Tuberculosis of the testis and epididymis

The symptomology. There are two clinical forms of tuberculosis epididymitis. At first - the most frequent chronic form of tuberculosis appendage occurs without notice and is initially asymptomatic. When the feeling of embarrassment or mild pain in the scrotum attract the attention of the patient, in appendage already ewupawly various sizes thick lumpy infiltrate or a restricted site. The General condition of the patient is not disturbed.
20-25% of cases, the disease occurs rapidly, by type of acute epididymitis, with severe pain, high fever and fever, acute effusion in the membranes of the egg. Increased appendage exceeds the size of the testis in several times, the skin over it swell up and blushes, the amount corresponding to half of the scrotum is significantly increased. Acute phenomena gradually subside: dimensions of the epididymis decrease in 10-15 days from the onset, for it takes the same chronic character, as in the initial form.
Local changes after acute nephritis phenomena are expressed in the presence of dense, cartilage consistency, tuberous possible to reveal certain node in the epididymis. Nodes are found most often in the tail of the epididymis, less often on the rest of its duration. While in the tuberculosis process is not involved egg, it clearly delineated from increased bumpy epididymis (Fig. 87). With the transition process on the testicle on the place of the furrow, separating it from the epididymis, appears gradually increasing TB infiltrate the same nature as the nodes in the epididymis. The border between the epididymis and testis becomes first, fuzzy, and then disappears completely, fabric testicular dotted with tuberculosis tubercles (Fig. 87, b).
In most cases, TB granulomas in the epididymis or testis, being cheesy disintegration, form tuberculous abscesses, spiffyware with a total vaginal membrane and skin. The contents of tuberculous cavities often breaks out in the subcutaneous tissue, forming matecznik, giving a sense of siblani, and then the abscess is opened on the skin one or more holes. Around fistular holes skin sometimes ulcerated or it formed mushroom-like growths. From fistulas are allocated liquid cheesy mass. Fistulas can exist for years, occasionally closing and opening up. The spontaneous healing of tuberculosis of the testicle or epididymis is rare.
The ductus deferens is a thickened, sklerozirovanie, painless lace, sometimes with getcoursename bulges along it.
For tuberculosis of the testis and epididymis is characterized by the absence of a discharge from the urethra and transparent normal urine.
The diagnosis of tuberculosis epididymis or testis is no doubt at languid painless throughout the process. The disease are fever, without previous discharge from the urethra, the absence or insignificance of local pain indicate tuberculosis nature of epididymitis. Typical palpation changes in the epididymis, prostate, seminal vesicles, mentioned above, finally confirm the diagnosis. Particularly persuasive are purulent fistulas or fluktuiruyushchimi cold abscesses scrotum and celabrate sklerozirovanie the ductus deferens.
The above clinical symptoms allow, with rare exceptions, to differentiate tuberculosis appendage from gonorrheal or nonspecific epididymitis, in which the seal of the epididymis has no cartilage consistency and rough surfaces and not fistulas appear on the skin of the scrotum.
Differential diagnosis with a non-specific orchitis, syphilis and malignant tumors are based on the fact that unlike tuberculosis these diseases begin with eggs, not in the epididymis, and they rarely fistulas appear.
Positive results of serological reactions in syphilis or detection of tumor metastases finally discovers the true nature of the disease.
Conservative treatment of tuberculosis epididymis or testis never leads to a radical cure. Streptomycin, PAS, tibon, ftivazide, vitamin D2, salyuzid, metazid poorly act on TB external and internal male genital organs.
Treatment with streptomycin in combination with PASK, ftivazide etc. conducted before and after the operation on the scrotum, simplifies operation, promotes fast healing of wounds, smooth the flow of the postoperative period and therefore is a mandatory addition to the operation. The main method of treatment is surgery.
Surgical treatment of tuberculosis epididymis or testis may be: 1) the removal of the epididymis - epigalantamin; 2) the removal of the epididymis, together with the egg (orhoepididimit or semicastrate); 3) conservative operations in the epididymis and the egg - resection of the authority, the cut and the scraping of cavities (governatore).
If the egg is not affected, limited epideemia. If the office of the epididymis, it turns out that in the adjoining area of the testicle has cheesy decay, this part of the testicle is removed along with the appendage. In the diffuse lesion testicles should be removed together with the appendage.
When TB orhoepididimit can be limited to opening and emptying of cavities and foci of caseosa in the epididymis and testis and drainage of them, applying simultaneously treatment streptomycin, PASK, ftivazide or tibon. This organ-sparing surgical tactics shown in tuberculosis both testicles or the only one testicle.
If the adjoining appendage edge of the egg ewupawly dense site with no signs of softening, you can just epideemia per reverse development of TB infiltrate in the testicle under the influence of streptomycin, PASK, etc. If the skin of the scrotum fistula coming from the epididymis, should be removed together with the appendage area of affected skin.
Epigalantamin and orhoepididimit on one side is expedient to combine with excision of part of the VAS duct (Lazarescu) on the other side for protection of the second appendage from being hit by Mycobacterium tuberculosis from the affected prostate or seminal vesicles.