Acute Epididymo-orchitis Research Articles

Immunodeviation towards T cell-mediated immune response in the testes of LPS-induced mouse epididymo-orchitis

The testicular consequences of acute epididymo-orchitis remain largely unelucidated in long-term damage, which might be a neglected factor for male infertility. In this study, the differential phenotype of testicular immune cell subpopulations in lipopolysaccharide (LPS)-induced mouse epididymo-orchitis were analyzed by flow cytometry on day 1, day 7, and day 28. The number of macrophages, neutrophils, and myeloid-derived suppressor cells (MDSCs) steadily decreased in the testes with inoculation. Total F4/80-CD11c+ dendritic cells (DCs) maintained a relatively stable level, whereas conventional type 1 dendritic cells (cDC1) increased gradually from day 1 to day 28. There was a lower number of CD4+ and CD8+ T cells at day 1 and day 7, and they had similar results with a ceiling level at day 28. The testes displayed a higher level of CD3+ T cells but a lower frequency of macrophages, cDC2, and neutrophils at 28 days post-inoculation compared with the epididymis. In summary, our data indicates acute epididymo-orchitis could lead to long-term damage in the testes, which is characterized by CD3+ T cell (including CD4+ and CD8+ T cells)-mediated immune responses.

Presence of SARS-CoV-2 RNA in Semen and Reproductive Function of Asymptomatic and Mildly Symptomatic Male Patients with a High Viral Load

Background: The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on male fertility is a complex and evolving area of research. Although there is some evidence to suggest that the virus might have negative effects on semen from mild to moderate symptoms or recovery of coronavirus disease 2019 (COVID-19) and might induce epididymal-orchitis, further research is needed to definitively determine the risks. Objectives: This study aimed to investigate the presence of SARS-CoV-2 ribonucleic acid (RNA) in semen and to determine any possible implications of SARS-CoV-2 infection on semen parameters and genital tract complications. Methods: Thirty-two subjects with a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) cycle threshold (Ct) value of less than 20 were recruited, and semen samples were collected. Additionally, testicular discomfort and urogenital abnormality were assessed. Results: No SARS-CoV-2 RNA was detected in the seminal sample of men; however, semen quality impairment was detected, especially in patients with Ct values less than 15 in the upper respiratory tract. Total sperm count, the number of motile spermatozoa, progressive motility, and the percentage of normal morphology were significantly reduced. Acute epididymo-orchitis and testicular tenderness were observed in 4 patients in the acute stage of the disease. Conclusions: This study showed no evidence of SARS-CoV-2 RNA in semen, suggesting that sexual transmission of the virus is unlikely. However, semen quality impairment was observed in patients with SARS-CoV-2 infection, particularly those with higher viral loads. Further research is needed to elucidate the mechanisms by which SARS-CoV-2 affects male fertility and develop effective interventions to protect men's reproductive health during the pandemic.

1057 Fournier’s Gangrene Caused by Porphyromonas Asaccharolytica; a New Bug in the Block?

Abstract Introduction Fournier’s gangrene (FG) is a urological emergency characterised by a destructive inflammation of the genital and perineal area typically forming necrotising fasciitis that affects the external genitalia and the perineum resulting in the gangrene of infected tissues as well as generalised systemic deterioration in its severest form. Although FG is typically polymicrobial, we found it can very rarely be mono-microbial and caused by Porphyromonas asaccharolytica, an obligate anaerobic gram-negative rod. Case presentation We present a case of a 44-year-old man seen in the emergency department with bilateral scrotal swelling, redness, and pain. A diagnosis of acute epididymo-orchitis (on a background of chronic severe phimosis) was made. Ultrasound imaging of the testes was consistent with features suggestive of epididymo-orchitis and reactive hydrocoele. The patient also tested positive for the SARS-Cov-2 virus but had no respiratory symptoms. Empirical treatment, as per Trust antimicrobial policy, was initiated with intravenous Flucloxacillin which was changed, following the results of blood culture growth of Porphyromonas asaccharolytica, to Meropenem, Vancomycin and Clindamycin. On day 3 of admission, an ulcer was noticed at the base of the scrotum which progressed rapidly into a fulminant Fournier's gangrene. He was treated radically with urgent debridement and direct closure of the wounds and was discharged after 2 weeks on admission. Conclusions We report a case of Fournier’s gangrene caused by a rare gram-negative organism in an asymptomatic unvaccinated COVID-19 patient. Clinicians need to have a high index of suspicion that this organism can also be a cause of Fournier’s gangrene.

