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Diagnosed with inguinal hernia. What kind of treatment or surgery required?

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Practicing since : 1998
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Hi Doctor, One of my relative has one un-descended testis from birth.All these days he thought he had only a single testis as that was the only one he could feel in his sanctum.He is 30 years old.When he was a child his parents had shown to doctor and they said no treatment is required as the testis will automatically come down in Sac.when he was around 8 years old his parents again showed to doctors as the testis did not come down and again the doctors said it will come down later in life and said no treatment is necessary.Now in last 1 year he felt the presence of another testis in his sac when he sits in stools position.When he stands it is partially down in sac and when he sleeps its completely not felt in sac.So after getting advice to consult a urologist through health magic he got it diagnosed in manipal.So after ultra sound done he came to know some new revelations.The egg shaped mass with identical shape of testis which he thought was his undescended testis was told to him was a inguinal hernia.And the ultrasound doctor said that he has a left testis in inguinal region.The report says following "Realtime UltraSonography of the Scrotum and color dropler study" "Right testis measures 4.9 X 2 X 2.9 cm(Volume 15 cc).Normal in size and echotexture.No focal lesion.No surrounding free fluid.RIght epididymis measures 1 X 0.9 cm. Normal in size, no lession noted.Left scrotal sac is empty.Left testis is seen in the deep inguinal region.It measures 3.7 X 2 X 2.7cm (volume 11CC).There is herniation of omental fat into the left scrotal sac.The defect measures approx 1.8 cm. Impression:Undecended left testis.Left testis in inguinal region.Left inguinal hernia with omentum as its content." Now here are few of my questions: 1.He has no pain as accompanied with hernia.So is any kind of surgery or treatment required? Is this hernia size as in report small or large? I read that if the size of hernia is small then no surgery is required and healthy lifestyle is sufficient.Please advice. 2.Does his left testis which is undescended need to be operated on and brought down into sac at this age of 30.The doctors had said they were no problems seen in testis.So even in case the undescended testis is not fertile does it need to be removed or can it be brought down and kept in sac.? 3.If hernia does not need to be operated on then can undecended testis needs to be operated or its ok to leave it as it is? 4.In case you opt for surgery which of the surgeries do you suggest the best for his case? 5.What is the recovery period(how many days of leave he needs to apply from job and how many days he need to stay in hospital) and what are the pros and cons of the surgery ? When should it be really opted? Only in case of pain? 6.Does all these problems have impact on his sexual life and his ability to have children.He is unmarried so more concerned..? 7.Does congenital hernia(which he is not sure of) can stop the testis from undescending in sac? Any of your suggestions.Please provide a detailed reply for each points.You may ask any question if you have to get more clearity of his situation.
Posted Fri, 6 Dec 2013 in Urinary and Bladder Problems
Answered by Dr. Rajiv goel 11 hours later
Brief Answer: Left undescended testis with left inguinal hernia Detailed Answer: Dear Mr XXXXXXX You friend has left undescended testis with left inguinal hernia. He has been born with both the conditions ( Congenital). When in womb the testis is the abdomen and descends down at 28 weeks of pregnancy. The passage through which it descends remains patent in some and is known as processus vaginalis. The abdominal contents come out through this passage and are known as hernia. Hernia usually accompanies the undescended testis. Hernia is not responsible for the undescended testis. Infact, the converse is true. He should undergo surgery for his hernia as well as undescended testis and bring the testis down to the scrotum. Hernia is not be operated only when it pains; he should undergo surgery before it becomes too big or lands up in the middle of night with some complication. Surgery should be opted and testis brought to a place where it can be easily examined and felt. The incidence of testicular cancer is slightly higher in undescended testis and hence it should be at a position where it can be regularly examined.Both the surgeries are done at the same time. The hospital stay is usually 2 days and he shall need to be off work for week or so. Pain is there but not so severe that it limits normal activities. It is very safe surgery and has no major complications. The undescended testis does not contribute any sperms to the semen analysis because all the germ cells get damaged. He should get semen analysis to see how well his other testis is functioning and that shall decide his fertility potential. The undescended testis is producing testosterone and is thus contributing to his having normal erections and libido. Take care Sincerely Rajiv Goel
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Follow-up: Diagnosed with inguinal hernia. What kind of treatment or surgery required? 5 hours later
Some of my follow up questions are below,please provide point by point answer so that he can come to conclusion as to what is to be done next: 1.He is 30 now, so do you still want his undescended testis to be brought down into sac or be blindly removed ? 2.Removing of testis should be based on it being functional or not ?Which means he should get that testis tested before surgery? 3.I heard of the risk of testicle cancer ,so does this happen in case of only non-fuctional testis or in case of any undescended testis, irrespective of it being functional or non-functional?Will the damaged cells of his testis lead to cancer? 4.What are the symptoms of testicle cancer? 5.What are the symptoms of Hernia getting complicated or need faster surgery?(when is that decision needs to be made) 6.What is the name of surgery you suggest in this case? and how is it performed? 7.Will a person be able to lead a normal life of running,sports etc after the surgery?Will he be able to lead a normal married life? 8.Do you know of an exact similar case in your experience and is it all normal with him after surgery? 9.What are the side effects of surgery?Can you suggest some good hospitals in bangalore or hubli where this can be performed with experts? Is manipal good in these ?(I am asking your personal opinion) 10.As the bulge(of hernia in ingunal area and also felt in sac) goes away when you sleep do you think surgery is required(as i read somewhere if the bulge is retracticle then it can be left as it is)? Will the hernia size/bulge grow with age or is it constant?
