Scrotal Pain Research Articles

Postoperative Complications of Laparoscopic versus Open Varicocelectomy

Background: Varicocele, characterized by the dilation and swelling of testicular veins, significantly impacts male infertility and semen quality, affecting 10-15% of the male population. Surgical intervention is essential to alleviate these effects, with various techniques available, including laparoscopic and open subinguinal varicocelectomy. Objective: This study aimed to compare postoperative complications between laparoscopic and open subinguinal varicocelectomy to determine the superior approach in terms of patient outcomes and complications. Methods: A randomized controlled trial was conducted, involving 130 patients admitted to Hayatabad Medical Complex, Peshawar, from November 10, 2021, to July 31, 2022. Participants, presenting with symptoms of scrotal heaviness, testicular swelling, pain, and infertility, were randomly assigned to either the laparoscopic (Group L, n=70) or open subinguinal (Group O, n=60) varicocelectomy groups. Preoperative assessments included medical history, clinical examination, and necessary tests. Informed consent was obtained from all participants. Exclusion criteria included patients with malignancy, diabetes (BSR > 200 mg/dl), or unstable hemoglobin levels (Hb < 10 mg/dl). Postoperative complications, including wound erythema, hydrocele, epididymitis, and bruising, were documented and analyzed using SPSS version 25, with a significance level set at P ≤ 0.05. Results: The mean age of Group L was 27.3 years (±2.3), and Group O was 25.2 years (±3.5) (P = 0.042). Postoperative complications were significantly lower in Group L compared to Group O. Wound erythema was observed in 1.42% of Group L and 8.3% of Group O (P = 0.05). Hydrocele occurred in 2.8% of Group L versus 10% of Group O (P = 0.04). Epididymitis was found in 1.42% of Group L and 6.5% of Group O (P = 0.03). Bruising was noted in 1.66% of Group O, with no cases in Group L (P = 0.05). Conclusion: Laparoscopic varicocelectomy resulted in fewer postoperative complications compared to open subinguinal varicocelectomy, making it the preferred surgical approach for varicocele treatment. Further studies with larger sample sizes and long-term follow-up are recommended to validate these findings.

An Uncommon Cause of Testicular Infarct: A Case Report and Review of the Literature of Testicular Infarcts From Laparoscopic Inguinal Hernia Repair

BackgroundTesticular ischemia requires timely diagnosis and definitive management to avoid serious consequences such as orchiectomy. It is almost always caused by testicular torsion; however, there are other causes to be aware of. Case ReportA 32-year-old man developed testicular ischemia following a laparoscopic robotic-assisted inguinal hernia repair with preperitoneal mesh. The ischemia progressed to a fully infarcted testicle with no evidence of torsion on subsequent surgical exploration. He ultimately did require an orchiectomy. Why should an Emergency Physician be aware of this?While extremely rare, testicular ischemia or infarct must be considered in patients presenting with testicular pain shortly after inguinal hernia repair. Emergent surgical evaluation and loosening of the hernia mesh may be required to salvage the testicle.

Chronic Orchalgia in Adolescence: A Literature-Based Evaluation of Followed Patients

Orchalgia is defined as testicular pain that occurs continuously or at variable times, may be unilateral or bilateral, restricts the daily activities of the individual, and lasts for more than 3 months. Infection or local pathology may not be present. We aimed to emphasize the treatment options in cases of chronic orchalgia according to the etiology of our 3 cases who presented to the pediatric urology outpatient clinic due to testicular pain in the adolescent age group.

Paediatric testicular torsion in low- and middle-income countries: an OxPLORE scoping study.

Literature on paediatric surgical conditions in low- and middle-income countries (LMICs) remains limited. As a common emergency, timely treatment of testicular torsion acts as a benchmark of adequate emergency service delivery in paediatric surgery. This scoping study aims to synthesise all existing literature on paediatric testicular torsion in LMICs. A database search was conducted by the OxPLORE global paediatric surgery research group to identify studies containing the terms 'testicular torsion' or 'acute scrotum' originating from LMICs. A thematic analysis was applied to the results of the search and the quality of evidence was appraised for all included articles. This review included 17 studies with 1798 patients. All studies originated from middle-income countries and the majority (76%) had sample sizes smaller than 100 patients. All studies were appraised as providing less than adequate evidence. Included studies identified long delays to treatment and highlighted ongoing debates on the value of scoring systems and Doppler ultrasonography in diagnosing torsion. Major heterogeneity in surgical approaches to treatment of testicular torsion in children was also observed. Literature on paediatric testicular torsion in LMICs is scarce and heterogeneous. Prospective, multi-centre research on the management of this common paediatric surgical emergency is urgently required.