Outcome of acute epididymo-orchitis: risk factors for testicular loss

PurposeAcute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups.MethodsA retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period.Results140 patients were identified, the age range was 0–89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0–15-year-olds), sexually active young men (Group 2a, 16–35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b.ConclusionOverall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%).

A CROSS-SECTIONAL STUDY TO ASSESS CLINICO-EPIDEMIOLOGICAL FACTORS, DIAGNOSIS AND MANAGEMENT IN PATIENTS WITH ACUTE SCROTAL CONDITIONS

Background: Many acute scrotal conditions can present in similar way, Testicular torsion is a true surgical emergency because, the likelihood of testicular salvage decreases, as the duration of torsion increases. Other conditions that present in similar way to testicular torsion include, torsion of appendix testis, epididymo - orchitis, blunt trauma to testis, fournier's gangrene, haematocele, pyocele, etc. Aim: Assessment of clinico-epidemiological factors, diagnosis and management in patients with acute scrotal conditions. Methods: This observational, cross-sectional study was conducted on 75 patients which includes all cases of acute scrotal conditions within age group of 5 years to 70 years presenting to surgery OPD or casualty and getting admitted in a tertiary care centre in eastern part of Maharashtra during the period. Results: In our study acute epididymo-orchitis (46.7%) was the commonest cause of acute scrotal pathology followed by Fourneir's gangrene (24%).Incidence of scrotal cellulitis, pyocele, torsion testis, haematocele, were 9.3%,8%,6.7%, 2.7% respectively. One case each of testicular abscess(1.3%) and testicular tumour (1.3%) were also found. Out of 75 cases, 36 cases (48%) were managed conservatively. In Fournier's gangrene, only debridement was done in 8 cases, multiple debridement with secondary suturing was done in 5 cases, multiple debridement followed by skin grafting was done in 5 case. Scrotal exploration and drainage of testicular abscess was done in 1 case. Scrotal exploration with evacuation of hematoma was done in 2 cases of haematocele. Orchidectomy was done in total of 4 cases in which 3 cases have clinical diagnosis of testicular torsion and one case of testicular tumour. Also orchidectomy with contralateral orchidopexy was done in 2 cases of testicular torsion. Conclusion: The most common cause of acute scrotum was epididymo - orchitis which can be managed conservatively. Early exploration can salvage the testis in cases torsion of testis.

Coronavirus Disease Patients with Acute Testicular Infection: Ultrasound Imaging Findings

Introduction: Objectives: 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 SAIMS Indore, 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. Methods: 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. Results: A total of 150 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 non- severe COVID-19 group (P = .037). Conclusions: 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.

Early predictors of Brucella epididymo-orchitis.

Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery. The aim of our study is to identify early predictors of Brucella EO. We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for Brucella based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for Brucella orchitis. A comparison between Brucella-positive and Brucella-negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the Brucella group, 72% of the patients had a history of animal contact compared to 33% in non-Brucella group (P = 0.006). When comparing CBC parameters in the two groups, Brucella group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus Brucella negative group 17.35 ± 5.28, 7.8 ± 10.53, and P values were 0.037 and 0.004, respectively. Brucella group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non-Brucella group 13.22 ± 8.05 and P < 0.01. Brucella orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for Brucella orchitis in endemic areas.

