Testis & Urethra Varicocele

Varicocele

      This is the term that is used when there is dilatation and tortuous veins of the pampniform plexus of the cord. The cause is not known but since it occurs often on the left side it is suspected that :

1.    The vertical angle of junction of the testicular vein with the left renal vein is responsible

2.    Compression of the left renal vein by the left colon

3.    The venous valve at the junction is absent

      However, a varicocele in middled aged man one should look for a retroperitoneal lesion

5.1 PRESENTATION

      Some patients complain of a dull dragging pain or a fullness of the scrotum are examination. The varicocele has been described as a bag of worms. The patient should be examined lying down when these vein empty and the mass disappears. When the patient stands the bay worms reappears varicoceles may be accompanied by infertility.

5.2 Treatment

The testicular artery and the accompaning veins are identified in the inguinal canal or retroperitoneam through an incision above the anterior superior iliac spine. The veins ligated and cut to reduce the back pressure.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com

Now also available on android &smart phones same internet address.

Testis Ectopic & Torsion

Ectopic Testis

      Favourite sites of testicular ectopia (abnormal position) are superficial inguinal pouch, prepubic, femoral or perineal positions (Fig. 27.3a). Surgical correct positioning should be accomplished early.

4. Torsion

      Torsion or twist of the spermatic cord is the result of a larger mesentery of the testis allowing the testicle to twist freely within the scrotum.

*     If rotation exceeds 90o, it results in stopping of the blood supply

*     The patient presents with extreme pain of suddent onset and if allowed to continue for more than 4 hours results in gangrene and subsequent atrophy of the testicle, thus the need for early surgery.

*     Torsion should be suspected if there is rapid onset of severe pain, swelling of testis. Nausea, vomiting and occasionally fever is seen.

*     Involved testis is rather high in the scroptum and horizontal in position

*     Differential diagnosis between torsion and epidydimitis is possible, in case of torsion the entire testicle and appendages are involved in the swelling process, in epididymits, induration is confined to epididymis.

4.1 Prompt surgical intervention is required in a case of torsion. Derotation and fixation of testis it is if viable.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com

Now also available on android &smart phones same internet address.

Testis incomplete descent

Incomplete Descent

*     The testis is arrested at some point in its normal course of descent (Fig. 27.3) and is palpable on examination.

*     Usual sites is internal inguinal ring, there may be an associated congenital indirect inguinal hernia; if processes vaginalis has not been obliterated

*     Exploration with a high inguinal incision exposing the entire cord upto the internal inguinal ring is required.

*     The cord is completely freed from the processes vaginalis which is excised, neck of the peritoneal sac is closed.

·                The testis is then positioned and fixed within the scrotum (orchidopexy) using a variety of techniqes

Transeptal orchidopaxy Steps

-        testis identified in inguinal canal

-        open ingiunal canal

-        identify hernia sac and ligate

-        mobilize and leagnthen cord till it reaches scrotum

-        make an opening in the septal wall of scrotum

-        transpose testis through this opening

Close the inguinal canal and wound

*     Use of chronic gonadotropic in dosages of upto 500 units three times weekly for six weeks as stimulus to testicular descent may also be tried

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com

Now also available on android &smart phones same internet address.

Testis Urethra 2 development testis

TESTIS

3.1 Development

      The testis is developed from the genital fold of mesoderm lying below the developing kidney in the retroperitoneal space. The developing testis migrates from this intrabdominal position to the scrotum and takes with it a fold of peritoneum the tunica vaginalis.

3.2 Cryptorchidism

      The term “Cryptorchidism” should be reserved for those testis that are usually within the abdominal cavity and not palpable on examination.

*     Cryptorchid or intra-abdominal testis are observed unilaterally or bilaterally in 1 to 10% of male infants, cause is not known.

*     The Cryptorchid abdominal testis, if left untreated, will fail in its spermatogenic function.

*     It may however, secrete adequate amounts of androgens. Surgical intervention to bring it to the scrotum should be accomplished before the age of two years.

*     In unilateral cryptorchidism, surgical exploration is less urgent

*     In bilateral crypotrchidism, early surgical intervention is necessary.

*     For high intrabdominal testis anastmosis to inferior epigastric and testicular vessals is being practiced using micro-surgical techniques (Silber and Kelly)

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com
Now also available on android &smart phones same internet address