A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China

A novel nomogram to predict testicular torsion in children with acute scrotal pain: a single-center retrospective study in western China

Acute genital diseases

Acute genital diseases can occur at any age and are characterized by complaints of various kinds of the external genitalia. Pain, swelling, and redness of the scrotum, adjacent groin region, and immediate surroundings are the leading symptoms, the severity of which may vary. In addition, peritonitic symptoms such as nausea, vomiting, and circulatory sensations may be present and are comparable to symptoms of an acute abdomen. The term "acute scrotum" encompasses various clinical entities, where scrotal symptoms are predominant and represent aurological emergency situation. Immediate and comprehensive diagnostics are necessary to ensure timely management in case of necessary surgical intervention.

Microscopic subinguinal varicocelectomy with video telescopic operating microscope (VITOM) telescope: outcome analysis.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.

Evaluation of Botox treatment in patients with chronic scrotal pain: Protocol for a randomized double‐blinded control trial

AbstractBackgroundChronic scrotal pain is a common condition with a prevalence of 2.5–4.8% in male outpatients. Up to 40% of these patients report depressive symptoms and many feel isolated. Minimal invasive treatment is lacking, while spermatic cord injections of Botox® (BTX) have been proposed to offer long‐term pain relief.Study DesignThis research protocol comprises a prospective multicentre, randomized, double‐blinded clinical trial drawing patients from other urological departments in the region of Southern Denmark.End PointsThe primary end point will be reduction in pain evaluated by visual analogue score for pain at 3 months. Secondary end point will be length of effect of BTX injections along with changes in quality of life.Patients and MethodsThe study will include 50 patients for randomization to either spermatic cord block with 100 IE BTX or sterile saline. All patients will prior to randomization undergo physical examination and will be asked to fulfil multiple questionnaires regarding pain and impact in daily life, that is, (1) visual analogue score for pain, (2) quality of life (EQ‐5D‐5L), (3) Chronic Prostatitis Symptom Index (NIH‐CPSI), (4) ICD‐10 depression questionnaire (MDI), (5) Likert global assessment scale, and (6) International Index of Erectile Function questionnaire. Physical examination and fulfilment of the questionnaires will be repeated multiple times throughout the study period of 12 weeks. After this time point, patients will be unblinded, and the control arm will be given the opportunity of cross‐over.

Stripping versus ligation of vas deferens in microscopic denervation of spermatic cord in men with chronic orchialgia: A multicenter study.

Microdenervation of the spermatic cord (MSCD) is an effective treatment modality for men with intractable scrotal content pain. For patients not interested in preserving fertility, some centers advocate ligation of the vas during denervation, while others prefer stripping of the vas deferens to preserve the vasal artery, hence preserving vasculature to the testis and possibly decreasing post-operative congestion pain. To compare outcomes of patients with chronic orchialgia, who underwent MSCD by either stripping or ligating the vas deferens. A retrospective chart review of 85 patients who underwent MSCD from 2017-2023 was performed. Patients' demographics including history of prior surgical procedures were recorded. Response to surgery was evaluated as either complete resolution of pain, partial resolution of pain, or no improvement in pain. Eighty-five patients underwent MSCD with a median (interquartile range, IQR) age of 36 (25.5-46.5) years and median duration of pain of 16 (6-31) months. Thirty-seven patients underwent stripping of vas, while 48 underwent ligation of vas during MSCD. Median follow up was 12 months. Twenty-one (43.5%) patients had prior inguinal scrotal surgery in the ligation group compared to 5 (13.5%) in the stripping group, p=0.003. The etiology of pain was similar between the groups. The response to MSCD between the two groups was similar, 67.6% of patients who underwent stripping had complete resolution of pain versus 66.7% of those who had ligation (p=0.968), with similar rates of post-operative complications (p-value=0.132). In men with intractable chronic scrotal content pain with no interest in preserving fertility, ligation, or stripping of the vas deferens yields similar outcomes with regard to pain resolution. Both techniques are safe with no reports of any testicular atrophy.

