Fig. 676
Resection of scrotum for varicocele. (Hartmann.)
Treatment.
—Treatment of varicocele may be palliative, i. e., it may consist of suspension of the overloaded testicle and somewhat relaxed scrotum within a well-fitting suspensory bandage, and this suffices for most mild cases in normally minded individuals. When, however, the condition preys deeply upon the mind or upon the body, or when it is actually and anatomically advanced, then radical operation is legitimate and humane. Of the many operations recommended in time past only two will be described here, for it seems to me that all subcutaneous and blind methods are bad in theory as in practise.
Excision of the varicose veins is easily performed under local cocaine anesthesia. It is done by incision below the external ring, over the course of the cord, the cord itself being exposed for two to three inches. Here the enlarged veins appear usually in a group (the pampiniform plexus), and as such can be isolated and separated from the balance of the cord, it being essential to carefully exclude the vas, as injury to or division of this canal would naturally be followed by impotence of that testicle. The veins involved being isolated to an extent of two inches, are ligated above and below, the intervening portion being then exsected, after which it is my custom to utilize the catgut with which this ligation is effected, threading it on each side into a needle, using each as a suture, thus providing two sutures, by which the divided ends are approximated and tied together, the effect being to bring the testicle up and make a more effective suspensory of the cord itself.
Shortening of the Scrotum.
—To the above procedure, when the scrotum is much elongated and relaxed, may be added its shortening by a species of amputation. The entire procedure may be practised as follows: The scrotum being stretched downward is shortened by removing one and a half to three inches from the lower end of the scrotal pouch of skin and the contained connective tissue, including the septum. In this way the tunical sacs and lower ends of the testicle will be immediately exposed. The left testicle can now be drawn down, and the operation, described above, of exsection of a portion of its veins, may then be practised. This being completed the scrotal wound is closed with sutures, with or without catgut drainage. The effect is to not only remove the varicose veins, but to reduce the size of the scrotum, and to make it, as it were, a suspensory of living tissue ([Figs. 675] and [676]).