Acute Epididymitis Research Articles

Epstein\u2013Barr virus-associated infectious mononucleosis with acute epididymitis: a case report

BackgroundInfectious mononucleosis due to the Epstein–Barr virus is an infectious disease that causes the appearance of atypical lymphocytes in the peripheral blood; it mainly presents with fever, tonsillar pharyngitis, and lymphadenopathy. In addition to hepatitis, splenomegaly, and rashes, it can involve different organs. Here, a case of epididymitis as a rare complication in a patient with Epstein–Barr virus-associated infectious mononucleosis was reported.Case presentationA healthy 23-year-old man visited an outpatient clinic with fever and pharyngitis. Tonsillar pharyngitis, lymphadenopathy, atypical lymphocytes in the peripheral blood, liver dysfunction, and splenomegaly were observed. The patient was diagnosed with infectious mononucleosis based on clinical signs. The next day, the patient developed left testicular pain and was immediately transferred to the emergency outpatient ward. Pain, redness, and swelling were observed in the left scrotum. Ultrasonography revealed swelling of the epididymis and increased blood flow, and the patient was hospitalized with a diagnosis of left epididymitis. The patient’s symptoms improved with symptomatic treatment and was discharged on day 16 after admission. Changes in antibody titers established a definitive diagnosis of infectious mononucleosis caused by the Epstein–Barr virus. Based on the disease course, the patient was also diagnosed with infectious mononucleosis associated with unilateral epididymitis.ConclusionsThis is the first case report of Epstein–Barr virus-associated infectious mononucleosis complicated with acute epididymitis. Infectious mononucleosis can cause numerous organ-related complications; thus, physicians and healthcare workers should remain cognizant of Epstein–Barr virus-associated complications throughout the body and not just in the primary organs affected by infectious mononucleosis.

A0036 - Etiology of Acute Epididymitis (AE) in young patients under 35 years

A0036 - Etiology of Acute Epididymitis (AE) in young patients under 35 years

CLINICAL AND IMAGING FINDINGS OF ACUTE EPIDIDYMITIS IN CHILDREN

(Objective) The etiology of acute epididymitis in children remains poorly understood. Several studies have demonstrated that urine tests are negative in the majority of children with acute epididymitis, and the condition is self-limiting. The need for radiological evaluation of the urinary tract in children with acute epididymitis is still debatable. The aim of this study was to describe clinical and imaging findings in children with acute epididymitis. (Methods) We identified 47 children with acute epididymitis at our institute between 2017 and 2021.We retrospectively reviewed their clinical features and radiological and laboratory data. All children underwent ultrasonography of the kidney and urinary tract. (Results) Median patient age was 9 years (range, 6 months-16 years) and 60% of the cases occurred between the ages of 7 and 12 years. Thirteen children (28%) had a past history of genitourinary malformations. The common malformations were hypospadias in eight children and bladder dysfunction in three. Ultrasound revealed no new urinary tract abnormalities in the remaining 34 children. Urinalysis were performed in 27 children, nine of whom (33%) had pyuria. Urine culture was positive in two children. Of the nine children with genitourinary malformations, eight had pyuria. All 18 children without genitourinary malformations had a negative urinalysis except for one patient (p< 0.0001). (Conclusions) Acute epididymitis is a common cause of acute scrotum in pediatric patients. In this study, one-third of acute epididymitis cases presented pyuria, and about 30% had a past history of genitourinary malformations. The presence of pyuria was associated with a past history of genitourinary malformations. For children with no previous genitourinary malformations, routine use of ultrasound for the detection of urinary tract abnormalities is questionable due to the low yield.

ETIOLOGICAL AND PATHOLOGICAL STUDY OF EPIDEDE/lY'I‘IS IN GOATS IN BAGHDAD CITY

Testes from 700 male goats aged l - 3 years , slaughtered at Baghdad abatteir, were examined during 6 months period. Histological and bacteriological examinations were done when gross lesions were observed. The results revealed that epidedimytis was observed in 21 (3%) of the examined animals ; 16 (2.3%) cases were unilaterally affected and S (0.7%) cases were bilaterally affected.&#x0D; Bacteriological isolations from infected organs included :&#x0D; Corynebacterium ovis (6 isolates) and Actinomyces pyogenes (3 isolates) both constituted the majonty of isolates ; as well as E. coli (4 iso-lates), and Pseudomonas aeruginosa , Staphylococcus epidermidis, Cory. bovis., Staph. aureus, Cory , ulcerams &amp;. Yersinia pseuclotuberculosis ( 2 isolates of each ) and Campylobacter fetus (1 isolate).&#x0D; Histopathological examination showed 6 pathological patterns of epididmytis including acute epididymitis (14.2% of infected cases ) , subacute nomsuppurative epididymilis (9.5% od cases ) , chronic suppurative epididymitisd (28.5% of cases ), chronic non—suppurative epididymitis (19% of cases) and spermatic granuloma (14.2% of cases ).