A simplified treatment algorithm for chronic scrotal content pain syndrome

Abstract Background Chronic scrotal content pain (CSCP) is a devastating condition characterized by localized scrotal pain that persists for ≥ 3 months and interferes with daily activities. Approximately 2.5% of all urology outpatient visits are associated with CSCP. General urologists may have difficulty treating these patients because of uncertainties regarding the etiology and pathophysiology of CSCP. Therefore, we aimed to provide a simplified diagnostic and treatment approach for CSCP by subdividing it into distinct categories. Materials and methods We systematically reviewed the published literature in the PubMed, MEDLINE, and Cochrane databases for all reports on CSCP diagnosis and treatment using the keywords “chronic scrotal content pain,” “testicular pain,” “orchialgia,” “testicular pain syndrome,” “microdenervation of the spermatic cord,” “post-vasectomy pain syndrome,” “post-inguinal hernia repair pain,” “testialgia,” and “pudendal neuralgia.” This review included only CSCP-related articles published in English language. Results We subdivided CSCP syndrome into 5 clinical presentation types, including hyperactive cremasteric reflex, pain localized in the testicles, pain in the testis, spermatic cord, and groin, pain localized in the testicles, spermatic cord, groin, and pubis, and pain in the testicles, spermatic cord/groin, and penis/pelvis. Treatments were adjusted stepwise for each type and section. We included more information regarding the role of pudendal neuroglia in CSCP syndrome and discussed more options for nerve blocks for CSCP. For microsurgical spermatic cord denervation failure, we included treatment options for salvage ultrasound-guided targeted cryoablation, Botox injections, and posterior-inferior scrotal denervation. Conclusions Different CSCP subtypes could help general urologists assess the appropriate diagnostic and treatment approaches for scrotal pain management in daily practice.

Turkish validation of the chronic orchialgia symptom index and its association with the visual analog scale.

To conduct a translation and validation study of the Chronic Orchialgia Symptom Index (COSI), which has 12 questions in three domains pain (P), sexual symptoms (SS), and quality of life (QoL), in the Turkish language. The study included a total of 175 patients diagnosed with chronic scrotal content pain (CSCP) between January 2023 and January 2024. In addition to demographic data, the scores obtained on the COSI questionnaire and Visual Analog Scale (VAS) were recorded. Internal consistency was assessed using Cronbach alpha coefficients. Reliability was evaluated using the test-retest correlation method. The mean age of the patients was 37.2 ± 14.1 years and the median (IQR) duration of pain was 5.5 (9) months. The median total COSI score was determined as 13 (13) and the median subscores were 7 (7) for P, 1 (2) for SS, and 5 (6) for QoL. The test-retest correlation coefficient for each item was determined to be higher than r = 0.80 (p < 0.001). The Cronbach alpha values for the subscores were 0.80 for P, 0.71 for SS, and 0.80 for QoL. There was determined to be a statistically significant positive correlation between the VAS score and the COSI P, SS, QoL, and total scores (r: 0.63, p < 0.001; r = 0.32, p < 0.001; r = 0.56, p < 0.001; r = 0.59, p < 0.001, respectively). The optimal cutoff point of the COSI total score was determined to be 16.5 points (AUC:0.77, p < 0.001) for the determination of patients experiencing severe pain (⩾ 7.5) according to the VAS score. The Turkish version of the COSI questionnaire is a valid, reliable, and repeatable questionnaire that can be used to evaluate the effects of symptom severity in patients with CSCP.

Symptomatic Intraparenchymal Epididymal Cysts: Description of 11 cases.

