THE VAS DEFERENS 1385 



major of the epididymis, is at the bottom of the scrotum, and the vas deferens comes off from the 

 summit of the organ. 



The testis may require removal for malignant disease, tuberculous disease, cystic disease, in 

 cases of large hernia testis, and in some instances of incompletely descended or misplaced testes. 

 The operation of castration is a comparatively simple one. An incision is made into the cavity 

 of the tunica vaginalis from the external ring to the bottom of the scrotum. The coverings are 

 shelled off the organ, and the mesorchium, stretching between the back of the testis and the 

 scrotum, divided. The cord is then isolated, and an aneurism needle, armed with a double 

 ligature, passed under it, as high as is thought necessary, and the cord tied in two places, and 

 divided between the ligatures. Sometimes, in cases of malignant disease, it is desirable to 

 open the inguinal canal and tie the cord as near the internal abdominal ring as possible. 



A collection of serous fluid in the sac of the vaginal tunic of the testicle is known as an ordinary 

 or testicular hydrocele. In congenital hydrocele a communication remains between the tunica 

 vaginalis testis and the peritoneal cavity. This communication should have closed during 

 development. In infantile hydrocele the tunica vaginalis and part of the funicular process are 

 distended with fluid, but the funicular process is closed above and the cavity of the hydrocele 

 does not communicate with the peritoneal cavity. In encysted hydrocele of the cord the funicular 

 process is closed above and below, but between these points is not obliterated. In funicular 

 hydrocele the funicular process is closed below and open above. Congenital hydrocele can 

 usually be cured by the application of a truss. This obliterates the upper end of the funicular 

 process, and the obliteration once begun may proceed to completion. If it does not, the condi- 

 tion has become an infantile hydrocele. An infantile hydrocele can usually be cured by multiple 

 puncture or tapping. The same is true of encysted hydrocele of the cord. In hydrocele of the 

 funicular process a truss should be worn for a time and the fluid then evacuated by tapping. 

 In ordinary testicular hydrocele incise and pack, or incise and suture the cut edge of the parietal 

 laver of the tunic to the skin, or extirpate the parietal layer of the tunic. A successful method 

 is that of Longuet. He makes an incision, pulls out the testis, and allows all the coats except the 

 skin to fall behind and make a sheath for the cord. These coats are held behind by one catgut 

 suture. A bed is made for the testis beneath the skin toward the septum of the scrotum. The 

 testicle is rotated on its long axis, and placed in the bed, and the skin is sutured above it. This 

 operation is known as extraserous transposition. If a portion of bowel enters an open vaginal 

 process the condition is congenital hernia. 



In infantile hernia the funicular process is closed above but not below, and the hernia descends 

 in a special sac back of the vaginal tunic. If the hernia pushes down on the vaginal process and 

 causes it to double on itself the condition is encysted infantile hernia. 



THE VAS DEFERENS (DUCTUS DEFERENS) (Figs. 1128, 1136). 



The vas deferens, or seminal duct, the excretory duct of the testis, is the con- 

 tinuation of the epididymis. Commencing at the lower part of the globus minor, 

 it ascends along the posterior border of the testis and inner side of the epididymis, 

 and along the back part of the spermatic cord, through the inguinal canal to 

 the internal or deep abdominal ring. From the ring it curves around the outer 

 side of the deep epigastric artery, and ascends for about an inch in front of the 

 external iliac artery. It is next directed backward and slightly downward, and, 

 crossing the external iliac vessels obliquely, enters the pelvic cavity, where it lies 

 between the peritoneal membrane and the lateral wall of the pelvis, and passes 

 on the inner side of the impervious hypogastric artery and the obturator nerve 

 and vessels. It then crosses in front of the ureter, and, reaching the inner side 

 of this tube, bends at an acute angle, and runs inward and slightly forward 

 between the base of the bladder and the upper end of the seminal vesicle. Reach- 

 ing the inner side of the seminal vesicle, it is directed downward and inward 

 in contact with this structure and gradually approaches the vas of the opposite 

 side. Here the vas deferens lies between the base of the bladder and the rectum, 

 where it is enclosed, together with the seminal vesicle, in a sheath derived from the 

 rectovesical fascia. 



At the base of the bladder it becomes enlarged and sacculated, forming the 

 ampulla (ampulla ductus deferentis) (Fig. 1136), and then, becoming narrowed 

 at the base of the prostate, it is joined by the duct of the seminal vesicle to form 