Assessment of scrotal disorders using ultrasonography and Color Doppler Imaging

Background and Aim: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Ultrasound is an ideal imaging modality for the evaluation of scrotum in pediatric patients. Scrotal ultrasound can differentiate between solid and cystic masses and localize the mass as either testicular or Para testicular. The present study was aimed to know role of ultrasound and color Doppler imaging in the diagnosis of scrotal disorders. Material and Methods: It was prospective study conducted at Tertiary care teaching Hospital. We observed total 200 patients referred to the department of Radiodiagnosis for scrotal ultrasonography and Doppler study by the department of Surgery. Clinical history was obtained along with thorough physical examination before subjecting the patients for ultrasound examination. The Grey scale & color Doppler ultrasound routinely performed in all these patients. Results: Majority of cases had inflammatory lesion (32%) followed by hydrocele (28%), hernia (9%), undescended testis (8%) and scrotal tumors (3%). In majority of cases left side involved (36%) followed by right side (32%) while 64 cases bilateral side involved. With color doppler appearance of inflammatory scrotal pathology we found that there were 19 cases of acute epididymo orchitis, 10 cases with diffuse increase in vascularity. Among 5 cases of chronic epididymo-orchitis, 4 cases showed increase in vascularity. Conclusion: High-frequency ultrasonography enables in clear demonstration of morphological alterations associated with acute scrotal inflammatory diseases, and color Doppler sonography is highly sensitive in diagnosing acute scrotal pathology. In addition, Color Doppler sonography accurately differentiates between testicular ischemia and torsion from acute inflammatory diseases in acute painful scrotal conditions.

Ameliorating effect of gold nanoparticles decorated on biodegradable apple pectin modified magnetic nanoparticles on epididymo-orchitis inducing alterations in sperm quality and spermatogenic cells apoptosis

• Fe 3 O 4 @AP-Au NPs reduced spermatogenic cells apoptotic indexes and prostate weight gain. • Fe 3 O 4 @AP-Au NPs improved the sperm percentage with total motility, normal morphology, and progressive motility and Johnsen’s and Miller’s criteria. • The particles are almost homo-morphic and are sized between 30-50 nm. In the current years, conjugated bio-nanomaterials involving magnetic core are interested as promising platform in modern generation biological composites for the treatment of several types of inflammations such as epididymo-orchitis. In this regard, we described a novel Au NPs supported apple pectin (AP) modified magnetic Fe 3 O 4 nanoparticles as a novel nano-biocomposite (Fe 3 O 4 @AP-Au NPs). The post-synthetically modified biogenic material was analyzed in details over a number of physicochemical methods like, Fourier transformed infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), elemental mapping, X-ray diffraction (XRD) and inductively coupled plasma-optical emission spectroscopy (ICP-OES). In the in vivo part, we divided 80 Wistar rats into five following groups (n=16 per group): a. Control-intact group, b. Vehicle group, c. Fe 3 O 4 @AP-Au NPs group, d. epididymo-orchitis group, and e. epididymo-orchitis/ Fe 3 O 4 @AP-Au NPs group. We assessed relative sex organs weight, body weight, germ cell apoptosis, Johnson’s criteria, sperm parameters, and germ cell layers number. Acute epididymo-orchitis raised the prostate relative weight and seminal vesicles and apoptotic indexes of spermatogenic cells, also decreased the quality of sperm such as sperm concentration, normal sperm percentage, and total motility and Johnsen’s and Miller’s scores. Fe 3 O 4 @AP-Au NPs group reduced spermatogenic cells apoptotic indexes and prostate weight gain and improved the sperm percentage with total motility, normal morphology, and progressive motility and Johnsen’s and Miller’s criteria.

Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data.

BackgroundDuring the Coronavirus Disease 2019 (COVID‐19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID‐19 infection and scrotal infection are associated.Materials and methodsPatients with a COVID‐19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data.ResultsThe median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo‐orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group.ConclusionsEven if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID‐19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.