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

Follow‐up results regarding fixation of contralateral testis after testicular torsion in children

AbstractThe aim is to investigate the possible advantages and disadvantages of contralateral testicular fixation (CTF) for boys with testicular torsion (TT) by long‐term clinical follow‐up results. A retrospective cohort study was conducted on TT boys at Children’s Hospital of Chongqing Medical University from September 2005 to December 2020. The baseline characteristics, intraoperative findings, and clinical follow‐up results were compared between TT patients underwent orchiopexy with or without CTF, and orchiectomy with or without CTF, respectively. The χ2 test and the Fisher’s Exact test were used to compare dichotomous outcomes, and the Mann‐Whitney U test was used to compare continuous outcomes without normal distribution. A total of 140 cases were included in this study. The bell clapper deformity was found in 30.4% of all torsed testes underwent orchiopexy, 16.4% during contralateral testicular exploration, and only 10.9% in bilateral sides. Contralateral testicular volume, adverse events, and paternity rates were comparable between patients underwent orchiopexy with or without CTF, and no subsequent contralateral TT observed during follow‐up. However, those patients underwent orchiectomy without CTF had more incidence of scrotal discomfort than those had orchiectomy with CTF (P = 0.027). In addition, one boy suffered subsequent contralateral TT after orchiectomy without CTF. The incidence of bell clapper deformity was lower in this research than that of literature reports. CTF would not induce testicular volume loss, atrophy or scrotal pain. Contralateral testicular discomfort and even subsequent TT could be more easily observed during follow‐up in patients without CTF. We still recommend routine surgical fixation of contralateral testicle during surgery.

Combination of pregabalin and Amitriptyline in management of chronic idiopathic pain following penile prosthesis implantation: a pilot study

BackgroundChronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management.ResultsThe study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%).ConclusionThe combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach.This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 (REC-FMASU@med.asu.edu.eg). Trial registrationno FMASU R98/2023.

(O-25) SURGICAL TREATMENT FOR CHRONIC TESTICULAR PAIN: A SYSTEMATIC REVIEW

Abstract Introduction and Objetives Chronic testicular pain (CTP) is defined as 3 months of intermittent or constant testicular pain that is significantly bothersome to the patient. There exist a variety of different surgical treatment options for CTP. They are generally kept as second or even third-line option for persistent cases. This study aims to review and elucidate the literature about surgical treatment for chronic testicular pain. Methods We searched Pubmed, Embase and Cochrane for articles evaluating surgical treatments for CTP. Search terms included “orchialgia”, “spermatic cord”, “chronic scrotal pain”, “chronic testicular pain” and “surgery”. Results Microsurgical Denervation of the Spermatic Cord (MDSC) is the surgical standard when a procedure is indicated for idiopathic chronic orchialgia unresponsive to conservative therapies. The positive response to spermatic cord block is a predictor of MDSC response. Pain relief after MDSC ranges from 76% to 100%. Ultrasound-guided targeted cryoablation could be used in persistent CTP after MDSC with 75% success rate. Epididymectomy is better indicated for CTP in structural abnormality such as cyst, granuloma or mass, with pain relief reaching 50% to 92%. In case of post-vasectomy pain syndrome, vasectomy reversal and MDSC has an overall success from 50% to 100% and 71% to 81% respectively. Ilioinguinal and genitofemoral peripheral nerve stimulation could be used in persistant CTP, and spinal cord stimulation as well. Orchiectomy can be considered as a last resort in case patients do not respond to other forms of treatment, but do not delivers a 100% relief a pain. Conclusion Although it’s variables choices, there is not a gold standard surgical treatment for CTP, representing a challenge for clinicians. Large, controlled trials must be performed to establish strong and reliable evidence for the surgical treatment of CTP. Financing No conflict.

An unusual testicular mass: myeloid sarcoma as a rare extramedullary manifestation of acute myeloid leukemia

BackgroundWe report an unusual testicular mass with small bowel and retroperitoneal lymph node deposit proven to be myeloid sarcoma after complete histopathological and hematological workup. Myeloid sarcoma (MS) usually involves lymph nodes and head and neck regions. Uncommon sites like testis and ovary are rarely involved and pose a diagnostic challenge. Extramedullary myeloid sarcoma is most commonly associated with hematological malignancies like acute myeloid leukemia and myelodysplastic syndromes. It can precede or co-occur with AML. Considering it as a differential diagnosis in atypical presentation of testicular tumor helps in early treatment.Case presentationWe present a case of TMS with small bowel and retroperitoneal deposits presenting initially as intussusception and a vague scrotal pain. The patient underwent unilateral left radical inguinal orchidectomy. Surgical pathology revealed myeloid sarcoma of the testicle. And later jejunojejunostomy was done for small bowel deposit causing obstruction with retroperitoneal lymph node biopsy taken which revealed granulocytic sarcoma deposit. He developed peripheral blood involvement 4 weeks postoperatively, and bone marrow biopsy showed acute myeloid leukemia.ConclusionsWith very short median survival period of 7.5 months, high index of suspicion is required where multifocal lesions are observed in various sites as in our case.

