Acute Epididymo-orchitis Research Articles

CLINICOECHOGRAPHIC CHARACTERISTIC OF TESTICLE ABSCESS

Aim. The aim of the study was to investigate the peculiar features of clinicoechographic picture of the testicle abscess. Materials and methods. The work is based on retrospective analysis of 10 testicle abscess cases observed over the period of 2005-2015. Standard clinicolaboratory studies and high resolution ultrasonography were applied. Results. Among acute inflammatory diseases of the testicle and appendage, the incidence of testicle abscess was 1 %. In 4/5 of cases, testicle abscess occurred as a complication of acute epididymoorchitis among patients over fifty with burdened immunodeficient background and different inflammatory urogenital diseases. According to ultrasonography data, testicle abscess at its acute stage was detected in 1 patient, subacute - in 2, chronic - in 7. The testicle abscess sizes were 28,4 (12-65) mm or 2,6 (1,3-5,5) cm3. Abscess occupied one segment of the testicle in 1 patient, two segments - in 5, total purulent melting of the testicle - in 4. By their acoustic signs, testicle abscess did not differ from those of the other localization. In its clinical course, testicle abscess at the acute and subacute stages was manifested as acute inflammatory disease of the testicle or appendage, at the chronic stage - as abscess and scrotal purulent fistula. As a result of clinicolaboratory study, testicle abscess was supposed in 4 patients, as a result of ultrasound study - testicle abscess was diagnosed in all patients. Pathomorphological study performed in 8 patients following orchiectomy indicated verification of testicle abscess in all of them. At the same time, in 1 case abscess was combined with testicle cancer, not revealed during the preoperative examination. Conclusions. Patients with acute inflammatory testicle and appendage diseases burdened by immunodeficient background (age over 50) have an increased risk for the development of testicle abscess and should be taken under a strict dynamic clinicolaboratory and echographic control in the course of mana-gement.

Acute Epididymo-orchitis - is empirical therapy for chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20`s. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 (43%) patients and in only 12 (14%) of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis.

Acute Epididymo-Orchitis: a Rare Cause of Delirium in Demented Patient

AbstractDelirium is a common presentation in elderly with diverse underlying causes. This elderly man presented with disturbed level of conscious level with no apparant precipitating factor. After thorough investigations and with substantial help from the caregiver, acute epididymo-orchitis was revealed as an unusual reason of deliriumn early and a quick identification of dementia is desirable to improve the overall care to the affected persons in the developing countries

Experience of Fournier’s gangrene clinical diagnostics

The article represents clinical cases review of rare and serious disease - Fournier’s gangrene. 3 patients with Fournier’s gangrene aged 53±13 years were followed up in Moscow City Clinical Urological Hospital №47 and City Clinical Hospital №57 in the period from 2005 to 2015. All patients with Fournier’s gangrene were admitted to the hospital with a different referral diagnoses: «acute epididymo-orchitis», «testicular abscess», «scrotal phlegmon». Standard clinical and laboratory tests, abdominal cavity and urogenital system plain radiography and ultrasound examination were performed. For genital organs ultrasound examination a high-resolution linear transducer (6-16 MHz) was used. Ultrasonography in the admission room allowed to exclude acute scrotal diseases in all patients, Fournier’s gangrene was diagnosed in 2 patients, and suspected in 1 patient. In all patients with Fournier’s gangrene ultrasound examination revealed marked thickening of testicular coats (more than 15 mm), the accumulation of a small amount of fluid between the testicular coats and in the tunica vaginalis cavity, testicular coats intense hypervascularization; normal blood flow and the unchanged structure of the testes and epididymis. Scrotal emphysema was detected by ultrasound examination in all patients, by the plain radiography and physical examination - in 2 patients. In all cases, ultrasound helped to clarify the cause of Fournier’s gangrene: to reveal anorectal abscesses, acute prostatovesiculitis and exclude acute epididymo-orchitis, scrotal phlegmon and testicular injury. As an illustration Fournier’s gangrene observation, which occurred as an anorectal abscess complication is presented. Ultrasonography allows to confirm the Fournier’s gangrene presumptive diagnosis (to reveal soft tissue of the penis and scrotum emphysema), make differential diagnosis of Fournier’s gangrene with other external genitalia and perianal area acute diseases, determine treatment strategy.