Super-selective prostatic arteries embolization in patients with benign prostate hyperplasia: prevention and treatment of complications

Introduction. Super-selective prostatic arteries embolization (PAE) is a modern minimally invasive surgical method for the treatment of benign prostatic hyperplasia (BPH). PAE is included in the Russian clinical guidelines for the BPH treatment and approved for use in the United States and European countries.Purpose of the study. To analyze the most common PAE-associated complications and to develop preventive arrangements.Materials and methods. During the period from 2013 to 2020, PAE as the main method of BPH treatment was used in 168 patients with an average age of 69.3 ± 8.1 (53-82) years. All patients underwent two-day antibiotic prophylaxis before the operation and lasted 7-10 days. For catheterization of the prostatic arteries, 2.0-2.8 Fr microcatheters and 4-5 Fr microconductors were used. For embolization, hydrogel microspheres with a diameter of 100-300 µm and 300-500 µm were used, as well as poly polyvinyl alcohol (PVA) microparticles with a diameter of 100-500 µm.Results. Bilateral PAE was successfully performed in 146 cases; unilateral PAE was performed in 22 patients due to anatomical features. Seventeen (10.1%) PAE from the orifice, super-selective PAE was performed in 67 (39.9%) cases, the PErFecTED embolization was performed in 84 (50.0%) patients. The most common complication was acute urinary retention (AUR) in 28 (16.6%) patients: trocar cystostomy was required in 11 (6.5%) patients, AUR was resolved using conservative therapy in 17 (10.2%) patients. In 23 (14.2%) cases, complications associated with unintentional embolization of the anastomoses of the prostate arteries were identified: rectal pain and/or the appearance of blood in the stool in 19 (11.3%) patients, the appearance of trophic ulcers on the glans penis in 5 (2.8%) patients. In addition, several adverse events that were not complications were noted: postembolization syndrome in 50 (29.7%) patients, and worsening of LUTS in 41 (24.4%) patients. Seven (4.1%) patients had acute epididymitis; 4 (2.4%) patients had a hematoma at the puncture site.Conclusion. PAE can cause a limited number of complications. It is necessary to unify the system for reporting PAE complications. Antibiotic prophylaxis is recommended. The use of visualization and X-ray navigation methods make it possible to make the PAE safer. The PErFecTED technique in combination with small particle sizes increases the risk of complications. The surgeon's experience and proficiency in special surgical techniques are essential. The transradial approach is promising, but further observation and an increase in patient samples are required. The question of choosing the optimal embolization drug continues to be relevant.

A Cautionary Tale of an Unfortunate Testis: Testicular Infarction and Rupture as a Rare Complication of Acute Epididymitis

Abstract Epididymo orchitis is a common cause of unilateral scrotal pain. Infection is caused by retrograde ascent of pathogens to the epididymitis and extension to the testis. This condition typically follows an indolent course and responds well to a course of culture directed antibiotics along with analgesiaand scrotal support. Albeit rare, more severe complications such as abscess formation, testicular infarction, and testicular loss are still possible despite receiving appropriate extended antibiotic therapy. A high index of suspicion of these complications should be maintained in any presentation of acute scrotum, as early recognition could allow for salvage of the testis. We hereby present a rare case of acute epididymo-orchitis progressing to testicular infarction and rupture in a 50 year old male.

