Epididymis is one big long tightly coiled tubule.
Rich blood supply with vascular anastomoses – head supplied by testicular artery, tail by artery to vas, some collaterals from cremasteric. The tail is generally only attached by connective tissue and more easily separated from the testis cf. head which has vascular and functional connections (efferent ductules drain into head/caput of epididymis).
Vas is posteromedial to epididymis.
Indications:
- Chronic epididymitis not responding to antibiotics
- Abscess formation with or without fistula
- Epididymal tumours
- Chronic pain localised to epididymis
Technique:
- Trans-scrotal approach
- Identification and high ligation of the straight vas – separating it from and protecting the testicular artery
- Combined dissection from head and tail – I prefer to start from tail – can use Allis for traction – stick to epididymal side
- Ligation of efferent ductules as needed
- Junction of testicular and epididymal arteries described at middle/upper third junction – selective ligation of epididymal artery
- Meticulous haemostasis
- Closure of tunical edges with suture
Complications:
- Haematoma
- All will have obstructive azoospermia / vasectomy on ipsilateral side
- Infection
- No improvement in pain
- De novo pain
- Testicular atrophy from testicular artery injury