P12 Management of acute epididymo-orchitis: ad hoc or evidence based?

Background/introduction A clear guideline exists for the management of acute epididymo-orchitis. Both the EAU and our local trust antibiotics guidelines state that patients aged 35 or younger, or those with suspected STI, be prescribed single dose ceftriaxone with a course of doxycycline; while patients over 35 receive ciprofloxacin. All patients should be investigated for an STI. Aim(s)/objectives This study looks at how the guidelines are being implemented in the accident and emergency (A&E) department of a large teaching hospital. Methods We reviewed the A&E notes of patients attending the department with suspected epididymo-orchitis between 1st May and 28th October 2014. 56 patients’ notes were scrutinised for a record of sexual history, investigations performed and final management. Results Of the 56-patient study cohort, 20 were aged ≤35 years (median age 51; range 36–84 years) and 36 >35 years (median age 25; range 20–34 years). A sexual history was documented in 26 (46%) cases, with one patient tested for presence of STI and six (10%) advised to visit the GUM clinic. Antibiotics were prescribed for 55 patients; 28 (50%) received ciprofloxacin (mean age 53.5, range 21–91 years), two (aged 25 and 27 years) doxycycline, 13 (23%) both ciprofloxacin and doxycycline (mean age 36.5, range 20–63 years), and 12 (21%) received different antibiotics (mean age 50.8, range21–83 years). 17 patients (30%) were prescribed antibiotics correctly according to the guideline. Discussion/conclusion Despite a robust and clear guideline on epididymo-orchitis our results show that antibiotic prescribing is often incorrect. Furthermore, the work-up for an STI as a cause of epididymo-orchitis is incomplete.

Values of applying color Doppler ultrasound in the diagnosis of testicular torsion and acute epididymo-orchitis

Objective To analyze and compare the values of applying color Doppler ultrasound in the diagnosis of testicular torsio and acute epididymo-orchitis. Methods 90 males in our hospital were selected and divided into the testicular torsion group and acute epididymo-orchitis group,color Doppler ultrasound was applied in the two groups. Results After examination by color Doppler ultrasound,it showed that there were significant differences in blood supply of testicle,epididymis between the two groups,the diagnostic result was accurate with statistical significance(χ2= 11.408,11.944,P< 0.05). Conclusion It can highlight the images and blood supply features of testicular torsion and acute epididymo-orchitis that applying color Doppler ultrasound,and as an economic,practical,accurate and non-invasive examination,it can diagnose testicular torsion and acute epididymo-orchitis accurately,so it's the preference for testicular torsio and acute epididymo-orchitis. Key words: Ultrasound,doppler,color; Testicular diseases

Autoantibodies against protein disulfide isomerase ER-60 are a diagnostic marker for low-grade testicular inflammation.

