pole of the epididymis. This condition is usually caused by an obstruction of the tubular
system that conveys the sperm. An epididymovasostomy may be attempted after
excision of the mass to maintain the system.
b. Operative Procedure.
(1) The mass is approached through a scrotal incision as for
hydrocelectomy or varicocelectomy.
(2) The structures of the testis and spermatic cord are identified, and the
cyst is dissected free. Bleeding is controlled with clamps and ligatures in routine
fashion.
(3) The wound is closed and dressed as for hydrocelectomy refer to
paragraph 3-31c(3).
3-35. VARICOCELECTOMY
a. General. This procedure involves ligation and partial excision of dilated veins
in the scrotum. It is done to reduce congestion of the testes and to improve
spermatogenic function. The condition occurs more frequently on the left, since the vein
of the left testis is connected to the renal vein and is under greater pressure. The veins
of the pampiniform plexus of the spermatic cord become tortuous and engorged,
causing a bag of redundant veins.
b. Operative Procedure.
(1) The incision may be made low in the inguinal canal or in the upper
portion of the scrotum. The structures of the spermatic cord are identified and the
vessels dissected free from the vas deferens.
(2) The abnormal vessels in the inguinal canal are clamped and ligated.
The redundant portions are excised. The remaining structures are sutured to the
external oblique fascia above the external inguinal ring to support the testicle.
(3)
A Penrose drain may be placed. The incision is closed in layers.
3-36. ORCHIECTOMY
a. General. This operation involves the removal of the testis or testes.
Removal of both testes is castration and renders the patient both sterile and deficient in
male hormones. Because of the social implications, this operation, like vasectomy,
requires particular attention to legal permission. Bilateral orchiectomy is usually
performed to control carcinoma of the prostate. A unilateral orchiectomy may be
MD0928
3-35