Acute Epididymitis in Children: The Role of Radiologic Studies

Abstract

Assessment of the role of radiologic studies in the detection of significant urologic anomalies in boys with acute epididymitis. Retrospective chart reviews of patients with a diagnosis of acute epididymitis over a period of 15 years (January 1989 to December 2003). Patients presented with an acute scrotum and documented ipsilateral testicular/epididymal hyperemia on Doppler ultrasound plus any 2 of the following criteria: (1) high-grade fever (higher than 38.5 degrees C), (2) peripheral leukocytosis, (3) pyuria greater than 10 pus cells per high-power field, and (4) positive urine culture. The results of upper tract imaging and voiding cystourethrogram (VCUG) were reviewed for any anatomic abnormality. Sixteen patients were included in this review, age range 3 weeks to 16 years (median 10.5 years). Fifteen of 16 patients had upper tract imaging (13 renal ultrasound and 2 intravenous pyelogram [IVP]). All upper tract imaging studies were normal. VCUG was performed in 13 of 16 patients, and was normal in 12 of 13 patients. One patient had reflux to right seminal vesicle, which resolved spontaneously on a follow-up study. The follow-up period ranged from 1 month to 11 years (median 2 months). None of the patients had recurrent epididymitis, except the individual who had reflux to seminal vesicle. A full radiologic workup to include a renal ultrasound and VCUG should be obtained in children with acute epididymitis and a positive urine culture, or recurrent epididymitis. In a child with acute epididymitis and negative urine culture, urinary tract ultrasound is adequate. Because VCUG is of low yield in this population, its routine use should be questioned.