Is there a non-invasive biomarker for the diagnosis of testicular inflammatory lesions? In sera from infertile azoospermic patients with histologically confirmed low-grade testicular inflammation, significantly elevated titers of autoantibodies against disulfide isomerase family A, member 3 (ER-60) were found. Infection and inflammation of the genital tract are supposed to be responsible for up to 15% of cases among infertile males. However, specific seminal or serological markers are not available to assess subacute or chronic inflammatory conditions in the testis. This study consisted of the identification of autoantibodies for testicular antigens in sera of patients with low-grade testicular inflammation, validation of candidates, development of an ELISA for the most promising target antigen and measurement of autoantibodies titers in healthy normozoospermic men (n = 20); male blood donors (n = 14); men with impaired semen quality without (n = 14) or with (n = 26) symptoms of genital tract infection/inflammation; azoospermic men with histologically confirmed testicular inflammatory lesions (n = 16); men after pharmacotherapy of genital tract infection/inflammation (n = 15) and men with acute epididymo-orchitis (n = 30). Proteins in lysates of normal testicular tissue were separated by high-resolution 2D gel electrophoresis and probed with sera of 13 patients with histologically confirmed chronic testicular inflammation. There were 14 proteins that immunoreacted with a majority of these sera and could be identified by mass spectrometry. Of these 14 proteins, disulfide isomerase family A, member 3 (ER-60), transferrin and chaperonin containing TCP1 complex, subunit 5 (epsilon) (CCT5) were considered as specific. Since ER-60 reacted with 92% of patient sera, an ER-60-autoantibody ELISA was developed. The newly established ELISA detected significantly elevated titers of autoantibodies against ER-60 in the sera from infertile men with histologically confirmed chronic testicular inflammation (median 8.6; P < 0.01) compared with the control groups. Moreover, elevated levels of anti-ER-60 titers were detected in patients suffering from acute epididymo-orchitis (median 3.3; P < 0.05) as compared with healthy normozoospermic men (median 2.13; P < 0.001), male blood donors with unknown fertility status (median 2.72; P < 0.01), patients with impaired semen quality but no infection/inflammation (median 2.59; P < 0.001) and patients with symptoms of genital tract infections and/or inflammation (median 2.18; P < 0.001). Significantly lower levels of anti-ER-60 antibodies were measured in sera from patients after application of anti-inflammatory pharmacotherapy (median 1.9; P < 0.01) compared with those with histologically confirmed chronic testicular inflammation. The cut-off value of the assay was set to 6.6 U/ml based on a calculated sensitivity of 100% and a specificity of 81.2%. The results obtained in this study showed statistically significant elevated titers of ER-60 antibodies in sera from patients with histologically confirmed testicular inflammatory lesions and from a few patients with acute epididymo-orchitis. However, the number of serum samples tested was limited. Severe testicular damage seen in azoospermic patients could represent a bias towards ER-60 reactivity, while the assay does not allow for different etiologies of the lesions to be distinguished. Due to ethical reasons, the prevalence of testicular inflammatory lesions among controls and non-azoospermic men cannot be studied at the histological level. Measurement of ER-60 autoantibody titers in serum could be a novel non-invasive marker for the diagnosis of asymptomatic testicular inflammation causing male fertility disturbances. This study was supported by a grant of the Deutsche Forschungsgemeinschaft (ME 1323/4-4) and the Translational Science Fund (Wirtschafts-und Strukturbank Hessen-WI Bank). M.F., A.P., W.W., H.-C.S. and A.M. are supported by the LOEWE focus group 'MIBIE' (Male infertility during infection and inflammation). The ER-60 ELISA is protected by a patent to the Justus-Liebig-University of Giessen with A.M. and M.F. as inventors (patent no. DE 10 2008 053 503). T.Z. as employee of the DRG Company was responsible for the ELISA development.

Early diagnosis of testicular torsion in rats by measuring plasma d-dimer levels: comparative study with epididymitis

PurposeTo evaluate the differential diagnosis of testicular torsion and acute epididymo-orchitis by measuring the acute increase in plasma d-dimer levels in an experimental rat model. MethodsThirty male Wistar rats were randomly divided into 5 groups, 1 – sham operated group (acute term; 4hours), 2 – early torsion group (acute term; 4hours), 3 – late torsion group (long-term; 72hours), 4 – control of epididymitis group (vehicle injected; 0.1ml physiologic saline injected into the left ductus deferens) (long term; 72hours), 5 – epididymitis group (0.1ml Escherichia coli injected into the left ductus deferens), (n=6 for each group). ResultsSerum d-dimer levels were significantly higher compared with the sham operated group with early torsion (p=0.002). This elevation remained mildly in the late torsion group compared with the control group (p<0.001), but there was no difference between 4 and 72hours of the testis torsions (p=0.794). On the other hand, d-dimer levels were significantly higher in the torsion groups compared to the epididymitis group (p=0.042). ConclusionsThe present study demonstrated that testicular damage that occurs following testicular torsion shows a higher increase in d-dimer levels than epididymitis, suggesting that d-dimer level can be used as a diagnostic marker of testicular torsion.

Transvesical prostatectomy in the management of benign prostatic hyperplasia in a developing country.

