When to use the Chevassu maneuver during exploration of intrascrotal masses.

Overview

As many as 50 per cent of explorations for intrascrotal masses result in orchiectomy for benign disease. The most common diagnoses are hydrocele, epididymitis and benign testicular tumors. Many of these diagnoses could be made before orchiectomy if the tunica vaginalis and, occasionally, the tunica albuginea were opened, and the lesion biopsied. However, violation of the testicular tunics traditionally has been considered taboo because of the dangers of tumor seeding. In 1906 Chevassu suggested inguinal exploration and occlusion of the testicular vessels before biopsy of suspicious lesions. We have added scrotal hypothermia, double ligation of the gubernaculum before its division and irrigation with distilled water to provide a procedure that adheres to the principles of good cancer surgery. Its use during inguinal explorations for suspicious intrascrotal masses in 5 patients led to a benign diagnosis and preservation of the testis in 3 instances without subsequent testicular atrophy. Its judicious use can decrease the incidence of orchiectomy for benign disease.