Epididymal deformity
Introduction
Introduction to epididymal malformation Epididymal malformations are more common clinically, usually indicating that the epididymis is significantly longer or abnormally attached to the testis. There is no exact definition and uniform classification method to date. Epididymal malformations have structural abnormalities such as absence of epididymis, segmental atresia, and epididymal cyst. Generally, there are no clinical symptoms, mostly found through male infertility investigation and treatment of cryptorchidism, often combined with vas deferens. basic knowledge The proportion of illness: the probability of male disease is 0.012% Susceptible people: male Mode of infection: non-infectious Complications: hydrocele
Cause
Causes of epididymal malformation
Causes:
At the 6th week of the embryo, the middle kidney tube and the middle kidney tube are formed. These pipes will be transformed into male and female reproductive tracts. When the embryonic gonads differentiate into testis and produce testosterone, the kidney tube gradually evolves under the action of androgen. In the male reproductive duct, the head portion of the middle kidney tube becomes the epididymis attachment, and the testicular output tube derived from the middle renal tubule forms the epididymis head together with the epididymis tube formed by the zigzag coil of the middle kidney tube located below it. The epididymis tube forms the epididymis and the tail.
The etiology of congenital epididymal malformation is still unclear. Because the cryptorchidism patients have more epididymal malformations, their occurrence may be related to the endocrine dysfunction during embryonic development. Because of the low testosterone level, the middle and small renal tubules and the middle kidney tube are not developed or underdeveloped. And the formation of various types of epididymal malformations, such as the complete development of the kidney tube can lead to congenital epididymis, the absence of vas deferens, if the development of a certain part of the stop, the formation of this part of the lock, when the epididymis twists and turns around the obstacle, There may be a significant extension of the epididymis, resulting in a long sacral epididymal deformity.
Pathogenesis:
The epididymis is a drainage tube connecting the testicles. It has a slender and flat shape and is located on the posterolateral side of the testicle. Ten to fifteen testicular output tubes are convoluted into a cone shape, and the ends merge into a highly tortuous epididymal tube 4 to 6 cm long, according to Turck. For 94 cases of non-cryptorchidism, such as sputum, hydrocele, varicocele, etc., scrotal exploration, found that 83.9% of epididymis and epididymis tail attached to the testis, and the epididymis and testicles have a certain distance, Generally can accommodate a fingertip (Figure 1), the epididymis and testicles are completely close to only 12.5%.
Epididymal malformation mainly manifests as epididymal developmental disorder and abnormal adhesion to the testis. The former includes abscess of the epididymis, cystic changes in the head, middle and tail are not developed, and there is a fibrous cord-like atresia. The epididymis is obviously long and long, and the epididymis is missing. If it can be divided into:
1. The middle kidney tube is completely undeveloped, and the vas deferens, seminal vesicles and ejaculatory ducts are lacking.
2. The renal tubular dysplasia, the absence of the tail of the epididymis, accompanied by the absence of vas deferens.
3. The middle kidney tube does not develop into the epididymis tube, but directly into the vas deferens, the seminal vesicle and the ejaculatory duct, and the testicular output tube is connected with the vas deferens.
4. Without epididymis, the vas deferens is not connected with the testis, and the proximal end is blind. The epididymis attachment abnormalities include complete separation and partial separation of the epididymis from the testis. The latter refers to the attachment of the epididymis to the testis, and the epididymis does not adhere to the lower pole of the testicle.
Since the first classification of epididymal malformations by Scorer and Farrington in 1971, many different classification methods have been reported. In 1990, Koff and Scaletscky made some modifications based on the Scorer classification method, which divided the epididymal malformations into five categories:
Type I: long sacral epididymis: the epididymis is long sputum, and the testicle size is significantly longer, and is divided into 4 types:
1 2 times longer than the testicle size;
22 to 3 times;
33 to 4 times;
44 times or more.
Type II: Separation of epididymis from testis: According to the location and extent of separation, this type can be divided into the following three cases:
1 only the tail is separated;
Both tails are separated from the testes, but are close together;
The 3 tails are separated from the testicles and are far apart.
Type III: The epididymis is at an angle to the testicle.
1 simple angle;
2 accompanied by epididymal stenosis.
Type IV: epididymal atresia or epididymis, continuous interruption of any part of the vas deferens.
Type V: longer testicular mesangium.