The surgical management of benign prostatic hyperplasia (BPH) is evolving away from open surgery. In developing countries however majority of cases are managed by transvesical prostatectomy (TP). This study aims to describe our experience regarding the efficacy, complication profile and outcome of TP in the management of BPH in Nigeria. A descriptive, retrospective study carried out in three tertiary centers. Two hundred and ninety-seven patients were studied. Parameters examined included age, clinical features, investigations, type of postoperative bladder irrigation, prostate gland volume, duration of hospital stay, complications and outcome. Simple means and percentages with SPSS 16. Mean age was 65.2 ± 6.8 years (range 47-93 years). Presentation with severe lower urinary tract symptoms only occurred in 76 patients (25.7%); acute urinary retention was seen in 106 patients (35.7%). Chronic urinary retention, impaired renal function and haematuria occurred in 47 (15.8%), 37 (12.5%), and 31 patients (10.4%) respectively. On comorbidity, 63 patients (21.2%) were hypertensive and 24 patients (8.1%) had diabetes mellitus. Two hundred and twenty three patients (75%) had indwelling catheters at the time of surgery. Preoperative urinary catheter duration was 1 week-35 months. Mean duration of hospital stay was 8.8 days. Complications were transient urinary incontinence 33 patients (11.1%), urinary tract infection 38 patients (12.7%), and acute epididymoorchitis 15 patients (5.1%). Clot retention occurred in 40 patients (13.5%). Mortality rate was 1%. TP remains useful in developing climes. There is a need to emphasize effective preoperative workup so as to limit morbidity. Emphasis on variety of techniques for hemostasis is necessary.

Sepsis presenting as an acute purulent neonatal epididymo-orchitis: case report

Epididymitis, epididymo-orchitis, and infected hydrocele are uncommon in the neonatal period. It is very important to diff erentiate these entities from testicular torsion to salvage the aff ected testis and avoid unnecessary surgical exploration. Escherichia coli is an important and common cause of sepsis in neonatal period and also a common bacterium causing epididymo-orchitis from ascending route. We report a case of a newborn aff ected with epididymo-orchitis caused by early onset Escherichia coli sepsis. It is diffi cult to diff erentiate epididymo-orchitis from testicular torsion in neonatal period because the clinical signs of testicular torsion and epididymo-orchitis are similar. Color Doppler ultrasonography has an important role in diff erentiation of testicular torsion from epididymo-orchitis. In spite of clinical signs and ultrasonography, in some cases surgical exploration cannot be avoided to confi rm the accurate diagnosis.

Partial Testicular Torsion and Torsion-Detorsion Syndrome

Testicular torsion (TT) is a common cause of acute scrotal pain in young men and accounts for as many as 26% of cases of acute scrotum. Accurate diagnosis and differentiation of TT from acute epididymo-orchitis is essential because TT is treated surgically and epididymitis with or without orchitis is treated medically. Distinguishing TT from epididymo-orchitis is generally a clinical dilemma. Sonography remains the best imaging modality for these entities, but the sonographic findings can be complex and can mimic complicated epididymo-orchitis when dealing with partial TT and torsion-detorsion syndrome. This case report illustrates the complex sonography findings of surgically proven partial TT with torsion-detorsion syndrome.

A Case of Granulomatous Orchitis Due to Brucellosis With Unusual Clinical and Paraclinical Findings

Introduction: Granulomatous epididymo-orchitis is a rare complication of brucellosis that usually appears in patients with antecedent Brucella infection. Case Presentation: The current study reports an 18-year-old man with acute epididymo-orchitis. In this case, an anti-Brucella treatment was started based on epidemiological history and clinical findings, but the final diagnosis was established only after radical orchiectomy. Discussion: Especially in endemic areas of brucellosis, the disease should be considered in differential diagnosis of epididymo-orchitis. Throughout completion of anti-Brucella treatment, patients should be under close observation in order to assess the clinical improvement.

Ultrasound imaging of the “on call” acute scrotum

Causes of the acute scrotum1. Vascular– Spermatic cord torsion– Torsion of the appendix testis2. Trauma– Testicular rupture/fracture– Haematoma/haematocele– Penetrating injury3. Infective/Inflammatory– Epididymitis/epididymo-orchitis– Testicular abscess– Fournier’s gangrene4. Miscellaneous– Acute idiopathic scrotal oedema– Inguinoscrotal hernia– Testicular tumours– Henoch–Schonlein purpuraTorsion of the spermatic cord– Is a surgical emergency—irreversible ischaemia occurs after 6 h– Represents 17% of all acute scrotal presentations, the incidence is 1 in 4000 males– Intravaginal torsion is associated with the bell-clapper deformity. Presentation is most commonly between the ages of 12–18 years– Extravaginal torsion is rare and occurs in utero or the perinatal period, the testis is usually unsalvageable– Greyscale ultrasound may be normal in immediate post-torsion period. Following this, sonographic changes frequently mimic acute epididymo-orchitis.– Lack of flow or diminished flow on colour/power Doppler ...

