|LETTER TO EDITOR
|Year : 2011 | Volume
| Issue : 2 | Page : 270-272
A novel dressing for orchidectomy in prostate cancer
Department of Urology, Rajah Muthiah Medical College Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
|Date of Web Publication||11-Jul-2011|
S K Jariwala
Department of Urology, Rajah Muthiah Medical College Hospital, Annamalai University, Chidambaram, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jariwala S K. A novel dressing for orchidectomy in prostate cancer. Indian J Cancer 2011;48:270-2
We have seen advanced stage of prostate cancer (CaP) in India. Bilateral orchidectomy (BO) is offered to such patients. Although this is a simple operation, it has complications as well.  We present our method of dressing in an effort to prevent these complications.
In this method, we perform BO in standard fashion. An assistant applies Allis forceps to the bottom of scrotum to stretch it [Figure 1]. Gauze dressing with gamjee pad is then applied to the wound. A compression bandage is applied from the root of penis to the bottom of scrotum [Figure 2]. Allis forceps is then removed and dressing is completed. Two strips of adhesive plaster are applied from the side of dressing to the suprapubic region on each side [Figure 3].
Dressing is removed on postoperative day (POD) three and patient is discharged home. And, suture is removed on POD seven. From January 2008 to October 2009, we performed this procedure in 18 cases, with no complications so far.
The scrotum has unique features that predispose it to develop complications after surgery. It consists of multiple layers of loose tissue, which does not provide tamponade for haemostasis. The scrotum is empty after BO, thus creating a dead space for collection. Also, standard dressing slips out due to lack of support.
Our idea of dressing originated from compression dressing in hypospadias surgery. In hypospadias surgery, a glans stay suture is used to stretch the penis before dressing is applied. In our case, we stretched the scrotum with the help of Allis forceps and applied compression dressing in a circular fashion. This obliterated the dead space, preventing oedema and collection in the scrotum. Vascular compromise does not arise from padding. Dressing stays in place because its mouth at the root of scrotum fits snugly and side plasters. There is no need to wound bandage around the waist, as is done in standard scrotal dressing. Turban dressing does not provide adequate compression and slips out because the scrotum is empty. 
Acebal et al. described supreme dressing by using a bandage and taking purchase of both pelvic brims for loading points.  The dressing appears more like a lingerie at the back, and has a hole in the front for penis to pass through.
Scrotal hitch has disadvantages such as pain, difficulty in hitching in bilateral cases, retention of urine and absence of actual compression of the scrotum.  Also, urinary stream cannot be directed forward. When the hitch is removed the subsequent day, swelling appears.
Athletic scrotal support does not provide adequate tamponade in empty scrotum, as it slips out and is not readily available.
Shreedhar et al. applied tincture benzoic compound (TBC) on the scrotum and wrapped it with a 1-inch zinc oxide tape in the upward direction.  We believe that the application of TBC and tape to the scrotum is dangerous and should be prohibited.
A disadvantage of our method is that it can be used only in BO cases, and not for other scrotal surgeries.
We conclude that our method of dressing is simple, easily available, and effective for BO in CaP. We would like to name it as 'Chidambaram scrotal dressing' after the town's name where our hospital is situated.
| » References|| |
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|2.||Manson AL, MacDonald G. Turban scrotal dressing. J Urol 1987;137:238-9. |
|3.||Acebal LJ, Paez BA, Herrero PA, Bustamante AS, Sanchez SE, Berenquer SA. Supreme dressing in the prevention of hematoma and edema in scrotal surgery. Arch Esp Urol 1994;47:969-72. |
|4.||Griffin JH, Canning JR. The scrotal hitch for hemostasis and edema prevention in scrotal surgery. Urology 1997;49:307. |
|5.||Shreedhar R, Duncan T. A technique of preventing postoperative scrotal haematoma. Br J Clin Pract 1984;38:93-4. |
[Figure 1], [Figure 2], [Figure 3]