Testicular diseases

Testicular diseases are pathologies of the scrotum and its contents, appendages, and spermatic cords, which are closely interconnected by blood and lymph circulation, innervation, and function.

The scrotum has very delicate, richly innervated skin, is an erogenous zone, therefore it is often injured even with minor mechanical impact, diseases of the testicles may not occur, as they are easily displaced and pulled up. The tissue is loose, richly supplied with vessels, therefore even a small impact on this organ leads to the rapid development of edema or hematoma, which can reach large sizes, spread to the perineum, penis, thighs and abdomen. At the same time, diseases of the testicles and the contents of the scrotum lead to its enlargement and deformation with edema and the transition of inflammation to the skin of the scrotum. The formation of gas in the subcutaneous tissue, for example, with pneumothorax, leads to its accumulation in the tissue of the scrotum. Allergic reactions with the development of Quincke's edema are also accompanied by a sharp and rapid edema. The presence of a large number of sweat and sebaceous glands determines the predisposition to inflammatory processes: dermatitis, diaper rash, eczema, erysipelas, up to the development of phlegmon and gangrene of the skin and contents of the scrotum, since the process is always prone to deepening. Rarely, but specific diseases of the testicles can develop, usually associated with damage to the contents of the scrotum: tuberculosis, actinomycosis and other mycoses (rubrophytosis, epidermophytosis, candidiasis), syphilis. Viral infection is accompanied by the formation of pointed condylomas. Tumors, both benign and malignant, are rare and do not cause diagnostic difficulties.

Lightning gas gangrene (Fournier gangrene) can also develop with the association of clostridial microflora with E. coli, streptococcus, etc.

The disease develops suddenly, quickly, and can occur at any age. It begins with severe and progressive intoxication, edema, skin of the perineum, thighs, and abdomen. The skin becomes bluish, purple-brown with a black tint, and gas crepitation is often palpated. Urination may be impaired, and in some cases an acute urethral-perineal fistula is formed.

Testicular diseases are quite diverse, and sexologists are mostly involved in the diagnosis and treatment of disorders.

Surgical pathology includes common diseases of the testicles - orchitis, and if the appendages are involved in the process - orchoepididymitis. In most cases, orchitis is secondary, rarely purulent, more often infectious-allergic with epidemic mumps, brucellosis, typhoid and paratyphoid, hepatitis, scarlet fever, chickenpox, some types of purulent inflammation, especially if the microflora association includes allergenic viruses and fungi. Diseases of the testicles can occur with injuries, circulatory disorders in the spermatic cord (after hernioplasty, with a sharp contraction of the muscles of the anterior abdominal wall, with prolonged sexual arousal without ejaculation, with torsion).

Diseases of the testicles have a vivid clinical picture: sharp pains radiating to the spermatic cord, inguinal canal, lateral region of the thigh, lumbosacral region. General

The reaction proceeds according to the type of purulent-resorptive fever. The testicles are enlarged in size, dense, sharply painful upon palpation, the scrotum above them is not changed. In case of suppuration or necrosis of the testicles, the pain becomes uncontrollable, of a twitching nature, the scrotum swells, hyperemia appears, upon palpation,

Foci of softening. The general reaction of the organism proceeds with the development of intoxication syndrome.

It is necessary to differentiate it from hydrocele, in which it is enlarged but not painful, elastic consistency upon palpation, fluctuation is determined. In isolated epidimitis (rare), a dense and painful infiltrate is determined on the posterior surface of the testicles. In testicular torsion, the pain is very sharp not only in the entire testicle, but also in the spermatic cord, which is palpated as a dense, sharply painful cord. Neuralgia of the testicle (Astley-Cooper syndrome) may occur, which manifests itself in sharp transient pain in the form of shooting pains in it and along the spermatic cord at the slightest touch, disappears after blocking the spermatic cord with novocaine, is prone to relapse, but no visible changes in the testicles are noted.

Testicular diseases caused by specific infections (tuberculosis, syphilis, actinomycosis) are characterized by typical changes: moderate pain, the testicle is enlarged, slightly painful, with areas of compaction, ulcers and fistulas with characteristic discharge often form on the scrotum. Atrophy of the male testicles develops quite quickly.

Testicular diseases associated with the spermatic cord are quite rare; more often they are associated with other structures of the scrotum.

The most common pathology of the spermatic cord is varicocele - varicose veins, detected in 1-6% of men aged 18-30, mainly engaged in lifting weights and high physical activity. Most often localized on the left. Diagnostics is not difficult, since varicocele is visible to the eye. The clinical picture depends on the degree of the process. At degree 1, the dilated veins are localized within the spermatic cord, the cremasteric reflex is moderately reduced. There are no subjective sensations, varicocele mostly bothers as a cosmetic defect. At degree 2, the dilated veins descend to the lower pole of the testicle, the spermatic cord is thickened, the corresponding half of the scrotum and the testicle itself are significantly lowered, since the cremasteric reflex is significantly weakened. Subjective sensations of this disease of the testicles usually appear after physical exertion: pain, discomfort in the perineum, often there is a decrease in potency. At stage 3, the testicle is edematous or atrophied, lowered into a flabby and enlarged scrotum, which is completely filled with dilated nodular veins. Pain in the testicles, perineum, sacrum and lower back is constant, impotence is almost complete. Surgical treatment is absolutely indicated only at stage 3. At other stages, it is either not required at all, or plastic surgeries are performed in urological departments at the patient's request.

Funiculitis is an inflammation of the spermatic cord, which is rarely isolated and is most often associated with orchitis.

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