DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Azoospermia.
2. Bilateral absence of vas deferens.
POSTOPERATIVE DIAGNOSES:
1. Azoospermia.
2. Bilateral absence of vas deferens.
OPERATION PERFORMED: Bilateral open testicular biopsies.
SURGEON: John Doe, MD
ANESTHETIC: General anesthesia via LMA.
COMPLICATIONS: None.
DRAINS: None.
ESTIMATED BLOOD LOSS: Minimal.
INDICATIONS FOR OPERATION: This patient has a history of azoospermia. He has been evaluated to rule out retrograde ejaculation. On physical examination, he has no palpable vas deferens on either side. The patient’s FSH level is normal. We have recommended bilateral open testicular biopsies for both pathologic diagnosis and also possible sperm preservation for eventual in vitro fertilization. Informed consent has been obtained.
DESCRIPTION OF OPERATION: The patient was placed on the operating table in the supine position. General anesthesia was administered via LMA. The genitalia were sterilely prepped and draped in the usual fashion.
A midline scrotal incision was made and carried down to the surface of the left testicle. A small amount of hydrocele fluid was released when the tunica was opened. The testicle itself appeared quite normal. The left vas deferens was absent. A series of small incisions were made along the length of the testicles in order to provide complete biopsies of the entire testicular surface. Biopsies were obtained in the top, middle, and lower sections, and each small specimen was placed in a single container for the reproductive lab. A biopsy was also obtained from the central portion of the testicle and will go to pathology for pathologic examination. The small incisions were then closed with interrupted 4-0 chromic sutures. There was no evidence of bleeding. Hemostasis was obtained when needed with electrocautery. The testicle was then returned to an intrascrotal position.
The right-sided testicular biopsy was performed in an identical fashion, and again, samples were sent to both reproductive studies and to pathology. The incisions were closed with interrupted 4-0 chromic sutures. Hemostasis was obtained. The testicle was returned to an intrascrotal position. Incidental note was also made that the vas is absent on the right side.
The tunica layers were then closed with running 3-0 chromic sutures. The dartos layer was closed with a running 3-0 chromic suture. The skin was closed with a 2-0 chromic vertical mattress interrupted suture. Polysporin ointment was applied followed by sterile dressings and a scrotal support. The patient tolerated the procedure well and went to the recovery room in satisfactory condition. Sponge and needle counts were correct x2.
