What are the post-operative care instructions for an epididymectomy?

Post-Operative Care After Epididymectomy

Epididymectomy is an effective treatment for chronic epididymal pain with approximately 70-90% of patients experiencing complete resolution or significant improvement in pain symptoms. 1, 2

Pain Management

• Multimodal pain management should be implemented using non-opioid analgesics as the foundation of treatment 3:

  • Acetaminophen (paracetamol) should be scheduled regularly (up to 1000mg every 6 hours, maximum 4g daily) 3
  • NSAIDs such as ibuprofen (400mg every 6-8 hours) are highly effective for post-epididymectomy pain and should be used unless contraindicated 4, 3
  • Opioids should be minimized and used only if needed for breakthrough pain 3

• Local cold packs applied to the scrotum can help reduce pain and swelling 3

Activity Restrictions

• Patients should avoid strenuous physical activity for 7-10 days following surgery 3
• Early mobilization is recommended (at least 30 minutes on the day of surgery and 6 hours/day thereafter) to prevent complications 3
• Sexual activity should be avoided until cleared by the surgeon (typically 2-4 weeks)

Wound Care

• Keep the surgical area clean and dry 3
• Gentle daily cleansing with mild soap and water is recommended 3
• Sitz baths twice daily until the first wound check can help with comfort and healing 3
• Wear supportive underwear or scrotal support to minimize discomfort and swelling 3

Urinary Catheter Management

• If a urinary catheter was placed, it should typically be removed within 24 hours after surgery unless otherwise indicated 3
• A voiding trial should be performed after catheter removal to ensure adequate bladder function 3

Follow-up Care

• Patients should have a follow-up appointment within 2 weeks after surgery 3
• Clear documentation of the procedure and technique used should be available for review 3

Expected Outcomes

• Complete pain resolution can be expected in approximately 70% of patients 1, 2
• An additional 10-20% of patients will experience significant improvement in pain 1, 2
• Factors associated with poorer outcomes include:
  • Pain duration >1 year prior to surgery 1
  • History of psychiatric conditions 1
  • Prior scrotal/inguinal/abdominal surgeries other than vasectomy 1

When to Seek Medical Attention

• Fever >38°C (100.4°F) 3
• Excessive bleeding or discharge from the surgical site 3
• Severe pain not controlled with prescribed medications 3
• Signs of infection (increasing redness, warmth, swelling) 3
• Inability to urinate after catheter removal 3

Potential Complications

• Post-operative infection (uncommon) 3
• Hematoma formation 3
• Persistent pain (occurs in approximately 30% of cases) 1, 2
• Urinary retention (rare) 3

Long-term Considerations

• For patients with bilateral epididymectomy who wish to preserve fertility, sperm banking should have been discussed preoperatively 5
• Some patients may develop chronic testicular pain that requires additional management 5