Other abnormalities of the testicle include congenital atrophy or absence, while in a few cases a third testicle has been found, it lying in contact with one or the other of the naturally separated normal pair.
INJURIES TO THE TESTICLE.
Injuries to the testicle are of common occurrence, on account of their exposed position, yet less common than would otherwise occur were it not for their extreme movability. Aside from the lacerated, incised, or punctured wounds which may be inflicted the testicle suffers most often from contusions, always with resulting swelling, and sometimes with considerable effusion, of which a large amount may be accommodated in a distended tunica vaginalis.
HEMATOMA OF THE TESTICLE.
Hematomas of the testicle are also thus frequently produced. When of a limited degree of severity spontaneous absorption of blood may be expected, and should be favored by physiological rest, i. e., confinement in bed, with elevation of the scrotum and the application of water dressings. Large extravasations of blood, when fresh, may be withdrawn by the trocar, but when clotted will require incision and evacuation of clots, which should always be practised, as it leads to great saving of time. Extravasation is usually followed by induration, and more or less permanent enlargement, which will be slow to disappear; absorption may be encouraged by the use of a weak mercurial ointment.
TUBERCULOSIS OF THE TESTICLE.
Tuberculosis of the testicle simulates very closely that occurring in the lungs, in that one may see a disseminated miliary process, with subsequent coalescence and formation of caseous nodules, subsequently breaking down into abscess cavities, while at the same time the surrounding membranes, i. e., the tunica vaginalis, are involved, and effusion (hydrocele) occurs just as in the pleural cavity. In other words every appearance of pulmonary consumption may be imitated within the small extent of the testicles and the epididymis. Of these two parts the latter suffers much more frequently. Here are caused irregular nodules, which may later unite, giving to the entire epididymis a much enlarged, irregular shape, with induration, frequently extending upward along the cord, and always tending so to extend unless the disease be early seen and recognized. Too often adhesions to the skin occur, with ulceration and formation of fistulas, and perhaps more or less extensive ulcers, while in many instances the entire length of the vas becomes infected, and frequently even the prostate and corresponding vesicle become involved. By this time there will be more or less involvement of the inguinal lymphatics, and the patient may be already showing evidences of general tuberculous infection, at least those of some serious constitutional impression made by the local disease. One has to differentiate as between tuberculosis, syphilis, and cancer, which may be difficult in the early stages; but when the disease has extended beyond the epididymis itself it is rarely difficult to recognize, unless entirely masked by distention of the tunica vaginalis with fluid.
Treatment.
—The treatment for tuberculosis of the testicle is extirpation, i. e., castration, which includes the removal not only of the diseased organ, but of all the tissues, including the skin, to which it may be abnormally adherent, and of the spermatic cord, which, if necessary, should be followed into the pelvis by a long incision extending up along the inguinal canal. To remove a tuberculous testis and leave a tuberculous cord is to accomplish very little, while the latter, being an extraperitoneal tissue, may be followed with relative safety, even to the depths of the pelvis. Local applications in these cases give little relief. This teaching is at variance with that of some writers, but is justified by experience.