Comprehensive Urology

Diseases and Conditions

Procedures

Imaging Services

The daVinci System

Delta Medix Patient General Information

Excisional Biopsy of a Penile or Scrotal Lesion Excision of a Cyst or Abscess Drainage

Definition

Excision = to cut and remove

Biopsy = to take part of a tissue and have it analyzed

Penile = pertaining to the penis

Scrotal = the scrotum is the skin sac covering the testicles

Lesion = abnormal appearing or feeling tissue

Cyst = a collection of debris enclosed in a tissue capsule (can be infected)Abscess = an infected site walled off by tissue

Lumps on the penis or scrotum may be benign (not cancerous), malignant (cancerous), or infectious. Although we can often differentiate them by their location, appearance, and rate of growth, we may sometimes recommend excision and further microscopic examination by a trained pathologist. Alternatively, they may be excised for cosmetic reasons or because they are causing discomfort.

Cysts are far more common on the scrotum than on the penis. They are usually benign. Abscesses are more common on the scrotum as well. An abscess is usually a surgical emergency and should usually be drained. This is especially true in diabetic patients, those chronically on steroids, and patients with other disorders of the immune system.

Preparation

A small abscess can be drained in the office. If it is large or complex, we may send you to the hospital and perform the procedure in an operating room. If we are sending you to the hospital, do not eat or drink anything because you may need anesthesia.

*If your surgery is being done in the office, we suggest that you eat lightly no closer than one hour prior to your procedure.

If you are scheduled for an elective procedure in the hospital with anesthesia, you will be asked not to eat or drink anything after midnight on the evening prior to your surgery. You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure may not be performed if you are currently taking or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners, aspirin, anti-inflammatory medicines, etc..."). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past ten days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.

If you are having an excision of a large scrotal lesion, we will insist that you have a good quality scrotal support (jock strap) or pair of jockey shorts ready at home. You will need to wear it for a few days after surgery. If a large scrotal abscess was drained, you should stop on the way home to purchase a scrotal support. It helps to reduce discomfort and swelling.

Procedure

To review the basics of what we discussed in the office: These procedures are usually short, but vary in time based on the size, location or complexity of the lesion. The type of incision varies according to the particular procedure.

In cases of abscess, the infection is usually incised and the infection drained. The area may be thoroughly irrigated, and when present, any necrotic (dead or dying) tissue is then removed. The area may then be packed with sterile gauze. Closing an abscess cavity almost ensures its recurrence, and so the incision is left open to drain.

With lesions or small masses, the area is cut away from the normal tissue so as not to disturb the edges of the lesion. When a lesion or mass is suspicious, we make sure that we excise it entirely with a margin of healthy surrounding tissue. The specimen will be sent to the pathologist for microscopic analysis. If the lesion was on the penis, a dressing may be applied.

If a cyst, we try to remove the entire capsule in order to prevent its recurrence. Simple drainage of a cyst may not be effective because the capsule may refill. The specimen will be sent to the pathologist for analysis. We then close the incision and may apply an antibiotic ointment.

Post Procedure

You will be in the recovery room for a short time before being sent home. If done in the office, we will observe you for a while. You must have someone to take you home if you received sedation or anesthesia. If your procedure was done only with local anesthetic injection, we may just observe you for a short while before you are allowed to drive. You may have discomfort over the incision. If your procedure was on the scrotum, there may be no dressing directly adherent to the incision and so the stitches (if placed) may be visible. If on the penis, a gauze dressing may be wrapped around the area. Occasionally there is some bloodstaining on the stitches, and this is normal. If you see active blood oozing, please contact us. You will remove the dressing the following morning and take a shower. Some surgeons may ask you to avoid baths and others may ask you to take warm baths a couple of times per day depending on the circumstances. *If you had an abscess drained, we often will ask you to start taking warm, soapy baths twice a day immediately. We ask that you refrain from very strenuous activity until your follow-up. Every patient has some degree of swelling and bruising, and it is not possible to predict in whom this might be minimal or significant. If a lesion was excised, we may ask you to apply ice compresses as directed to help reduce swelling in the first several hours. We encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. Some patients have almost no discomfort while others are somewhat uncomfortable for a few days; longer is rare. We may provide you with a prescription for pain medication but you certainly may take an over-the-counter medication to which you are not allergic. In cases of abscess and in a few ofthe other lesions, we may also give you a prescription for an antibiotic. The sutures we use are usually self-dissolving, and therefore just fall out on their own within 1-2 weeks after surgery.
*Following excision of a penile lesion, you may not engage in any sexual activity until otherwise instructed.

Expectations of Outcome

If the lesion removed was anything but a cyst or abscess, it will take up to a week to get a report back from the pathologist. In many cases, no other treatments are necessary. Lesions on the scrotum usually heal very quickly and without noticeable scars. Lesions on the glans penis(top or head of the penis) usually have more swelling and bleeding. Abscess cavities, with proper wound care, slowly close on their own over the next few days to weeks.

Possible Complications of the Procedure ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may generate questions if you are still concerned. Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:

  • Recurrence or Persistence: Rarely, a cyst or abscess can return. This is unusual with a formal excision or proper drainage, but more common after a simple needle drainage procedure.
  • Hematoma: This is when a small blood vessel continues to ooze or bleed under the suture line after the procedure is over. The result is greater swelling and bruising. Drainage is rarely necessary and it almost always resolves over time...much like any bad bruising or swelling. If the hematoma is unusually large (cumbersome or painful) or does not show resolution in a reasonable amount of time, a procedure to evacuate the clots may be required.
  • Infection: Infection is possible in any procedure. Usually, local wound care and antibiotics are sufficient. Occasionally, an infection would require partially opening the wound to allow proper drainage.
  • Scarring: All surgeries leave some degree of a scar. Scars resulting from infection leave more noticeable scars.
  • Chronic Pain: As with any procedure, a patient can develop chronic pain in an area that has undergone surgery.

Typically, the pain disappears over time. If persistent, further evaluation would be necessary.

We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).

The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.

Delta Medix, P.C.