Coronavirus Infection of the Urinary Bladder and Lower Urinary Tract: A Review and Update

COVID-19 infection does affect males and females. Even though the commonest manifestations of COVID-19 infection tend to be related to symptoms associated with the respiratory tract, many other organs of the body also tend to be affected and COVID-19 infection of these other organs could manifest contemporaneously with symptoms of the respiratory tract system in addition to symptoms of the affected organs. At times COVID-19 may initially manifest solely related to non-respiratory tract organs and because the symptoms are non-specific without a high index of suspicion, the diagnosis of COVID-19 infection may be missed initially or there may be delay in the diagnosis which would tend to lead to spreading of the disease. Some of the manifestations of COVID-19 infection of the urinary bladder may include: Lower urinary tract symptoms of urinary frequency, and or urinary urgency, and or nocturia, and or urinary incontinence, or on rare occasions non-visible or visible haematuria, or acute retention of urine. The aforementioned symptoms may occur as De novo (new-onset) symptoms alone or they may be associated with or without fever, with or without respiratory tract symptoms. Some individuals who already have lower urinary tract symptoms could experience worsening of their previous lower urinary tract symptoms and if the clinician does not have a high index of suspicion for the possible development of COVID-19 infection, and the clinician does blame the symptoms on benign prostatic hyperplasia then the diagnosis could be missed or delayed. If the COVID-19 cystitis is associated with COVID-19 infection of the male genital tract then some of the patients could experience scrotal discomfort, swelling of the scrotum, erythema of the scrotum, or low-flow priapism or clinical and radiology imaging features of acute orchitis, or acute epididymitis, or acute epididymo-orchitis. However, if the lower urinary tract symptoms are associated with respiratory tract symptoms all clinicians globally are aware of the fact that a high index of suspicion for COVID-19 infection should be exercised. What is important is that every clinician and every individual should be made aware of the fact that the development of De novo lower urinary tract symptoms or sudden onset of worsening lower urinary tract symptoms should be regarded as possibly due to COVID-19 infection and appropriate tests should be undertaken to confirm or negate the diagnosis of COVID-19 infection quickly. Diagnosis of COVID-19 infection of the urinary bladder can be confirmed the undertaking of various COVID-19 infection tests but COVID-19 PCR test has tended to be a common test that most people use globally.

C-Type Natriuretic Peptide Plays an Anti-Inflammatory Role in Rat Epididymitis Induced by UPEC.

Human epididymitis is mainly caused by retrograde urinary tract infection with uropathogenic Escherichia coli (UPEC). This disease is an important factor (accounting for 20–30%) causing male infertility. C-type natriuretic peptide (CNP), a protein composed of 22 amino acids, is proved to play an immunoregulatory role in respiratory and cardiovascular systems. CNP is expressed extremely high in the epididymis, but whether CNP plays the same role in acute epididymitis is unclear. At first, we established an acute caput epididymitis model in rats with UPEC and treated them with CNP to measure inflammatory damage. Then RNA-seq transcriptome technology was used to reveal potential signal pathways. Secondly, the turbidity and activity of UPEC were assessed using a microplate reader and the amount of UPEC by agar plates after incubation with CNP. Thirdly, macrophages in caput epididymis were tested by immunohistochemistry (IHC). Meanwhile, lipopolysaccharide (LPS) with or without CNP was used to stimulate the macrophage (RAW264.7) in vitro and to detect the expression level of pro-inflammatory factors. Finally, the macrophage (RAW264.7) was treated with CNP, 8-Br-cGMP [cyclic guanosinc monophosphate (cGMP) analog] and KT5823 [protein kinase G (PKG) inhibitor], and the expression level of nuclear factor-k-gene binding (NF-kB) signal pathway was examined. The results showed that the damage of epididymis induced by UPEC as well as the pro-inflammatory factors could be alleviated significantly with CNP treatment. CNP could inhibit the activity and numbers of bacteria in both in vivo and in vitro experiments. Moreover, CNP repressed the invasion, and the expression of pro-inflammatory factors (such as NF-kB, IL-1β, IL-6, TNF-α) in macrophages and its effect could be inhibited by KT5823. Therefore, we drew a conclusion from the above experiments that CNP alleviates the acute epididymitis injury induced by UPEC. On one hand, CNP could inhibit the growth of UPEC. On the other hand, CNP could decrease invasion and inflammatory reaction of macrophages; the mechanism was involved in inhibiting NF-kB signal pathway through the cGMP/PKG in macrophages. This research would open up the possibility of using CNP as a potential treatment for epididymitis.

SARS-CoV-2 infection affects the lower urinary tract and male genital system: A systematic review.

