on what you should do without reviewing your case.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
That being said, you can continue to ask for additional anesthesia opinions to see if one is willing to do your case without general anesthesia.
I cannot give a specfic opinion on what you should do without reviewing your case.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
Member Comments (4)
by Bill1, Oct 06, 2005 12:00AM
To: Urology - General
0
by Bill1, Oct 06, 2005 12:00AM
To: Urology - General
0
by James44, Nov 07, 2005 12:00AM
To: Urology - General
0
by Guanche, Nov 12, 2005 12:00AM
To: Urology - General
0
by Willabor, Apr 01, 2008 08:17AM
A related discussion, How Much would a Spermatocelectomy Cost!? was started.
