Deferentitis

DEFERENTITIS (deferentitis), inflammation of the vas deferens, occurring for the most part in conjunction with inflammation of the epididymis. Cases of isolated involvement without the simultaneous participation of the epididymis in the disease are observed rarely. More often, the upper segment of the vas deferens or its ampulla, located in the lesser pelvis, is affected (see Ampullitis). Inflammation spreads here to the vas deferens from the affected posterior urethra, prostate, or seminal vesicles, and also from the primarily affected epididymis. In the latter case, inflammatory changes are most sharply expressed in the part of the vas deferens adjacent to the epididymis, gradually diminishing in the direction of the lesser pelvis. Among the causative agents of deferentitis, the gonococcus stands in first place, followed by the tubercle bacillus. Deferentitis can also be secondarily caused by other microorganisms penetrating into the epididymis from the urethra (staphylococcus, streptococcus, colon bacillus) or having entered the epididymis via the hematogenous route—malaria plasmodia, typhoid bacillus, influenza bacillus, etc. Trauma can also be a cause of deferentitis. Subjective complaints are reduced to pains in the region of the scrotum, inguinal canal, or rectum. The spread of the inflammatory process to the peritoneum covering the vas deferens may be accompanied by a sharp disturbance of the general condition, an increase in temperature, constipation, and meteorism. The vas deferens can be palpated from the side of the scrotum and through the rectum in the form of a dense, painful cord, often reaching the thickness of a finger. Characteristic of tuberculous involvement are nodules of various sizes, arranged like beads along the course of the thickened, as a rule painless, vas deferens. The absence of gonorrhea in the anamnesis, the presence of a non-gonococcal urethral lesion, and a sluggish, chronic course—in contrast to the stormy gonococcal process—all speak in favor of non-gonorrheal deferentitis. For the diagnosis of deferentitis, the body's reaction to a specific vaccine is checked, and a blood test for the Bordet-Gengou reaction is performed. The outcome of tuberculous deferentitis depends on the extent of the process, the general condition of the patient, and the conditions of his life and work. With simultaneous involvement of the prostate and seminal vesicles, the prognosis is unfavorable. With early recognition, the tuberculous process can be stopped by appropriate conservative or surgical treatment. As a result of any deferentitis, there remains an obliteration of the lumen of the vas deferens and obstruction to spermatozoa due to connective tissue changes in the thickness of its walls. The prophylaxis of deferentitis is reduced to the prevention of the introduction of infection into the urethra and to the elimination of any abuses of sexual intercourse and trauma to the epididymis and vas deferens, which predispose to the localization of infection in the latter. The treatment of deferentitis consists of rest and the local application of heat in all its forms, depending on the acuteness of the process: compresses, baths, blue light, diathermy, etc. Vaccine therapy and lactotherapy are used with success. In tuberculous epididymitis, hygienic measures and climate treatment stand in first place. Treatment with intramuscular injections of iodoform emulsion according to Gotz is also recommended. In the absence of involvement of the sex glands, surgical removal of the epididymis and the affected parts of the vas deferens is used.