Acute epididymo-orchitis complicating Streptococcus pneumoniae bacteremia in an adult smoker and alcoholic with community acquired pneumonia

INTRODUCTION: Although hematogenous acute epididymo-orchitis complicating Gram negative bacteremia, tuberculosis and brucellosis have been reported in medical literature, there is paucity of report on acute epididymo-orchitis complicating Streptococcus pneumoniae bacteremia. CASE REPORT: We report the case of hematogenous acute epididymo-orchitis from S. pneumoniae bacteremia in an adult chronic cigarette smoker and alcoholic with community acquired pneumonia. CONCLUSION: We recommend that acute epididymo-orchitis should be remember as a sequel of S. pneumoniae bacteremia especially in adult males with immune suppression DOI: http://dx.doi.org/10.3126/ijim.v1i2.7411 Int J Infect Microbiol 2012;1(1):80-83

Torsion of the Testis and factors that determine the choice of Orchidectomy and unilateral Orchidopexy

To determine the age group affected by testicular torsion and the relationship with orchidectomy and unilateral orchidopexy. To determine if seasonal variation affects the incidence of torsion of the testis. Data of confirmed patients with testicular torsion from July 1998 to June 2010 were retrieved. They were divided into two, group I (age<21 years) and group II (age e"21 years). The indices analyzed were the relationship of age group, occupation on orchidectomy and unilateral orchidopexy and seasonal variation and torsion. Cases of acute epididymo-orchitis, torsion of appendix testis, and testicular tumor were excluded from the study. A total of 169 confirmed cases of testicular torsion were analysed.The estimated incidence was 12.1 cases per 100,000 populations. Their age range from 9 months to 45 years and mean age 23.8±7.6 (SD). 62.1% of torsion occurred at e" 21 years. One hundred and twenty patients (71%) had bilateral orchidopexy, 32 (18.9%) had orchidectomy and 17 (10.1%) had unilateral orchidopexy. In group II; unilateral orchidopexy was significant (p<0.03) and there was a correlation between the occupation and orchidectomy (p<0.02). There was no statistical correlation between total torsion and humidity (r=0.321, p=0.309), or ambient temperature (r=0.248, p=0.437). Testicular torsion was commoner in men age e" 21 years and more students lost their testes. Unilateral orchidopexy should be considered in some cases. There was no relationship between torsion, orchidectomy, ambient temperature and relative humidity. The need for rigorous pre-school and pre-employment health education is advocated.

1092 IMPACT OF BACTERIAL EPIDIDYMITIS ON SEMEN QUALITY AFTER ANTIBIOTIC TREATMENT

INTRODUCTION AND OBJECTIVES: Male genital tract infections are suggested to be an important cause for male infertility. However, prospective studies investigating semen parameters after successful treatment of acute epididymitis are lacking. We present a prospective study to assess semen parameters after antibiotic treatment of acute unilateral epididymo-orchitis. METHODS: Since May 2007 we enrolled 32 men in the reproductive age (median age 30 years, range 18-66) presenting with acute unilateral epididymitis. Following the CDC guideline recommendations for antimicrobial therapy of acute epididymitis, all patients received Levofloxacin 500 mg/day for 10 days. Paired semen samples after two and twelve weeks were collected from all patients. Basic semen parameters included volume, pH value, sperm concentration, motility, and morphology according to WHO 1999 recommendations. As inflammatory markers peroxidase-positive leukocytes and polymorphonuclear elastase were quantified. Statistical analysis was performed using the Wilcoxon test. RESULTS: The bacterial spectrum included E. coli (n 12), Enterococcus faecalis (n 1), C. trachomatis (n 6), N. gonorrhoeae (n 1), and Mycoplasma spp. (n 1). In 11 patients no pathogen was identified. However, eight of those received prior antimicrobial therapy. Compared to the first analysis, a significant decrease in seminal pH value, peroxidase-positive leukocyte numbers, and seminal elastase was documented and associated with a significant increase in sperm concentration, total sperm count, progressive motility, and percentage of morphologically normal sperms after twelve weeks. Semen volume was constant over time. One patient developed persistent azoospermia after acute unilateral epididymo-orchitis. CONCLUSIONS: After successful antimicrobial therapy according to CDC guidelines semen parameters recover in patients with unilateral epididymitis. A persistent azoospermia is a rare event.

