Contents 1 Pinyin 2 English reference 3 Overview 4 Disease name 5 English name 6 Classification 7 ICD number 8 Epidemiology 9 Cause 10 Pathogenesis 11 Clinical manifestations of epididymal malformation 12 Complications of epididymal malformation 13 Examination 14 Diagnosis 15 Treatment of epididymal malformations 16 Related drugs 17 Related examinations: 1 Chinese patent medicines for the treatment of epididymal malformations 2 Drugs related to epididymal malformations 1 Pinyin

fù gāo jī xíng 2 English reference

deformity of epididymis 3 Overview

The epididymis is the semen discharge duct connected to the testicles. It is slender and flat in shape and is located on the posterolateral side of the testicles. Epididymal malformations are more common clinically, usually referring to significant elongation of the epididymis or abnormal attachment to the testicles. Since Scorer and Farrington first classified epididymal malformations in 1971, many different classification methods have been reported, but there is still no precise definition and unified classification method.

Epididymal malformations include structural abnormalities such as absence of the epididymis, segmental atresia, and epididymal cysts. Generally, there are no clinical symptoms. They are mostly discovered through male infertility investigation and cryptorchidism surgery. Most of them have cryptorchidism, inguinal hernia and hydrocele, and are often combined with vas deferens malformation. The cause of congenital epididymal malformations is unknown.

When epididymal malformation does not affect fertility, no treatment is required. Segmental epididymal atresia can be treated with epididymal vas deferens anastomosis. Epididymal cysts can be treated by puncture, aspiration, and injection of sclerosing agent. However, due to the high recurrence rate, it is not as safe and reliable as surgical methods, so it is rarely used now. Patients with epididymal absence cannot be treated by themselves, and the main purpose is to solve fertility problems. If the patient's testicular spermatogenic function is normal, assisted reproductive treatment is possible. For patients with epididymal malformation combined with cryptorchidism, testicular fixation should be performed promptly.

4 Disease name

Epididymal malformation 5 English name

Deformity of epididymis 6 Classification

Urology> Urogenital congenital malformation > Congenital malformations of the male reproductive system 7 ICD number

Q55.4 8 Epidemiology

Epididymal malformations include epididymal absence, segmental atresia, epididymal cyst and other structural abnormalities. Generally without any clinical symptoms, it is mostly discovered through male infertility investigation and cryptorchidism surgery, and is often accompanied by vas deferens malformation. Michlson (1949) synthesized 74 cases of epididymal and vas deferens malformations, 81% of which were epididymal malformations, 72% of which were combined with vas deferens malformations, and 41% of the 74 cases occurred in cryptorchidism. According to statistics, the incidence rate of cryptorchidism patients with developmental malformations of the epididymis and vas deferens is 36% to 79%. 9 Causes

In the 6th week of embryonic life, the mesonephric ducts and paramesonephric ducts are formed, and these ducts will evolve into the male and female reproductive tracts. When the embryonic gonads differentiate into testes and produce testosterone, the mesonephric ducts gradually evolve into male reproductive ducts under the influence of androgens. The head end of the mesonephric duct becomes the epididymal appendage. The testicular efferent duct, which is derived from the mesonephric tubule, and the epididymal duct formed by the growth and twisting of the mesonephric duct below it together form the head of the epididymis. The remaining epididymis The tube forms the body and tail of the epididymis.

The cause of congenital epididymal malformations is unknown. Since patients with cryptorchidism often have epididymal malformations, their occurrence may be related to endocrine dysfunction during embryonic development. Due to low testosterone levels, the mesonephric tubules and mesonephric ducts are underdeveloped or underdeveloped, resulting in various types of epididymal malformations. If the mesonephric duct is completely underdeveloped, it may lead to congenital absence of epididymis and vas deferens. If development stops at a certain part, atresia will occur. When the epididymal tube is twisted and coiled, the epididymis may be significantly lengthened and a long loop-shaped epididymal deformity may occur. 10 Pathogenesis

The epididymis is the seminal duct connected to the testicles. It has a slender and flat shape and is located on the posterolateral side of the testicles. 10 to 15 testicular efferent ducts are twisted into a cone shape, and the ends merge into a highly tortuous epididymal duct that is 4 to 6 cm long. According to Turck's scrotal exploration of 94 cases of non-cryptorchidism, such as hernia, hydrocele, varicocele, etc., it was found that 83.9% of the epididymal head and epididymal tail are attached to the testicles, and there is a certain gap between the epididymal body and the testicles. The distance can generally accommodate a fingertip (Figure 1), and only 12.5% ??of cases are completely close to the epididymis and testis (Figure 2).

Epididymal malformations are mainly characterized by developmental disorders of the epididymis and abnormal attachment to the testicles. The former includes absence of the epididymis, cystic degeneration of the head, underdevelopment of the middle and tail parts, fibrous cord-like atresia, and obvious elongation of the epididymis into a long loop shape. Absence of the epididymis can be further divided into:

1. The mesonephric duct is completely underdeveloped, and the vas deferens, seminal vesicles and sperm ducts are all missing.

