THE SPERMATIC DUCTS. 1953 



with it are a few veins ; the cremasteric lies to the outer side of the cord, near its 

 surface ; the spermatic is in front of the cord, surrounded by the anterior group of 

 veins, and can scarcely be distinguished from them. Each artery should have a 

 separate ligature, but the two sets of veins may be tied en masse ; the divided cord 

 should be secured with artery forceps until the end of the operation. 



When the cord is extensively involved, the incision should be extended up along 

 Poupart's ligament. It is deepened to the peritoneum, which is stripped up, allowing 

 access to the lymph-nodes of the pelvis. When the lymphatic involvement extends 

 upward beyond reach, it may be attacked through a transperitoneal opening. The 

 nodes into which the lymph-vessels of the cord pass completely surround the aorta. 

 There is, moreover, one lying upon the external iliac artery which probably will be 

 involved. 



Hydrocele an effusion into the tunica vaginalis may begin in the acute form 

 (vide supra), may result from disease of the cord, the epididymis, or more par- 

 ticularly the testis, or may appear to be " idiopathic," i.e. , with no discoverable 

 preceding pathological condition of the scrotal contents. In the majority of such 

 cases it is thought (Jacobson) that the effusion of fluid commences passively and 

 without any irritation or inflammation to begin with, the causes predisposing to its 

 production being the pendent position, the less vigorous condition of the cremaster 

 and dartos, feebler cardiac circulation, deficiency of tone in the scrotal blood-vessels 

 and lymphatics, together with, perhaps, a tendency to venous congestion from 

 hepatic and renal degeneration. All these conditions, which combine to bring about 

 a passive effusion, naturally begin to be most active in middle life, this being the age 

 when the ordinary hydrocele of the tunica vaginalis is most frequently met with. 

 After a while, as the fluid increases in bulk, it becomes, from exposure to friction, 

 etc. , liable to irritation and to inflammatory changes, which show themselves in both 

 the fluid and the tunica vaginalis itself. 



The anatomical relations of the effusion to the testicle and epididymis, the char- 

 acteristic slow increase in size of the affected side of the scrotum, the effacement of 

 the rugse, the drag upon the cord, and the referred pains sometimes caused by it 

 have been sufficiently explained (vide supra}. 



Congenital hydrocele depends for its existence upon the maintenance of a com- 

 munication between the tunica vaginalis and the abdominal cavity. The funicular 

 portion of the tunic does not become obliterated. The fluid may come from the 

 general abdominal cavity or may be exuded from the vaginal tunic. It may develop 

 in early infancy or not until later in life. 



Infantile hydrocele is an effusion into a sac formed by more or less of the unob- 

 literated funicular portion of the vaginal tunic. This sac is closed from the peritoneal 

 cavity above and communicates with the tunica vaginalis testis below. 



Bilocular hydrocele is a comparatively rare form of infantile hydrocele. The 

 funicular portion of the tunica vaginalis is commonly obliterated at the internal ring. 

 Below this the whole tunica vaginalis may be patulous, or it may be closed just above 

 the position of the testis. As the fluid accumulates, sacculation develops, the tumor 

 extending either backward and downward into the pelvis or more commonly upward 

 and inward between the abdominal muscles and the peritoneum. 



Encysted hydrocele of the cord, or funicular hydrocele, consists of an accumula- 

 tion of fluid within an unobliterated portion of the funicular portion of the tunica 

 vaginalis. This accumulation is closed from the peritoneal cavity above and from the 

 tunica vaginalis testis below. The hydrocele may be unilocular, bilocular, or multi- 

 locular, in the latter case forming a series of small cysts along the course of the cord. 

 These cysts may be placed in the inguinal canal, and are more common on the right 

 side. They are usually observed in children, and may be complicated by hernia. 



THE SPERMATIC DUCTS. 



The spermatic ducts are two tortuous canals, one on either side, that connect the 

 epididymi with the urethra and thus provide channels for the escape of the products 

 of the sexual glands. Each duct is divisible into the vas deferens and its ampulla 

 and the ejaculatory duct ; at the upper end of the latter the spermatic duct is connected 



12.3 