PubMed, Scopus, and ISI Web of Knowledge databases were searched to identify studies published up to December 2020 on the involvement of urinary and male genital systems in COVID‐19. Sixteen studies involving a total of 575 patients (538 males and 37 females) were included in this systematic review. The COVID‐19 phase was available for 479 patients: 426 in the acute and 53 in the recovery phase. De novo lower urinary tract symptoms (LUTS) were observed in 43 patients and deterioration of pre‐existing LUTS in 7. Bladder hemorrhage was observed in three patients and acute urinary retention in one. Regarding the male genital system, scrotal discomfort was observed in 8 patients, swelling in 14, pain in 16, and erythema in 1; low flow priapism was observed in 2 patients. Ultrasound examination identified acute orchitis in 10 patients, acute epididymitis in 7, and acute epididymo‐orchitis in 16. A case–control study reported that patients with moderate COVID‐19 show a significant reduction in sperm concertation, the total number of sperms per ejaculate, progressive motility, and complete motility. In contrast to what is known from the first studies on the subject, this review also includes subsequent studies that give evidence of the involvement of the lower urinary tract and male genital system in COVID‐19.

Epididymitis and its aetiologies in a central London sexual health clinic

Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.

Catheter Management and Risk Stratification of Patients With in Inpatient Treatment Due to Acute Epididymitis.

Objective: This study aims to evaluate catheter management in acute epididymitis (AE) patients requiring inpatient treatment and risk factors predicting severity of disease.Material and Methods: Patients with diagnosed AE and inpatient treatment between 2004 and 2019 at the University Hospital Frankfurt were analyzed. A risk score, rating severity of AE, including residual urine > 100 ml, fever > 38.0°C, C-reactive protein (CRP) > 5 mg/dl, and white blood count (WBC) > 10/nl was introduced.Results: Of 334 patients, 107 (32%) received a catheter (transurethral (TC): n = 53, 16%, suprapubic (SPC): n = 54, 16%). Catheter patients were older, exhibited more comorbidities, and had higher CRP and WBC compared with the non-catheter group (NC). Median length of stay (LOS) was longer in the catheter group (7 vs. 6 days, p < 0.001), whereas necessity of abscess surgery and recurrent epididymitis did not differ. No differences in those parameters were recorded between TC and SPC. According to our established risk score, 147 (44%) patients exhibited 0–1 (low-risk) and 187 (56%) 2–4 risk factors (high-risk). In the high-risk group, patients received a catheter significantly more often than with low-risk (TC: 22 vs. 9%; SPC: 19 vs. 12%, both p ≤ 0.01). Catheter or high-risk patients exhibited positive urine cultures more frequently than NC or low-risk patients. LOS was comparable between high-risk patients with catheter and low-risk NC patients.Conclusion: Patients with AE who received a catheter at admission were older, multimorbid, and exhibited more severe symptoms of disease compared with the NC patients. A protective effect of catheters might be attributable to patients with adverse risk constellations or high burden of comorbidities. The introduced risk score indicates a possibility for risk stratification.

Ultrasound Imaging Findings of Acute Testicular Infection in Patients With Coronavirus Disease 2019: A Single-Center-Based Study in Wuhan, China.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in Wuhan, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation. We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups. A total of 142 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the nonsevere COVID-19 group (P = .037). This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.

