DISEASE OF TESTIS

Diseases Of Testis

             1. HYDROCELE

Collection of abnormal amount of serous fluid in the tunica vaginalis is called HYDROCElE.

# Mechanism of abnormal collection of fluid , 

✓ Excess secretion of fluid

✓ Defective absorptive mechanism

✓ Connection of tunica vaginalis with peritoneal cavity 

✓ Lymphatic obstruction

Classification of Hydrocele

A) Congenital 

- Patent processus vaginalis to peritoneal cavity.

B) Acquired 

- Idiopathic

* Secondary to disease of testis 

    Eg. Trauma , Filariasis , Tuberculosis etc.

Clinical Features

√ History of swelling scrotums

√ Soft , cystic , swelling in scrotums

√ Transillumination test positive

√ Cough impulse negative

√ Dull or dragging pain on scrotums

Treatment

✓ Aspiration or trapping if surgery is contraindicated

✓ Excision of the whole or part of the sac : small hydrocele

✓ Eversion of the sac - large hydrocele

Complications

- Haematocele 

- Pyocele 

- Atrophy of testis 

- Herniation of hydrocele sac

- Rupture of hydrocele

Post - operative complications

- Haematoma (collection of blood under the skin)

- Wound infection

- Recurrence of the hydrocele

- Accidental injury if vas deference 

       

                  2. TORSION OF TESTIS

Twisting if the testis with the interference to the arterial blood supply is called torsion off testis. The torsion occurs in the spermatic cord.

Predisposing factors

- Inversion of testis 

- High investment of tunica vaginalis

- Sudden contraction of spirally attached cremasteric muscle leads to rotation of testis 

Clinical Features

✓ Age 10-25 years 

✓ Sudden agonising pain : the groin and lower abdomen

✓ Vomiting

✓ Swollen testis , tenderness and scrotum is inflamed 

Investigation

√ USG of testis ; Doopler study to confirm the diagnosis.

Differential Diagnosis

- Acute epididymo-orchitis

- Strangulated inguinal hernia

Treatment

Referred to higher center for confirm diagnosis and treatment

✓ Urgent exploration , untwisting of the cord and testis 

✓ Orchidopexy to prevent recurrence

✓ Opposite testis should also be fixed 

✓ Orchidectomy if testis is gangrenous

Complications

√ Gangrene of testis 

√ Infertility

                   3. UNDESCENDED TESTIS

Testis is arrested somewhere in its normal pathway to scrotum is called undescended testis.

Causes 

✓ Muscular hypotonia e.g. poor muscle tone condition like Down's syndrome

✓ Gubernaculum dysfunction

✓ Maternal human chorionic gonadotropin deficiency

✓ Familial 

✓ Retroperitoneal adhesions prevent the descent of the testis.

Clinical Features

- Right is more common than left side 

- Cryptorchidism : Impalpable testis 

- Empty scrotum , underdeveloped ( loss of skin rogue ) 

- Testis can be felt above the deep inguinal ring or along the inguinal canal 

Treatment

√ Orchidopexy done before age of 2 years ( in case of bilateral ) , 4 years ( in case of unilateral)

√ Repair of hernia 

√ Orchidectomy if testis is atropic and none functioning 

√ Hormonal therapy

√ Parent counseling

Complications

✓ Increased risk of trauma 

✓ Torsion of testis 

✓ Atrophy of the testis

✓ Indirect inguinal hernia 

✓ Defective spermatogenesis

✓ Psychological upset