Right Testicular Pain and Epididymo-Orchitis Caused by Enterobius Vermicularis

A rare case of epididymo-orchitis due to nematode infection by Enterobius vermicularis is reported. A 38-year-old male presented with right testicular pain. He was diagnosed with acute right epididymo-orchitis. Right epididymo-orchiectomy was performed. Microscopic examination showed parts of the body of the oxyurid in one section, thus confirming the diagnosis of pinworm infection. Although ectopic pinworm infections are broadly reported, testicular involvement is very rare. To our knowledge, this is the third reported case in the literature.

Community Associated Methicillin-Resistant Staphylococcus Aureus Causing Acute Urinary Tract Infection and Epididymo-Orchitis: A Case Report

Acute epididymitis is most commonly infectious in etiology, usually secondary to a urinary tract infection (UTI) or a sexually transmitted infections (like gonorrhea and chlamydia). Enteric gram-negative bacteria (like Escherichia coli) and coagulase-negative Staphylococcus saprophyticus are the most frequently encountered organisms associated with UTIs. Staphylococcus aureus, especially methicillin-resistant Staphylococcus aureus (MRSA), is an uncommon pathogen when considering community associated acute UTI and acute epididymitis. We present an unusual case of a 28-years-old immunocompetent male, who presented with a left scrotal swelling and was found to have acute epididymo-orchitis due to an acute MRSA UTI.

Evaluation of Epididymo-Orchtis-A Study of 100 Cases

Background: Acute epididymo-orchitis is a common clinical problem in urological practice. It is not an uncommon disease in our country to cause work loss particularly in active group of people. Aim of the study: The aim of this study was to see the predisposing factors involved, aetiopathology and progression of disease process.Methods:This prospective study was conducted in department of surgery, Kumudini Women’s Medical College Hospital, Tangail from April 2008 to March 2009. Hundred patients of inflammation of epididymis and testis were included in this study.Results:Out of 100 patients, majority (48%) were in monogamous relationship. All patients (100%) had scrotal pain, 22% had scrotal swelling, 59% had fever, 32% had dysuria and 11% had urethral discharge. All patients presented with tenderness of the testis and epididymis and 82% cases had both epididymal and testicular swelling. Thirty two percent cases had urinary tract infection, trauma and promiscuous sexual contact were associated with the disease in 2% and 18% cases, respectively. History of masturbation was noted in 18% cases. By urine routine microscopy 28% had pus cell and 03% had RBC in urine, 16 cases were positive in urine culture, among 15% were E.coll and 01% were found Klebsiela. Forty patients were tested Chlamydial CFT and 16(40%) were found positive, out of 12 Filarial CFT tested 01(8.33 %) was found positive, Gram staining of urethral discharge revealed Neisseria gonorhhoae in 02(18.18%) cases. In maximum cases no actiological factor was found. Majority cases under 35 years were infected with Chlamydia and patients older than 35 years were mostly infected with E.coli.Conclusion:This study reflects that maximum of our study patients report to hospital nearly at right time with relatively better health status and outcome of available treatment facilities are satisfactory.

Rare Manifestations of Acute Scrotum- A Case Report

Acute scrotum is referred to patients presenting with acute pain or swelling in scrotum or its contents. Clinical evaluation and appropriate radiological investigations helps us to pin point the aetiology of acute scrotum. Male genitourinary cases range from 0.5-2.5% of all emergency cases, although very few cases report the incidence of acute scrotum. Purpose of this case report is to highlight two very rarely reported events presented as scrotal pain and testicular swelling in a 39-year-old male and a 31-year-old- male patient. After radiological examination a diagnosis of acute scrotum was made. Commonly causation is attributed to either acute torsion or acute epididymo-orchitis. Routinely, management of acute scrotum include colour doppler scrotum, based on its findings further treatment is decided either surgical exploration or conservative treatment. Early evaluation and timely management is imperative in preserving the viability of gonads.