Answered by Dr. Rajiv goel 1 hour later
Brief Answer: Surgery Detailed Answer: Dear sir, Surgery is certainly required and testis should be brought down rather than sacrificing it. Testis is surely functional; it is providing testosterone. Testicular cancer happens in any undescended tetis. Some studies suggest that there is increased incidence even in the normal descended contralateral testis. The first sign of testicular cancer is hard lump. Hence the testis if not to the sac should be brought to such a place where it can be felt. There are no symptoms of hernia getting complicated. It may remain uncomplicated forever or may get complicated even today. The surgey is orchidopexy and hernia repair. It can be done open as well as laparoscopically. The patient is able to lead normal life and also continue sports activities. his sexual life is absolutely normal. Such patients are routinely encountered in our practice and they do well. There are no major side effects of surgery other that some pain, infection or bleeding. these side effects are common to all surgeries. You can get him operated at Manipal. Reducible hernia has lesser complaiction rate but it can still encounter complications. Hence all hernias should be operated if the age of patient is less than 70 yrs. The hernia can remain the same or even grow. Take care Sincerely Rajiv goel
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Follow-up: Diagnosed with inguinal hernia. What kind of treatment or surgery required? 25 minutes later
Hi Doctor I am bit confused when you said "Testis is surely functional; it is providing testosterone. Testicular cancer happens in any undescended tetis. Some studies suggest that there is increased incidence even in the normal descended contralateral testis" 1.Are you referring here to undescended testis and saying its functional or about descended testis? As you are saying it need not be sacrificed ? 2.Can testicular cancer spread from undescended to decended testis? If so then there is a risk of bringing it down. Isn't it? 3.Between open as well as laparoscopically, which one do you suggest best in this case where you have to repair hernia and also bring down testis? 4.Do you know any other hospitals which are expertised in this in Bangalore? 5.The side effects of surgery you mentioned are temporary or for life long? 6.Will the damaged cells of undescended testis lead to cancer or is it something else leads to cancer?
Answered by Dr. Rajiv goel 15 hours later
Brief Answer: Cancer Detailed Answer: Undescended testis is functional and providing testosterone. The normal testis is providing testosterone as well as sperms. Hence as far as possible the undescended testis should not be sacrificed. Cancer does not spread from one testis to another. The very fact that one has undescended testis leads to changes in the body and this leads to increased chances of cancer in both the testis. Removing the undescended testis does not decrease the incidence of cancer in normal testis. I shall prefer laparoscopic and it can be done at apollo, Fortis. The side effects are temporary and may last for 3-6 months. Take care sincerely Rajiv goel
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Follow-up: Diagnosed with inguinal hernia. What kind of treatment or surgery required? 12 hours later
I had shown him in Manipal for initial analysis and for ultra sound. So from your personal opinion do they also have expertise in this area or you know any expert doctor in this? We would do this in banaglore or hubli. If you know of any hospitals or doctors in Hubli that would be of great help. Please suggest
Answered by Dr. Rajiv goel 11 hours later
Brief Answer: Manipal hospital Detailed Answer: Dear Sir, This procedure can be done at manipal hospital. Unfortunately I am not aware of any doctor in Hubli. Sincerely Rajiv goel
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