ACUTE EPIDIDYMO-ORCHITIS(the last lesson)

BILHARZIASIS

: MODE OF INFESTATION

• Anastomotic channels between the superior and inferior mesenteric veins (portal system) and the right and left testicular veins.

• The deferential veins (along vas deference) connecting the vesico-prostatic plexus of veins and the veins of the spermatic cord (posterior group).

BILHARZIASIS: PATHOLOGY

• Granular or miliary form: Small lentil-like nodules are scattered all over the spermatic cord and epididymis and their coverings.

• Solitary form (LOCALISED MASS): This is the commonest type. The most common site is the terminal 7-8 centimeters of the cord. The mass may involve the epididymis, more commonly the globus major. In lesions of the globus minor the rest of epididymis and the cord may be free. On the contrary, in case of globus major lesions usually involve the cord, sometimes in continuity. In some patients, multiple masses are scattered along the spermatic cord up to the external ring "Bilharzial Rosary".

• Massive type: Extensive Bilharzial infiltration of the intrascrotal part of the cord, epididymis and all the cord coverings down to and around the testis.

SYPHILIS

• Interstitial fibrosis causes painless destruction of the testis, with loss of testicular sensation. This type is found in congenital and tertiary syphilis.

• Gumma: presents as a unilateral painless swelling of the testis which grows slowly. It feels hard and heavy and is very difficult to distinguish from a neoplasm without surgical exploration. It may break- down leading to an anterior sinus

Leprous orchitis: causes testicular atrophy in over 25 per cent of male leper.