Persistent Epididymitis Due to Bacteroides fragilis After Biopsy of the Prostate

To the Editor: Infectious and noninfectious etiologies account for epididymitis. In older men, bacteriuria caused by prostatic hypertrophy, urethral instrumentation, and urologic surgery including prostatic biopsy can all lead to infection of the epididymis.1 Enterobactereciae, like Escherichia coli and other coliforms, are the most common pathogens implicated in infectious epididymitis in men older than 35 years.2 Appropriate antibiotic therapy must empirically provide coverage of these organisms. The Centers for Disease Control and Prevention (CDC) guidelines consider fluroquinolones as the first-line agents.3 Obligate anaerobic microorganisms are not commonly reported as potential pathogens for epididymitis. We report the first case of acute epididymitis due to Bacteroides fragilis that did not respond to standard care of therapy and ultimately required surgical scrotal exploration and orchiectomy. A 72-year-old man presented to our institution complaining of progressively worsening swelling and pain of the left scrotum of 3-week duration. This started shortly after a transrectal ultrasound-guided biopsy of the prostate gland 1 month before our evaluation. Sulfamethoxazole/trimethoprim was prescribed postoperatively as prophylaxis. The patient had a history significant for chronic lymphocytic leukemia on ibrutinib, which was held because of concerns of active infection. The prostatic biopsy revealed prostatic adenocarcinoma with a Gleason score of 3 + 3 = 6. The patient had completed a two 10-day course of antibiotics, levofloxacin, and sulfamethoxazole/trimethoprim, respectively, with minimal relief. The prostatic specific antibody was 6.31 ng/mL before the biopsy. The white blood cell count was 12,000 cells/mm3, and creatinine 1.2 mg/dL. The urinalysis showed negative leukocyte esterase and urine culture showed less than 1000 CFU/mL. A scrotal ultrasound (Fig. 1) demonstrated marked left acute epididymitis with phlegmon in the tail of the epididymis and thickening of the left anterior scrotal wall. A trial of ertapenem was started. Because of persistent and increasing pain and swelling, the patient underwent an orchiectomy. Histological examination revealed evidence of acute and chronic epididymitis (Fig. 2). Tissue culture grew moderate Bacteroides fragilis. Speciation was confirmed by matrix-assisted laser desorption time-of-flight mass spectrometry. The minimum inhibitory concentration for metronidazole was 8 mg/L or less. The patient completed a short postoperative course of cefpodoxime with metronidazole without any postsurgical complications.FIGURE 1: Ultrasound demonstrating acute epididymitis (asterisk).FIGURE 2: A, Epididymis hematoxylin and eosin stain, magnification ×40. B, Hematoxylin and eosin stain, acute and chronic inflammation of the epididymis at ×200 magnification.Prostatic biopsies can rarely lead to chronic prostatitis and epididymitis (1%).4 Infections due to anaerobic bacteria of the genitourinary tract have been described, like periurethral abscess, prostatic abscess, urethritis, cystitis, but not of the epididymis.5 Szoke et al6 in their cohort of 50 patients with chronic prostatitis reported 93 anaerobes cultured from expressed prostatic secretions, with 13 isolates being Bacteroides urealyticus and Bacteroides species. In their review, the isolation of these bacteria was likely the etiology of therapy-resistant chronic bacterial prostatitis.6 We theorize that the transrectal prostatic biopsy likely introduced B. fragilis—which colonizes the gastrointestinal tract including the rectum and is often isolated from rectal abscesses—to the procedure site, which then spread to the epididymis. The patient was treated for epididymitis with appropriate empiric antibiotic therapies without clinical response. In these rare cases of therapy-resistant epididymitis, anaerobic bacteria should be considered as possible etiology. Collection of semen specimen or epididymal aspiration—in consultation with a urologist—can be considered for both aerobic/anaerobic cultures.7,8 Empiric anaerobic antibiotic coverage should also be considered in cases of epididymitis after transrectal prostatic biopsies. Maymonah Belal, MD Stony Brook Medical Center Stony Brook, NY,Monica Mcgee, MS, MT Department of Microbiology Veterans Affairs Medical Center Northport NYZeena Lobo, MD Division of Infectious Diseases Veterans Affairs Medical Center Northport, NYGeorge Psevdos, MD Division of Infectious Diseases Veterans Affairs Medical Center Northport, NY Stony Brook University School of Medicine Stony Brook, NY [email protected]

Cohort study of high-intensity focused ultrasound in the treatment of localised prostate cancer treatment: Medium-term results from a single centre.

We report medium-term results in men receiving primary whole-gland HIFU (WG-HIFU) and following salvage treatment. One hundred and twenty-eight patients in a single hospital were enrolled. The enrolled patients were treated with WG-HIFU for primary localized prostate cancer. Salvage treatment include androgen deprivation therapy, secondary HIFU and salvage radiation therapy. Our primary outcomes were biochemical recurrence-free survival, salvage treatment-free survival, and metastasis-free survival. Secondary outcomes included urinary incontinence, de novo erectile dysfunction, acute epididymitis, bladder neck contracture, and urethral stricture. The 5-year biochemical recurrence-free survival rates were 85.7%, 82.7%, and 45.2% for D'Amico low-, intermediate-, and high-risk groups, respectively. Multivariate analysis revealed high risk group is the only predictor of significant shorter biochemical recurrence free survival, salvage treatment free survival, and metastasis free survival. Of 38 patients receiving salvage treatment after biochemical recurrence, 29 (76.3%) became free from biochemical recurrence. Rates of the adverse events of urinary incontinence, acute epididymitis, bladder neck contracture or urethral stricture, and de novo erectile dysfunction were 2.3%, 10.9%, 20.3%, 65.6%, respectively. In conclusion, WG-HIFU is an effective treatment option for localised prostate cancer, especially in D'Amico low- and intermediate-risk cases. The success rate of salvage treatment with radiation therapy and secondary HIFU for biochemical recurrence was acceptable. Fewer adverse events were caused by HIFU, especially incontinence and erectile dysfunction, than by radical prostatectomy and radiotherapy.

