1088 Edited1.pdf 898 | Miscellaneous Tight Swimming Trunks to Prevent Post Scrotal Surgery Hematoma An Experimental Justification Yahya A Al-Abed, Thomas W Carr Purpose: To conduct a study to measure the pressure effects of the different scrotal supports applied on a simulated expanding scrotal hematoma. Materials and Methods: We created a model of an expanding hematoma with simultaneous pressure - tion of any support. Then, three types of scrotal supports were tested, including Euron Net Knickers, scrotal suspensory bandage, and tight swimming trunks brand Speedo® brief and shorts. Subsequent pressures were recorded using the model created, which was applied inside the supports worn by two male volunteers A and B. Results: Without any external compression, the pressure inside the simulated expanding hemato- ma “balloon” reached a maximum of 15 cmH2O. The pressures measured whilst wearing “Netelast knickers” in both subjects A and B reached a maximum of 15 cmH2O suggesting that this garment exerted no measurable compression. The suspensory scrotal support was then tested in both subjects. resulting in falling of the balloon outside the scrotal support. Subsequently, Speedo® briefs and shorts 2 2O were reached in subjects A and B, respectively. When using Speedo® shorts, however, maximum pressures of 55 cmH2 2 Conclusion: The use of tight swimming trunks (Speedo®) has led to satisfactory results in the pre- vention of hematoma post scrotal surgery. Keywords: scrotum, hematoma, injuries, wounds, testis Corresponding Author: Yahya A Al-Abed, MD; MRCS (Eng) Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea SS0 0RY, United Kingdom Tel: +44 170 243 5555 Fax: +44 170 238 5833 E-mail: yalabed@yahoo. co.uk Received August 2011 Accepted January 2012 Department of Urol- ogy, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea SS0 0RY, United Kingdom MISCELLANEOUS 899Vol. 10 | No. 2 | Spring 2013 |U R O LO G Y J O U R N A L INTRODUCTION Hematoma following scrotal surgery is a well rec-ognized complication and can be associated with - ity, and psychological distress. The reported incidence of scrotal hematoma following surgery varies in different stud- (1) while others (2) Several techniques have been described in the literature to minimize the risk of bleeding associated with scrotal surgery. A number of stud- ies were performed using different methods of compression applied to the scrotum in an attempt to prevent hematoma formation. In practice, these methods of scrotal com- pression include “Netelast Knickers”, suspensory scrotal support, and scrotal bandaging. However, no study has at- tempted to measure the pressure exerted on the scrotum by these different techniques. We doubt that any of these scrotal supports exert enough pressure around the lax scrotum to prevent hematoma col- lection. In our clinical experience, the use of tight swim- ming trunks (Speedo®) has led to satisfactory results in the prevention of hematoma post scrotal surgery. We set out to test the physiological basis of this method by conducting a study to measure the pressure effects of the different scrotal supports on a simulated expanding scrotal hematoma. MATERIALS AND METHODS We created a model of an expanding hematoma with simul- taneous pressure recording using urodynamic system Duet 1). This catheter was attached to the urodynamic machine - To ensure that the compliance of the balloon alone was low, this model was initially tested without applying any external pressure. The total pressure rise under these condi- tions was 15 cm H2 - tal supports used in this study were: “Netelast knickers” tight swimming trunks Speedo® brief and shorts (Warnaco The empty condom attached to the double lumen urethral the scrotum of two volunteers (A and B) while wearing the methods were recorded. RESULTS - matoma “balloon” rose to a maximum of 15 cmH2 1A). The pressures measured whilst wearing “Netelast knickers” in subjects A and B reached a maximum of 15 cmH2 measurable compression; this maximum was obtained in The suspensory scrotal support was then tested on both - lated hematoma pushed the scrotal support forward result- Figure 1. The simulated expanding hematoma. Post Surgery Scrotal Hematoma | Al-Abed and Carr 900 | ing in falling of the balloon outside the scrotal support. The 2O when the result was similar in both subjects. We infer that some com- pression was exerted, but as the hematoma expanded, the garment could not contain it and its usefulness was com- promised. and shorts, were tested in subjects A and B. The result 2 cmH2O in subjects A and B, respectively, when the balloon - quently, the Speedo® shorts were tested in both subjects. As 2 pressure continued to raise steadily reaching maximum of 55 cmH2 2O in subject B at the DISCUSSION - methods of scrotal support used after scrotal surgery. His- torically, post-surgery scrotal hematoma is the urologists’ - ity. The lax nature of the scrotum makes it prone to hematoma formation. practice in scrotal surgery to ensure good hemostasis and to carefully suture the dartos muscle layer as it is a common source of bleeding. It seems likely that most scrotal hematomas occur as a re- Figure 2A. Euron Net Knickers “Netelast knickers”. Figure 3. Testing the simulated expanding hematoma while wearing a Speedo® shorts in a male volunteer. Figure 2B. Suspensory scrotal support. Figure 2C. Tight swimming trunks Speedo® brief and shorts. Miscellaneous 901Vol. 10 | No. 2 | Spring 2013 |U R O LO G Y J O U R N A L Post Surgery Scrotal Hematoma | Al-Abed and Carr sult of capillary or venous bleeding as arterial bleeding will be easily seen and dealt with at the time of operation. A relatively modest increase in scrotal pressure achieved with external compression should therefore be effective in the prevention of this debilitating complication. In our study design, we simulated an expanding hematoma using a novel model created by the authors. This study shows that the currently used methods of scrotal support in hospitals have limited value as the pressure exerted by these methods on the scrotum is not high enough to prevent hematoma for- mation. The results clearly show a lack of compression in respect to “Netelast pants” and scrotal supports. However, the use of tight swimming trunks, Speedo® briefs and shorts, showed promising results. The pressures exerted - nal compression is exerted at an early stage of the hema- toma formation, thereby hopefully preventing expansion. Speedo® swimwear was 55 cmH2 thought to be high enough to prevent a hematoma forma- tion yet unlikely to affect testicular perfusion and subse- quent damage. Other techniques to achieve the same end have been report- ed. Possibly the most practical are the so-called “Turban”(1) - they require pendulous testicles and are not suitable to apply in men with smaller scrotums. Although we did not include these techniques in the present study, for reasons of comfort, we anticipate that it would provide good compression. The neck of the scrotum can be constricted excessively if the bandage is too tight. It is impossible for the patients to re- design was created to simulate an expanding scrotal hema- toma, we appreciate the scrotal wall structure and compli- ance is different. An animal model might be therefore more realistic. However, an ideal next step would be a clinical of hematoma post scrotal surgery. Graph A Graph D Graph B Graph E Graph C Graph F H 2 O H 2 O H 2 O H 2 O H 2 O H 2 O 902 | CONCLUSION Whilst we recognize this study’s limitations, we believe that of use and absence of discernible risk justify its routine use. CONFLICT OF INTEREST None declared. ACKNOWLEDGEMENTS Collie for their assistance in the urodynamics laboratory during this study. REFERENCES 1. Manson AL, MacDonald G. "Turban" scrotal dressing. J Urol. 1987;137:238-9. 2. Moloney GE. Comparison of results of treatment of hydro- cele and epididymal cysts by surgery and injection. Br Med J. 1975;3:478-9. 3. Shah PA, Dewoolkar VV, Changlani TT. Ambulatory hy- drocele surgery: a review of 50 cases. 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