The cord participates essentially by its contained vas deferens and lymphatics in the consequences of acute and chronic infections, travelling in either direction, and thus it may be involved in tuberculous, syphilitic, or malignant disease. These expressions, however, are secondary and the conditions have been described above. Encysted hydrocele of the cord implies simple dilatation of an incompletely obliterated canal of Nuck, by which there may be formed along the cord one or more cystic expansions, causing tumors rarely attaining a size greater than a pigeon’s egg, which are innocent collections of fluid, corresponding to the ordinary hydroceles that may occur below. They are ordinarily not difficult of recognition, and are the most common form of neoplasms occurring in this region. They are amenable to the same treatment as that described for hydrocele.
Fig. 674
Varicocele. (Hartmann.)
SPERMATOCELE.
Spermatocele implies a cystic tumor in whose contained fluid, no matter what its source, are found spermatozoa, which may be seen alive under the microscope if examined immediately after removal. Spermatoceles are usually found at the lower end of the cord and in close connection with the testicle. Their occurrence is not uncommon, but somewhat difficult to explain, for it implies connection, at least at some time, between the structures of the cord and a more or less displaced seminiferous tubule. Spermatoceles are rarely diagnosticated as such until aspiration or evacuation and examination of their fluid contents, which usually are of a milky appearance. In general they are to be treated like any other cysts, and by the same methods.
VARICOCELE.
This exceedingly prevalent affection is the result of a varicose condition of the pampiniform plexuses and of the spermatic veins. It occurs in perhaps 10 or 12 per cent. of adult males, rarely before puberty, and almost invariably upon the left side, varicocele upon the right side being as rare as 1 in 500 cases. Its confinement to the left side is explained partly by compression of the left spermatic veins beneath an overloaded and distended sigmoid, and by the disadvantage at which the blood current from the left spermatic vein empties into the vena cava, this being on the left side at a right angle, while on the right the angle is oblique. It has occasionally to do with accident or injury, as well as with occupation or habit. It occurs more frequently in those who are long in the saddle and in those who ride the bicycle to excess. (See [Fig. 674].)
Varicocele is usually of slow development, and discovered finally by accident or by attention being drawn to these parts through quack advertisements or misleading statements. The effect is to produce an elongated mass of varicose veins, often described as feeling like a “bag of angle worms,” occupying the lower portion of the cord and extending down upon the back of the testicle. In the more advanced cases the condition can be traced almost to the external ring, but is always more marked low down than higher up. Sometimes it is so extreme that the entire group of veins corresponds in bulk to a hen’s egg; ordinarily it is but a fraction of this size. The consequence is increase of weight and production of dragging sensation upon the cord, often referred to the back, and displacement downward of the testicle, with consequent elongation of the scrotum, which may so greatly relax that it appears to be twice its normal length and contains this varicose mass at its lower extremity. Such a condition will naturally produce a certain degree of discomfort and annoyance, but beyond this it is innocent, save that it is made to cause much mental anxiety, mainly through ignorance, and has led thousands of victims to quacks, for treatment for conditions dishonestly represented and treated as both distressing and extreme. It is true that a large mass of enlarged veins may in time produce some atrophy of the testicle; it is likewise true, also, that virility or masculine potency may be to a trifling extent limited in this way. It is not true, however, that impotence can be so produced, because the affection is limited to but one organ, so that the impotency of which many men complain is mainly of psychical origin. Such individuals need explanations and advice as much as treatment, although it is difficult to elevate many of them from the condition of sexual hypochondria into which they gradually fall.
Fig. 675