Value of vasotomy in seminal vesiculitis

Abstract

(1) The urethra bears the brunt of gonococcal infections. It is favoured by better drainage and constant flushing with urine as compared to the seminal vesicles.(2) In the urethra, structures more recently acquired morphologically, like Littre's glands, are more prone to chronicity. They were developed originally as accessories to the seminal tracts.(3) The lymphatics from the urethra possibly play an important role in the extension of infection to the vesicles. This can be considered as an argument against the rationale of vasotomy.(4) The incidence of vesiculitis based on clinical grounds has been found not to exceed 30% in a large number of cases of gonorrhoea.(5) Many of the cases exhibited no acute stage.(6) The time of occurrence is difficult to ascertain. It was found that the more protracted the case, the more likely are the vesicles to get involved.(7) No evidence was found to support the estimates of Belfeild and Wolbarst that the majority of cases develop vesiculitis and that during the first month.(8) In chronic cases, the term vesiculitis gives the impression of a localised lesion. It is better to use the term "genital tract infection", in particular when thinking of treatment.(9) The symptomatology may be complex and cases liable to be wrongly diagnosed.(10) The pathology of vesiculitis throws great doubts on the value of vesicular medication.(11) Evidences of filling of the vesicles have been found lacking in many cases despite successful injection at the time of operation. The impression one gains is that the drug passes to the urethra at once in many cases.(12) The rationale of vasotomy is better based on its ability to promote drainage than on the supposed action on gonococci of the chemicals used.(13) Because of the associated prostatitis, vasotomy is probably irrational in acute cases. Furthermore the majority of cases recover quickly with simple measures.(14) In acute gonococcal arthritis it does not give the dramatic cure as claimed by its protagonists.(15) In chronic cases, the more healthy the wall of the vesicle, the better is the prospect of success of vasotomy.(16) In these chronic cases the value of the operation has been overrated. The results obtained do not justify the enthusiastic claims for it. It very often fails and may be accompanied by complications.(17) The more common complications are thickening of the cord and epididymitis. This latter does occur without wound sepsis.(18) Other surgical methods of treatment have not been favoured in this country and do not seem to offer any better results than conservative measures.(19) For success the urethra and other parts of the urogenital tracts must be carefully examined to exclude the presence of other lesions that demand treatment as well.(20) In view of the more recent development of chemotherapy and its possible value in decreasing the incidence of vesiculitis in general, and in view of the possible future development of artificial fever and thermal therapy for the treatment of more resistant cases, it seems probable that vasotomy will be unnecessary, even the so- called "bugbear" cases.