Diseases of and operations on the male genitalia

operations on the male genitaliaCongenital Malformations

Congenital malformations may be any of sev­eral specific abnormalities, but none is frequent.

The commonest is failure of the testis to de­scend into the scrotum, known as undescended testis or cryptorchism. The organ may remain within the abdomen, or in the inguinal canal, or in the upper portion of the scrotum. Any degree of nondescent may occur on either side or both. In most cases there is an associated potential or actual hernia. Occasionally the organ will descend spontaneously with age, but more often it demands surgical correction by fixing the testis in its normal location. A two- stage operation may be neccssary. The hernial defect may be simultaneously repaired. Formerly hormonal therapy was used. Waiting until puberty or for the possibility of spontaneous descent has also been advocated. Most surgeons now believe, however, that the undescended tes­ticle should be operated on between five to eight years of age. If the testicle remains undescended, it will not develop normally and in manhood is sterile. There is a greater tendency toward malignant change in the undescended testis.

When there is failure of the urethra to form normally in the penis, the opening may lie along the underside of the penis, a condition called hypospadias. When the abnormal ureth­ral opening is through the upper wall of the penis, it is called epispadias. These conditions are correctable by plastic operative procedures.

Other congenital abnormalities may occur but fortunately they are not common.

Infections

Infections of the male reproductive system may occur in any of the parts.

Inflammation of the testis is called orchitis, and of the epididymis epididymitis. These con­ditions usually occur by infection ascending through the vas deferens to reach these parts. Medical measures usually suffice to cure these conditions, but occasionally operation for drain­age or slitting of the gonad capsule is needed. Infection of the seminal vesicle (seminal vesicu­litis) is usually secondary to other infections of the system.

Prostatitis is a most common disease of this system. Because of the position of the gland, the swelling associated with inflammation of the prostate may interfere with the process of evacuation of the bladder. This is often present in the gland which is already somewhat en­larged. Medical measures frequently will allevi­ate the condition. Treatment may also entail massaging of the prostate gland through the rectum to empty the gland of its secretions and infected debris.

Inflammation of the urethra is called ureth­ritis. Inflammation of the glans of the penis is called balanitis. This is usually associated with infection of the prepuce, or prepucitis. Topical drugs and medi­cal measures usually effect a cure, but occasion­ally removal of the foreskin, circumcision, may be required.

Infections along the course of the male geni­tal tract, particularly of the testis, epididymis, seminal vesicle, and prostate, may render the male temporarily or permanently sterile.

Tumors

Tumors of the male reproductive tract may occur in several locations, and may be benign or malignant. Cancerous tumors always demand early radical excision along with the lymph glands to which they drain. Benign tumors also usually require surgical removal.

Cancer of the testis may rise from any of the component parts, and some kinds are vicious, rapidly growing new growths. In these sacrifice of the testis, the spermatic cord, and the lymph nodes of the area must be afforded by opera­tion; x-ray treatment may be necessary.

Enlargement of the prostate gland, called be­nign prostatic hypertrophy (over-growth), is the commonest tumor of the system. Associated with this disease are symptoms of abnormal urination and usually prostatitis. Partial or com­plete removal of the prostate gland may be necessary. Cancer of the prostate gland is all too common. Treatment rests with surgical re­moval of the gland, x-ray treatment, other radio­active measures, and hormones.

Prostatectomy (prostate-out) is performed by several different methods. When the gland is approached by incision through the lower ab­dominal wall and through the bladder, it is known as suprapubic or transvesicle pros­tatectomy. Approach to the gland from below by incision behind the scrotum is called perineal prostatectomy. Removal of the gland by in­strumentation through the urethra is trans­urethral resection (TUR). In this method specially lighted instruments with electrical cut­ting wires at the inner end are inserted through the urethra, and the gland is partially cut away by direct vision. In this instance no incision is needed. The choice of operative approach to the gland depends on the nature of the disease, the patient’s age and condition, and many other in­dividual conditions.

Other Conditions

Other conditions peculiar to the male repro­ductive organs are fairly common. Phimosis is the condition where the prepuce opening is nar­rowed so that the prepuce cannot be retracted back over the glans. When the penis is erect this may give rise to discomfort and poorly gratified coitus. There also results poor hygiene, so that balanitis occurs. Phimosis is correctable by circumcision, or removal of the foreskin. In acute severe balanitis a slit-incision through the top of the prepuce may be necessary to relieve the constriction, and this is followed by complete circumcision after the infectious process has subsided.

Paraphimosis is a less common constriction of the foreskin wherein the constricting band is caught back over the glans, giving rise to con­gestion and swelling and painful erections. This is correctable by operation, usually entailing complete circumcision.

Most of such diseases of the prepuce and the glans are prevented, and better hygiene afforded, by prophylactic circumcision. Most surgeons now believe that all male infants should be cir­cumcised shortly after birth, whenever practical.

Strictures of the urethra, which usually result from infections, are mentioned.

Varicocele is tortuosity and enlargement of the veins of the spermatic cord. This gives rise to a marked enlargement of the scrotal contents on the affected side. Actually this condition is varicose veins of the spermatic cord. Pain and tenderness may result from the added weight in the region from the greatly increased amount of blood which remains stagnant in the dilated cluster of veins along the spermatic cord. The greatest enlargement occurs about the penis just above the testis and any degree of swelling and discomfort may occur. Usually the condi­tion is progressive. Frequently no treatment is necessary as the symptoms are not severe. Tem­porary relief is often provided by the wearing of a scrotal support. Definitive treatment, how­ever, rests with the operative removal of the clusters of enlarged veins.

Hydrocele is essentially an abnormal collec­tion of fluid around the testis. Normally there is a small amount of fluid encased around the testis by a thin membrane about the organ, and increase in the amount of fluid gives rise to hydrocele. Marked enlargement of the area may result. In some instances hydrocele is attribut­able to infection or injury, but in most cases the causative factor is not apparent. Temporary relief of the pressure and weight may be pro­vided by simple withdrawal of the fluid by needle puncture; however, the fluid promptly forms again. Permanent cure necessitates oper­ative procedure wherein the distended collect­ing membrane is removed and everted around the testis.

Hydrocele of the cord may develop as an excessive collection of fluid at any level along the cord, since the membrane which surrounds the testis continues up as one of the cord cov­erings. Frequently hernia is associated with hydrocele; simultaneous operative repair may be accomplished.

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