Background: Tuberculous epididymitis is one of the causes of chronic epididymal lesions. It is difficult to diagnose in the absence of renal involvement. Aim : To profile isolated tuberculous epididymitis and to assess our approach in the evaluation of this group of patients. Setting and Design : Retrospective study done at Christian Medical College, Vellore, South India. Methods and Materials : Between 1992 and 2002, 156 fine needle aspiration cytology specimens and 108 epididymal biopsies were carried out in 187 men for evaluation of chronic epididymal nodules. Isolated epididymal tuberculosis was defined as tuberculous infection affecting the epididymis without evidence of renal involvement as documented by the absence of acid fast bacilli in the urine sample and on imaging. The age, laterality, mode of presentation and method of histological diagnosis were studied with the objective of profiling isolated tuberculous epididymitis. Results : Fifty-four of the 187 men (median age 32 years; interquartile range: 21-37 years) had tuberculous epididymitis. Fourteen were excluded from the analysis (10 had associated urinary tract tuberculosis and 4 were lost to follow-up). None of the 40 men with isolated tuberculous epididymitis had urinary symptoms. Bilateral involvement was seen in five (12.5%) cases. The salient presenting features included painful swelling (16 subjects, 40%), scrotal sinus (4, 20%) and acute epididymitis (2, 10%). Past history or concomitant presence of tuberculosis was noted in three subjects each. Anti TB treatment resulted in a complete response in 10 and partial response in 18. Five subjects underwent epididymectomy. Tuberculous epididymitis was found incidentally in 5 (10%) cases on high orchiectomy specimen done for suspected testicular tumour. Conclusions : Tuberculous epididymitis can be the sole presentation of genitourinary tuberculosis.

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Isolated tuberculous epididymitis: a review of forty cases.

52 relatively fresh (5 hours-2 days after death) adult human autopsy testes of normal size and consistency were removed from 26 subjects aged 19-55 years (mean age 41 years) and analyzed by histology and microradiography. It was found that the human epididymis is covered by a thick densely vascularized connective tissue sheath containing a network of blood vessels supplied by the same gross arteries as the epididymal duct itself. However the rete testis is poorly vascularized. The more distal segments of the epididymis have less dense capillarization surrounding the epididymal duct while in the vas deferens the blood vessels form a double capillary network. The outer network surrounds the smooth muscle layers while the inner is located immediately beneath the duct epithelium. In contrast to arterial coiling in some other organs such as aged and hypertensive kidneys and senile brain coiling in reproductive organs seems to be a normal adult feature. No histological changes suggestive of degeneration were found in coiled epididymal arteries of young males and this coiling seems to be present throughout the period of sexual maturity. In the fox such coiling appears as a reversible involutive phenomenon during the period of sexual inactivity. This study suggests that the lobulated head of the human epididymis is functionally analogous to the structure which is called the initial segment in the rat. Since the relative size of the segment performing a similar function in man seems to be different from that of the rat the efficiency and deleterious effects of a drug interfering with reabsorption of testicular secretions may well be different in man than in the rat and hormonal interference likewise may have different results in the human.

Microvascular structure of the human epididymis.

Male Reproductive Physiology

The involvement of the epididymis in the process of sperm maturation appears to be concerned with enabling gamete contact to occur (see Parts I,II) and the more terminal events of fertilisation may not require epididymal input (Glover and Nicander, 1971). The organ has evolved along with sperm maturation (Glover and Nicander, 1971) and the need for capacitation (Bedford, 1983), although spermatozoa at all stages of their maturation require conditions compatible with their survival.

E. W. Macmillan

Papers

The blood supply of the epididymis in man.