Increase of leucocyte-derived extracellular traps (ETs) in semen samples from human acute epididymitis patients-a pilot study.

To study the effector mechanism against pathogens of polymorphonuclear neutrophils (PMN) and macrophages, called ETosis, involving the release of extracellular traps (ETs) in patients with acute epididymitis. To assess the different ET phenotypes present in semen samples and to identify correlations between ETosis and clinical parameters. Samples from patients diagnosed with acute epididymitis were examined and compared with samples from uninfected controls. Biochemical analyses of seminal fluid included determination of peroxidase, α-glucosidase, fructose, and elastase levels. ETosis in semen was determined through presence of citrullinated histones, global histones, and extracellular DNA. Different ETosis phenotypes such as spread ETs, aggregated ETs, and diffuse ETs were identified by co-localisation of extruded DNA with myeloperoxidase and global histones. Anti-CD15+ and anti-CD68+ antibodies were used to identify different cell lines. Revealed a high number of ETs compared with the control group. The mean number of CD15+PMN and CD68+ macrophages was higher in the acute epididymitis group. ETosis increase in ejaculates correlated with clinical parameters such as enhancement of elastase concentrations and diminution of fructose in the semen. This work shows for the first time the presence of ETs and their components in semen from patients with acute epididymitis. The presence of infections is an important factor for induction of ETs in semen. Furthermore, the presence of ETosis in ejaculates is suggestive of developing infectious processes and might possibly have a diagnostic value.

634 - Prediction of bacterial etiology in pediatric patients with acute epididymitis: A comparison of C-reactive protein and urinalysis in diagnostic accuracy

634 - Prediction of bacterial etiology in pediatric patients with acute epididymitis: A comparison of C-reactive protein and urinalysis in diagnostic accuracy

Варианты осложнений при синдроме острой мошонки у детей

To establish causes of complications and repeated surgical procedures in patients with acute scrotal pathology during the short- and long-term follow-up. The treatment results of 3315 patients aged 0 to 18 years with various forms of acute scrotal pathology were analyzed. A total of 43 complications were documented, 32 of them required surgical intervention. The most common complication is testicular necrosis due to incorrect judgement of viability after torsion with performing an organ-preserving procedure, which is dictated by the surgeons desire to preserve a testicle. Such a decision is made without objective data and in all cases leads to repeated procedure due to testicular necrosis. Inappropriate surgical hemostasis is often associated with improper surgical technique and underestimation of inflammatory tissue changes. Purulent complications are the most common in acute epididymitis and are caused by the presence of an inflammatory focus in the scrotum. Wide revision of the scrotum in case of testicular appendages pathology is not justified, since the second appendage is rarely found, while the invasiveness of the procedure increases. Complications were more common in the early postoperative period (88.4%). Purulent complications are directly dependent on the duration of the disease and are exacerbated by the secondary inflammatory process. Most of complications are treatable; performing of preventive measures helps to avoid them.

In silico vaccine design against Chlamydia trachomatis infection.

Chlamydia trachomatis, a gram-negative bacterium known to infect the genital sites mainly columnar epithelial cells of the cervix, urethra and rectum in women and causes acute epididymitis, urinary tract inflammation and DNA damage to the sperms in men, hence considered to be one of the major sexually transmitted infections. The infection is asymptomatic in many people and remains untreated leading to serious health complications, including pelvic inflammatory disease, ectopic pregnancy and infertility. The current treatment options include antibiotics, but the pathogen has gained resistance against many antibiotics. The present work involves an in silico reverse vaccinology approach for identifying the immunogens as vaccine candidates that can be effective against reinfections and should be capable of inducing long-term protective immunity against Chlamydial infections. This study identifies the putative vaccine candidates that are membrane bound with high antigenicity properties; antigenicity induces the immunogenicity which involves identification of T-cell and B-cell epitopes that induce both humoral and cell-mediated immunity. The epitopes ‘LSWEMELAY’, ‘LSNTEGYRY’, ‘TSDLGQMEY’, ‘FIDLLQAIY’ and ‘FSNNFSDIY’ were predicted as core sequences for class I MHC molecules. The identified epitopes showed promising ability to interact with the human leukocyte antigens (HLA). These epitopes showed maximum population coverage with epitope conservancy above 80%. Molecular docking was performed to test the binding affinities of the identified epitopes with the HLA molecule to study the binding cleft interactions. The vaccine candidate thus identified from this study showed to possess the potential to activate the B- and T-cell immune responses which are more specific and make the body stronger against infections and effective for reinfections.Electronic supplementary materialThe online version of this article (10.1007/s13721-020-00243-w) contains supplementary material, which is available to authorized users.

