65) Ectopic Testis & Varicocele скачать в хорошем качестве

65) Ectopic Testis & Varicocele

ECTOPIC TESTIS - Ectopic testis is one in which the testis fails to descend into the scrotum and is deviated from its normal path of descent by far much less common than un-descended testis. An ectopic testis is an otherwise a normal testis an un-descended testis is often under developed. According to Lockwood the gubernaculum testis have five tails : 1.The scrotal tail - which is the main once. 2.Pubic tail - atteched to the pubic tubercle. 3.Perineal tail - atteched to the perineum. 4.Inguinal tail - atteched to the front of the inguinal canal. 5.Femoral tail - atteached to the saphenous opening. The scrotal tail is the strongest and the other tails normally disappear and that is why the testis normally descends to the scrotum. one of the four accessory tails becomes stronger the testis is drawn towards the attachment of that tail and then the testis is called an "ectopic testis". Positions of the ectopic testis- (a)Superficial inguinal pouch - This is the commonest type. The testis lies lateral to the superficial inguinal ring, in the plane between the aponeurosis of the external Oblique and the membranous layer of the superficial fascia ( fascia of scarpa) This is due to the pall of the inguinal tail. (b)Pubo-penile ectopia - This is extremely rare. The testis lies in front of the pubis at the root of the penis. it is due to pull of the pubic tail. (c)Perineal ectopia-The testis lies in the superficial perineal pouch i.e under the fascia of Colles and between it and the superficial periental muscles a swelling is seen in front of the anus on one side of the midline it is due to pull of the perineal tail. (d)Crural of femoral ectopia- The testis lies at the roof of the thigh near the fossa ovalis (saphenous opening) , it is due to pull of the femoral tail. COMPARISON BETWEEN UNDESCENDED TESTIS AND ECTOPIC TESTIS Undescended testis - 1.The testis is arrested in its normal path of descent 2.Undescended testis is usually undeveloped 3.Scrotum is not developed on that side and empty. 4.The length of the spermatic cord may be short 5.Spermatogenesis is poor after 6 years of age. 6.Undescended testes may be associated with indirect inguinal hernia 7.Treatment -mainly operation; though hor mone therapy may be tried in selected cases. Operation is not at all successful after pu.berty 8. Complications-List of complications has already been mentioned Ectopic testis- 1.The testis deviates from its normal path of descent. 2.The testis is fully developed. 3.Though empty, the scrotum is usually fully developed. 4.The length of the spermatic cord is usually longer. 5.Spermatogenesis is perfect. 6.This is never associated with indirect inguinal.hernia 7.Treatment is operation and is usually successful. 8.Complications- The main complication liability to injury TORSION OF THE TESTIS OR TORSION OF THE SPERMATIC CORD - Causes strangulation of the blood supply to the testis und unless it is treated within 3 to 4 hours, testicular atrophy is inevitable. VARICOCELE - Varicocele means varicosity of the veins of the spermatic cord. The veins become dilated, elongated and tortuous. The veins of the spermatic cord include the pampiniform plexus i.e testicular veins and the cremasteric veins. Surgical anatomy.- Veins of the spermatic cord include 3 groups of veins (i)Veins draining the testis and epididymis. (ii) Veins accompanying the vasdeferens. (iii) Veins of the cremasteric muscle. Causes- (a) The left testicular vein drains into the left renal vein at right angle. (b) The total length of the testicular vein is more on the left side than on the right side (c) of cases left testicular artery arches over the left renal vein and thus obstructs it and (d) The loaded sigmoid colon may press upon the testicular vein and cause varicocele due to obstruction in drainage (f) The left suprarenal vein also drains into the left renal vein and circulating adrenalin may cause constriction of the testicular vein at the site or drainage (g)Occasionally the left renal vein may pass between abdominal aorta behind and the superior mesenteric artery in front and may be pressurised by these two arteries which may lead to obstruction in its drainage hence the testicular vein to cause varicocele of the left side. (h)Incompetent valves are more common in the left testicular vein. Treatment - 1.Conservative treatment.- No treatment is required unless the varicocele is thought to contrib ute to infertility or is painful or so large as to disturb the patient. Scrotal support and reassurance often relieve discomfort. 2.Operative treatment.- Indications for operation are: (i)Varicocele is painful and is worrying the patient inspite of conservative treatment (ii)The varicocele is so big as to disturb the patient. (iii)When varicocele contributes to infertility. (iv)When the testis hangs at an abnormally low level (v)When this condition makes one medically unfit for any job.