Acute Epididymo-Orchitis as a Rare Cause of Testicular Infarction

A 59-year-old male presented to his primary care physician with dysuria and was empirically treated for a urinary tract infection with ciprofloxacin for 2 weeks. He subsequently developed left testicular pain and was seen in the emergency department (ED) where urine culture grew less than 10,000 colony forming units of gram negative rods. Testicular ultrasound (US) at that time was normal, and he was discharged home with double strength trimethoprim-sulfamethoxazole from the ED. He re-presented to the ED 6 days later with continued left testicular pain and was found to be febrile to 100.4F with otherwise normal laboratory values.

A Rare Presentation of Acute Epididymoorchitis Leading to Infarction of Testes with Catastrophic Outcomes: Case Report and Literature Review

A Rare Presentation of Acute Epididymoorchitis Leading to Infarction of Testes with Catastrophic Outcomes: Case Report and Literature Review

SONOGRAPHIC IMAGING OF ACUTE SCROTAL PAIN

Background: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Clinical /Physical examination adds only a little information. Color Doppler ultrasound is the modality of choice to differentiate testicular torsion from inflammatory conditions.&#x0D; Aim of Study: The aim of this study is to observe the epidemiology of acute scrotum and their presentation, there by facilitating a systematic approach in identifying those patients who need early intervention to decrease associated morbidity and mortality.&#x0D; Conclusion: Acute scrotum is a common case seen in the today's scenario with considerable mortality and morbidity. In our study acute epididymo-orchitis was the commonest cause followed by torsion of testis the primary objective of management of acute scrotum is to avoid testicular loss. Acute scrotal swellings are common in younger &amp; middle age individuals with variable symptoms. These cases need careful examination, proper evaluation and prompt treatment. The likelihood of testicular salvage in torsion depends on the interval between onset of pain and surgical intervention. Routine clinical examination gives only a little information. Doppler ultrasound assessment of patients at intermediate clinical risk of testicular torsion significantly reduced the frequency of negative surgical explorations without increased rate of missed testicular torsions.(1) In the imaging algorithm for testicular torsion in childhood, we differentiate between the two main entities, the peri- and neonatal torsion and torsions in children and infants older than 1 month. Imaging should not cause any delay in diagnosis but contribute to increase the specificity of diagnosis of testicular torsion in order to avoid unnecessary surgical explorations. (2)&#x0D; Keywords: Sonographic Imaging in Acute Scrotal Pain.

1050 An Audit of the Management of Acute Epididymo-orchitis

Abstract Aim To evaluate the management of patients referred to our Surgical Assessment Unit presenting with acute epididymo-orchitis. Concordance with local antibiotic guidance, the use of ultrasound scanning, and microbiological testing were all assessed over a one-year period. Method All adult patients presenting with acute epididymo-orchitis in 2019 were identified retrospectively using ICD-10 codes and the choice of antibiotic used was compared to our own local guidance. The use of ultrasound scanning was recorded and whether this led to a change in diagnosis or management. Use of microbiological investigations including urine microscopy &amp; culture and sexual health screening were assessed. Results After exclusion criteria were applied 64 cases were identified with an average age of 55 (16-88). Concordance with local antibiotic guidance was low with 3/64 patients receiving antibiotics in-line with local guidance. This was predominantly due to the frequent use of Ciprofloxacin (49/64) which is not advised locally, however is in-keeping with guidance from organisations such as EAU/BASHH. Ultrasound was used acutely in 46/64 patients with 28/46 showing evidence of epididymo-orchitis, 15/46 were normal and 1/46 confirmed an abscess which required surgical drainage. All normal scans were still treated with antibiotics based on clinical findings. 25/64 had a urine sample sent for MC&amp;S and uptake of sexual health screening was low. Conclusions Urologists should be aware of differences between local prescribing policy and broader guidance from relevant organisations. Epididymo-orchitis remains a clinical diagnosis and ultrasound should be reserved acutely for diagnostic uncertainty, unwell patients, or failure to improve.

Abstract 20 - Diagnostic evaluation of acute epididymo-orchitis. Are we compliant with European Association of Urology guidelines?

Abstract 20 - Diagnostic evaluation of acute epididymo-orchitis. Are we compliant with European Association of Urology guidelines?

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.