2. The mesonephric ducts are underdeveloped, the tail of the epididymal body is absent, and the vas deferens is also absent.

3. The mesonephric duct does not develop into the epididymal duct, but directly evolves into the vas deferens, seminal vesicles and sperm ducts. The testicular efferent duct is connected to the vas deferens.

4. There is no epididymis, the vas deferens is not connected to the testis, and its proximal end is blind. Abnormal attachment of the epididymis includes complete separation and partial separation of the epididymis and testicles. The latter means that the head of the epididymis is not connected to the testicles, and the epididymis is not attached to the lower pole of the testicles.

Since Scorer and Farrington first classified epididymal malformations in 1971, many different classification methods have been reported. In 1990, Koff and Scaletscky made some modifications based on the Scorer classification method. Epididymal malformations are divided into 5 categories:

Type I: long loop-shaped epididymis: the epididymis is long loop-shaped, significantly longer than the size of the testicles, and is divided into 4 types: ① 2 times longer than the size of the testicles; ② 2 to 3 times; ③ 3 to 4 times; ④ more than 4 times.

Type II: Separation of epididymis and testis: According to the location and degree of separation, this type can be divided into the following three situations: ① Only the tail is separated; ② Both the head and tail are separated from the testis, but the distance is relatively large. Close; ③The head and tail are separated from the testicles, far apart.

Type III: The epididymis and testis become angled. ① Simple angulation; ② accompanied by epididymal stenosis.

Type IV: epididymal atresia or interruption of continuity at any part of the epididymis and vas deferens.

Type V: longer mesentery.

The different types of epididymal malformations mentioned above can coexist in the same patient. Koff’s data shows that long loop epididymal malformations are the most common in cryptorchidism and ectopic testes, accounting for about 79.3%. , separation of the epididymis from the testis was 45.1%, angulation of the epididymis and testis was 8.5%, atresia of the epididymis or vas deferens was 3.7%, and longer mesentery was 1.2%. The Koff classification method cannot yet include all epididymal malformations. Based on relevant data, the various types of epididymal malformations are summarized (Figure 3). 11 Clinical manifestations of epididymal malformations

Patients with epididymal malformations do not have any discomfort and often present clinically with cryptorchidism or male infertility. 12 Complications of epididymal malformations

Epididymal malformations are mostly accompanied by cryptorchidism, inguinal hernia and hydrocele. 13 Examination

Imaging examinations such as B-ultrasound and CT are not helpful in the diagnosis of epididymal malformations. 14 Diagnosis

Except for epididymal capitis cyst, there were no obvious abnormal signs of other epididymal malformations in the physical examination. It is often diagnosed during surgical exploration for cryptorchidism or male infertility. 15 Treatment of epididymal malformations

When epididymal malformations do not affect fertility, no treatment is required. Segmental epididymal atresia can be treated with epididymal vas deferens anastomosis. Under a surgical microscope with a magnification of 10 to 20 times, two epididymal and vas deferens anastomosis methods, Silber and Wagenknecht, were used. The main difference between the two is that the Silber method uses an end-to-end anastomosis of the dilated epididymal duct and the vas deferens, while the Wagenknecht method uses an end-to-side anastomosis of the dilated epididymal duct and the vas deferens. Cut open the dilated epididymal duct, first collect the fluid flowing out of the broken end of the epididymal duct, and search for vaginal fluid. After confirming the presence of vaginal fluid, use 110 non-damaging nylon thread to anastomose the epididymal duct and the vas deferens mucosa, and usually suture 4 to 6 stitches intermittently. , and then use 90 non-invasive nylon thread to anastomose the epididymal capsule and the muscularis of the vas deferens.

Epididymal cysts can be treated by puncture, aspiration, and injection of sclerosing agent. However, due to the high recurrence rate, it is not as safe and reliable as surgical methods, and it is rarely used now. Patients with absent epididymis cannot be treated by themselves, and the main purpose is to solve fertility problems. If the patient's testicular spermatogenic function is normal, assisted reproductive treatment is possible. For patients with epididymal malformation combined with cryptorchidism, testicular fixation should be performed promptly. 16 Related Drugs

Testosterone 17 Related Tests

Yishenling Granules, a Chinese patent medicine used to treat epididymal malformations with testosterone

Yishenling Granules can significantly increase the growth rate of this model in mice Testicular weight, exponentially increase the number of epididymal cells and vaginal activity rate, and reduce the rate of vaginal deformities.

Cyclophosphamide can... Zuogui Pill

It is seen in cryptorchidism, orchitis, testicular tuberculosis, testicular malformation or long-term consumption of cottonseed oil, etc.; it is also seen in vas deferens obstruction caused by epididymal tuberculosis, epididymitis, etc.; ...More Chinese patent medicines for the treatment of epididymal malformations

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