Should I have my testicle removed, or should I try and do whateer is necessary to get the more expensive testicle-sparing surgery?

I have an inguinal hernia on the right side.

I went to 3 doctors who recommended I have a Bassini repair, or variant. This consists of making an incision in my groin and moving the layers of transversalis fascia, and internal oblique, over to my inginal ligament, so as to close up the hole that is allowing my internal organs to fall into my scrotum. Because the nerves and blood vessels that supply the testicle are in the area of the incision, they need to identify the relevant anatomy and be careful not to damage it.

2 other doctors, whom I was told accept Medicaid, said I needed to have my testicle removed on the right side, then have the hole that is allowing my internal organs to fall into my scrotum be sewed up. It is faster and easier to sew up the hole, if you remove the testicle first. They all said that if only one testicle is removed, I will still be able to have children, and I will not need any hormone replacement therapy, and it won't affect my quality of life.

This is how such hernias repaired before 1886 when advancement in knowledge of groin anatomy enabled Eduardo Bassini to invent his testicle-sparing surgery. After then, the Bassini operation gradually became the standard of care. By 1930 or so, most surgeons were recommending a Bassini or similar operation, and only removing testicles in patients who couldn't afford to pay for the more complicated Bassini repair, or who wanted to save money by choosing the cheaper operation -- tho if they had the money their surgeons almost always tried to talk them into having the Bassini.

I did some asking around, and found out that Medicaid won't pay for a more time-consuming, more complicated Shouldice repair. If I want one, I will have to both 1. not tell the doctor I have Medicaid (doctors aren't allowed to accept cash from medicaid patients) and 2. tell the doctor I have cash, supplying at least half of the cost up front. The cheapest Bassini type operation I have found, in the US, would be $7,000. It takes 45 minutest to an hour and 15 minutes. Having my testicle removed and the hole sewn up from there, would cost only about $3000. It would take 15 to 20 minutes.

You're going to do what you want to do.

I would of course go with the cheaper operation. Especially if you have insurance that's willing to pay for it.

kp, you would have your testicle removed, even tho the standard of care today is to repair the hernia without removing the testicle? Sparing the testicle isn't cutting edge, heroic surgery. It is what is routinely done by most surgeons.

If I had insurance that'd pay for the expensive surgery, sure. But I'm not shelling out $7000 of my own cash to save one testicle.

Do they do testicle transplants? If so sell that little guy, have the cheap surgery, and have your teeth fixed with the $7,000.

Is there anyway you can fight the medicare decision? If not, I don't think having one less testicle is a big deal (if you are looking for a woman's point of view.)

But what would you scratch?

$7000 or a testicle? :juggle:

Tough choice. Is there someone you can borrow the money from or maybe a teaching hospital that can give you a significant discount? If the surgery is so short and routine, then a teaching hospital might be a good option.

I would do everything I could to save my boys. Start up a website called savemynut.com or something and get people to donate via PayPal or something I could help set up the site if you want. Maybe enough people will help out in order to save your .... business. I guess it all depends on how soon you need this surgery.
~Wonder :-/

I work in healthcare, my first question to you is how old are you? If you are young i would assume you want kids in the future when and if you get married?
I would not have the testicle removed, they only want to do it that way due to your insurance and the cost. It is poor medicine to practice that way and i wouldnt let a doctor who thinks like that touch me.
I would have the testicle sparing more expensive surgery, let your insurance pay what they will and let the hospital eat some of the cost and you pay what you can and dont worry about it, keep your testicle.

Seriously, your body should be kept intact as long as possible. You never know what that 48 year old neighbor might be thinking.

I think the fact that the OP re-argued the point after the first suggestion to lose the testicle shows how he is feeling about it. You want to keep the testicle. And, of course, since it's your body I think you should do what you want.

Soilman, I tease you a lot, but seriously, God gave you two for a reason. I say seriously, do what it takes to keep everything in its original numbers.

Did you research, whether it would be cheaper to have the better operation done outside the U.S.?
You need your testicles not only for reproduction but also for the production of hormones. I agree with ~wonder and Life2k! Good luck!

Lothar, long time no see!

To the OP: I'd do whatever it took to save one of the boys. Don't even allow the idea of ball-removal to be within the realm of possibility. Yeah you'd function fine with one, but if you're young then you may someday need a backup later in your life. Long as the little dude is healthy, keep it where it belongs. May you have all the success you desire in this ordeal!

And testicle transplants?? That goes against what the basic nature of men is all about! I'm assuming the one who thought of that must be a female? :)

OP just wondering if you made a decision after getting all this good advice :)

It seems Medicaid is always trying to remove a part of your body.
http://physicianlink.uams.edu/casestudies/CSHerniaRepair.asp
This says that the less invasive surgery is generally covered by Medicaid. Perhaps you should call your social worker and ask for a booklet of covered procedures. There is actually a lot more work and chance for infection in amputating a part of the body then what the normal hernia repair takes. My husband had his repaired 5 years ago and my son had to have a double repair done when he was 4 months old. The incision site is quite small compared to what I imagine the site would look like for an amputation. They didn't seem to have any issues with the testicles either time and it was never mentioned.
Your social worker should have an HMO booklet stating what is covered by Medicaid and it should have a list of covered surgeons.
Mary