Epididymo–orchitis in primary care: is management adequate?

AbstractAcute epididymo‐orchitis is a common and increasing problem for GPs, which, if untreated, carries risks of significant sequelae, including infertility. Recent literature suggests widespread suboptimal management of epididymo‐orchitis in secondary care, in spite of published guidelines. In this article, the authors evaluated adherence to these guidelines in primary care. Copyright © 2012 John Wiley &amp; Sons

URINARY TRACT INFECTION Acute epididymo-orchitis: staging and treatment

IntroductionAcute epididymo-orchitis (AEO) is an acute inflammatory disease of the epididymis and ipsilateral testis. Treatment should be started immediately after diagnosis and includes antibiotics, analgesics, and, if necessary, surgery.Materials and methodsAfter AEO diagnosis, patients were treated conservatively with analgesics and antibiotics. If no clinical improvement was observed within the first 48-72 hours of conservative treatment, patients underwent surgery. Depending on examination results, 254 patients (pts.) were divided into three groups: 1) with palpable differences between the epididymis and testis (E/T+), and without neither hydrocele, local softening (malacia), nor abscess of the epididymis or testis; 2) with E/T+, absence of malacia, presence of hydrocele, and none, one, or a few small abscesses within the epididymis/testis and 3) without palpatory differentiation between the epididymis and testis, with or without malacia, with hydrocele, and none, one, or more abscesses of any size. We analyzed the clinical outcomes in each group.ResultsAll of patients from the first group were successfully treated with antibiotics. In the second group, conservative treatment was effective in 70 pts. (85.4% of this group), but the other 12 pts. (14.6%) did not show clinical improvement and underwent organ-sparing surgery. The majority of patients from the third group did not demonstrate an objective response to antibacterial treatment during the first 48-72 hours and, therefore, underwent surgery. Based on examination results and clinical outcomes we developed a classification system for AEO, which divides AEO into three stages and recommends an approach to its treatment.ConclusionsOur classification is able to systematize treatment approaches in patients with AEO.

Are Antibiotics Necessary for Pediatric Epididymitis?

To determine the percentage of cases of epididymitis in pediatric patients that is of bacterial cause and to identify factors that predict a positive urine culture. We conducted a retrospective chart review of patients diagnosed with acute epididymitis or epididymo-orchitis in 1 pediatric emergency department for 11 years. Charts were reviewed for historical, physical, laboratory, and radiologic data. A positive urine culture was used to identify patients with a bacterial cause of epididymitis. A total of 160 patient records were initially identified as having a diagnosis of epididymitis; of these, 20 met exclusion criteria or did not have records available for review and 140 cases of epididymitis were reviewed. Patients' age ranged from 2 months to 17 years, with a median age of 11 years. Of these patients, 91% received empiric antibiotic therapy. Also, of these patients, 97 (69%) had a urine culture sent, of whom 4 (4.1%; 95% confidence interval, 1.1%-10.2%) were positive. Of the 4 positive urine cultures, 3 had organisms not sensitive to usual empiric therapy for urinary tract infections. The boys with positive urine cultures were not significantly different from the other patients in age, maximum temperature, or number of white blood cells on urinalysis. Given the low incidence of urinary tract infections in boys with epididymitis, in prepubertal patients, antibiotic therapy can be reserved for young infants and those with pyuria or positive urine cultures. Because it is difficult to predict which patients will have a positive urine culture, urine cultures should be sent on all pediatric patients with epididymitis.

Community-acquired Pseudomonas aeruginosa Epididymo-orchitis With Abscess Formation in a Prepubertal Boy

Acute epididymo-orchitis is not a rare disease in children. We report a 10-year-old boy who presented to our hospital with a 14-day oral cefazoline treatment for left epididymo-orchitis without any voiding problem, uncontrollably resulting in abscess formation because of pseudomonal infection. We highlight the importance of alertness and sonographic examination to a community-acquired pseudomonal infection in prepubertal boys with a first episode of acute epididymitis.