Can Transurethral Resection of the Prostate (TURP) Be Another Gateway to the Focal Therapy of Localized Prostate Cancer?

Background and Objectives Minimally invasive methods are expected to avoid the risk of overtreatment and overtreatment of radical therapy to manage the increased number of patients with low-volume, low-grade localized prostate cancer. Based on our experience of radical transurethral resection of prostate cancer (TURPCa) as a radical treatment, we studied the efficacy and safety of focal TURPCa as a focal therapy for patients with localized prostate cancer. Materials and Methods We performed focal TURPCa in 49 patients during the period from July 2007 to August 2016 and followed them with prostate-specific antigen (PSA) testing for the mean period of 68.0 months. We selected the patient as a candidate for the study if the biopsy revealed that cancer foci were limited in one lobe, or the foci were several or less even found in both lobes. Standard TURP was followed by further resection and fulguration of the peripheral zone where cancer was considered to exist. We selected one of our three methods of focal TURPCa as follows: one lobe radical TURPCa, radical resection of the affected lobe with unaffected lobe being resected less vigorously; nerve-sparing radical TURPCa, radical resection of both lobes except for the posterolateral part of the prostate; target radical TURPCa, radical resection of the cancer focus and the surrounding prostate when the target is suggested single. Results Twelve patients were in the low-risk group (D’Amico), 29 in the intermediate-risk group, and 8 in the high-risk group. Pathological stages were as follows: pT0, three cases; pT2a-b, 17 cases; pT2c, 29 cases. The preoperative PSA of 6.15±2.73 ng/mL (mean±SD) dropped to 0.172±0.283 ng/mL postoperatively. PSA failure occurred in only two patients (4.1%). Incontinence did not develop and erectile function was preserved in eight (44.4%) of the 18 potent patients. The most frequent complication was bladder neck contracture (20.4%). Other complications included acute epididymitis (8.1%), bladder tamponade (2.0%). No patients died of prostate cancer. Conclusions Though the final assessment of efficacy will require long-term follow-up results with more cases, we may think focal TURPCa can be another treatment option as a focal therapy for localized prostate cancer.

S100A4 promotes the progression of lipopolysaccharide-induced acute epididymitis in mice†.

S100A4 has been suggested to be a critical regulator of tumor metastasis and is implicated in the progression of inflammation. The aim of this study is to investigate the expression and possible role of S100A4 in epididymitis. Using a mouse model of epididymitis induced by the injection of lipopolysaccharide (LPS) in the deferent duct, we found that LPS administration induced an upregulation of S100a4 transcription (P<0.05) and a recruitment of S100A4 positive cells in the epididymal interstitium of wild type (WT) mice. Co-immunofluorescence showed that S100A4 was mainly expressed by granulocytes, CD4 lymphocytes, and macrophages. Deficiency of S100A4 reduced epididymal pathological reaction and the mRNA levels of the pro-inflammatory cytokines IL-1β and TNF-α (P<0.01), suggesting that S100A4 promotes the progression of epididymitis. Furthermore, S100A4 deficiency alleviated the decline of sperm motility and rectified the abnormal expression of sperm membrane protein AMAD3, which suggested that in the progression of epididymitis, S100A4 aggravates the damage to sperm vitality. In addition, both Ki-67 marked cell proliferation and transferase-mediated dUTP-biotin nick end labeling detected cell apoptosis were reduced in S100a4-/- mice compared with WT mice after LPS treatment, indicating that S100A4 promotes both cell proliferation and cell apoptosis in epididymitis. Overall, these results demonstrate that S100A4 promotes the progression of LPS-induced epididymitis and facilitates a decline in sperm vitality, and its function may be related to the process of cell proliferation and apoptosis during inflammation.