The above-mentioned different types of epididymal malformations can exist in several types in the same patient. Koff's data indicate that the long sacral epididymal deformity is most common in cryptorchidism and ectopic testis, accounting for 79.3%, and the epididymis and testis are separated as 45.1. %, epididymis and testicular angulation angle is 8.5%, epididymis or vas deferens atresia is 3.7%, and longer testicular mesenteric is 1.2%. Koff classification method can not include all epididymal malformations, comprehensive data, generalized types of epididymal malformations .
Prevention
Epididymal malformation prevention
Prevention: There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to prevention and treatment of this disease. The cause of the disease is still unclear and is prevented according to congenital diseases. Prevention of deformity must pay attention to the first three months of pregnancy; fetal organs have formed in the late pregnancy, rarely deformed, but syphilis, anaerobic, mercury, carbon monoxide and other reasons may also lead to deformity.
Complication
Epididymal malformation complications Complications hydrocele
Most have cryptorchidism, inguinal hernia and hydrocele.
1. Semen cyst: A benign cyst that occurs in the spermatozoa of the testis or epididymis. The swelling of the swelling is mostly as large as a cube of sugar. People call it the third testicle. Fortunately, this situation is very rare. If you insist on eliminating those bumps, the doctor can remove the surgery for you. Avoid trauma to the testicles and scrotum. Have sex regularly and avoid long-term sexual impulses.
2, scrotal water cyst: caused by testicular malformation wrapped in the film layer of one or two testicles caused by excessive water production. Sometimes it happens after a testicular injury or orchitis, but in most cases there is no reason at all. The scrotum has an expanding bulge, and sometimes the cyst can reach as big as a football, but it doesn't feel pain. Doctor treatment: Excess tissue water can be drained through a minor anesthesia surgery, and the doctor should suture the scrotum holes that leak out of the fluid.
Symptom
Epididymal malformation symptoms common symptoms male infertility cyst epididymis swollen hard epididymal stones
Patients with epididymal malformations have no discomfort, and clinically often see cryptorchidism or male infertility.
Physical examination except for epididymal head cysts, other abnormalities have no obvious abnormal signs, and more often diagnosed in cryptorchidism or male infertility for surgical exploration. Generally, there are no clinical symptoms, mostly found through male infertility investigation and treatment of cryptorchidism, often combined with vas deferens.
Examine
Epididymal abnormality examination
B-ultrasound, CT and other imaging examinations do not contribute to the diagnosis of epididymal malformations.
Patients with cryptorchidism often come to the doctor because of scrotal emptiness and no testicles inside. There are also patients who are treated with "" as the main complaint, or because of bilateral cryptorchidism and infertility after marriage. Diagnosis is generally not difficult. However, the identification of cryptorchidism and testicular deficiencies that do not touch the testicles should be taken seriously, because the latter does not require surgery.
If the patient's chromosome is XY, serum follicle stimulating hormone (FSH) is elevated, serum testosterone (T) is decreased, and testosterone levels do not respond to chorionic gonadotropin (HCG) stimulation, it is absent from both testes. No surgical exploration is required.
For unilateral testicular defects, it is difficult to confirm the diagnosis before surgery, and the hormone test is normal. Gonadal venography, laparoscopy, B-ultrasound, and CT scan may be helpful in the diagnosis, and surgical exploration is still needed when necessary.
Diagnosis
Diagnosis and differential diagnosis of epididymis
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
Epididymitis: The epiphysis of the testis is surrounded by the epididymis. The sperm is temporarily stored here after production. Epididymitis, more common in people around the age of 30, mostly due to testicular malformation and bacterial infection, causing the bacteria into the epididymis through the vas deferens. It often occurs with posterior urethritis, prostatitis, seminal vesiculitis, etc. The site can be bilateral on one side, and the attack time can be urgent.
Orchitis: Caused by testicular malformation Epididymitis directly spread to the testicles, caused by bacteria. Acute oral orchitis in children is usually caused by mumps virus. Because severe orchitis loses its ability to grow, doctors use antibiotics in addition to painkillers; they also need to apply testicles cold. If the doctor is treated improperly in the acute phase, bacterial orchitis can form an abscess or evolve into chronic orchitis.
Varicocele: The incidence of varicocele accounts for 10% of the 30- to 40-year-old male. 90% of it will occur on the left side due to the accumulation of spermatic vein blood flow, which causes the venous plexus to dilate, distort and lengthen. The varicocele star will be caused by a kidney tumor. The reason that varicocele is worthy of attention is that it may be accompanied by testicular atrophy and spermatogenesis, leading to infertility.
