[Diagnosis]
I. Clinical manifestations
1. The age of onset is the same as that of renal tuberculosis, mostly seen in 20-40 years old, with a history of urological and reproductive system tuberculosis.
2. The main manifestations are swelling of the epididymis to form a hard mass with local pain. The vas deferens shows bead-like changes; tuberculosis lesions may form cold pustules, or ulcerate to the skin to form fistulas; seminal vesicle prostate tuberculosis may have hematospermia.
3. There is an irregular and limited hard mass at the tail of epididymis with an unsmooth surface and tenderness.
4. It should be differentiated from non-specific epididymitis or gonorrheal epididymitis.
Auxiliary examination
1.Urinary routine may have white blood cells and red blood cells.
2.Smear examination of semen or culture to find antacid bacilli.
3.Vas deferens and seminal vesicle angiography.
4.X-ray of upper urinary tract to clarify the presence of tuberculosis foci.
Diagnostic criteria
1.There are typical clinical manifestations.
2.Abnormal findings in auxiliary examination.
3. Pathological confirmation of the excised specimen.
[Treatment]
1. If tuberculosis is present in the urinary system at the same time, it should be treated according to the principles of treatment of urological tuberculosis; simple epididymal tuberculosis can often make the nodules subside by anti-tuberculosis drug treatment in the early stage and does not require surgery. The duration of medication can be slightly shorter.
2. Epididymal tuberculosis should be treated by epididymectomy, during which the epididymis and its diseased tissues should be completely removed and the vas deferens should be cut off by high ligation.
[Epididymal tuberculosis should be completely removed during surgery.]
1.Cure. After systematic anti-tuberculosis treatment, the epididymal tuberculosis lesion has been removed or the early epididymal tuberculosis nodule has completely regressed; no tuberculosis lesion exists in other parts of body.
2.Good. After anti-tuberculosis treatment, early epididymal tuberculosis nodules shrink but do not completely subside; epididymal tuberculosis nodules have been removed, but there are tuberculosis lesions in other parts of the body.
3. Not healed. The epididymal tuberculosis lesion is not completely removed, and there is skin fistula or abscess; the epididymal tuberculosis lesion does not subside after anti-tuberculosis treatment.