(PM-06) A RARE CASE OF SCROTAL URETHROCUTANEOUS FISTULA SECONDARY TO EROSION OF PENILE PROSTHESIS CONNECTOR TUBING

Abstract Objective The scrotal urethrocutaneous fistula is an uncommon pathology which can lead to serious complications, such as infections, scrotal abscesses, or even Fournier’s gangrene. We present an unusual case of scrotal urethrocutaneous fistula secondary to erosion of a penile prosthesis tubing in a patient with a history of erectile dysfunction. Case presentation A 68-year-old patient with no previous comorbidities and a history of prostate adenocarcinoma that was treated with radical prostatectomy + lymphadenectomy, without the need for subsequent adjuvant therapy. He was diagnosed with erectile dysfunction after surgery, refractory to intracavernous therapy therefore required a 3-component penile implant placement procedure performed extra-institutionally. Two years after the surgery, he consulted with our institution for scrotal pain and urine leak from the scrotum during micturition. Physical examination shows extrusion of prosthesis tubes in the scrotal area with no signs of infection or exposure of the cylinders. The patient was hospitalized for management with antibiotics and to replace the penile implant. A retrograde urethrography with contrast medium was performed during surgery. Fluoroscopy showed a fistulous pathway between the penile urethra and the scrotum. No passage of the contrast to the corpora cavernosa was seen. The urethral lesion and fistula were identified and repaired. A malleable prosthesis was used, considering the amount of scar tissue. The patient had an adequate postoperative period. A urethral catheter and a cystotomy were used for six weeks. After catheter removal, a voiding cystogram was performed, finding no fistulas. The patient was followed for 11 months with no complications. Conclusion Although scrotal urethrocutaneous fistulas are an infrequent complication after penile prosthesis implantation, a timely diagnosis is essential for conservative treatment and to avoid life-threatening complications. Financing No conflict.

Observation of the efficacy of elongated needle therapy in treating patients with ⅢB prostatitis of stagnant dampness-heat syndrome.

To observe the clinical efficacy in patients with ⅢB prostatitis of stagnant dampness-heat syndrome treated with elongated needle therapy. A total of 90 patients with ⅢB prostatitis of stagnant dampness-heat syndrome were selected and randomly divided into a treatment group(45 cases, 2 dropped out) and a control group(45 cases, 1 dropped out) using a random number table method. The control group was treated with oral administration of Qianlie Shutong Capsule, 3 capsules per dose, 3 times a day for a total of 4 weeks. The treatment group received elongated needle therapy at Qihai(CV6), Zhongji(CV3), bilateral Zhibian(BL54) and Shuidao(ST28), with one treatment per day for 4 weeks. Before and after treatment, the traditional Chinese medicine syndrome score, National Institutes of Health Chronic Prostatitis Symptom Index(NIH-CPSI) score were compared between the two groups, and the clinical efficacy was compared after treatment. Compared with that before treatment, the control group showed significant decrease in traditional Chinese medicine syndrome score, testicular pain, urinary frequency, unending remnants of urine, scrotal wetness, yellowish urine, urinary symptoms, and quality of life scores after treatment(P<0.05)；the treatment group showed significant decrease in traditional Chinese medicine syndrome score, and perineal pain, groin pain, pelvic pain, testicular pain, scrotal wetness, yellowish urine scores, NIH-CPSI total score, pain symptoms, urinary symptoms, and quality of life scores after treatment(P<0.05). After treatment, the treatment group showed significantly lower traditional Chinese medicine syndrome score, and perineal pain, groin pain, pelvic pain, testicular pain scores, NIH-CPSI total score, pain symptoms, and quality of life scores than those of the control group(P<0.05). The effective rate in the treatment group (63.64%, 28/43) was significantly higher than that in the control group (88.37%, 38/44, P<0.05). Elongated needle therapy can significantly improve the traditional Chinese medicine syndrome score, NIH-CPSI total score, and pain symptom scores in patients with ⅢB prostatitis of stagnant dampness-heat syndrome. It can significantly improve the cure rate in these patients and is particularly effective in relieving pain.

The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report

BackgroundGenitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male.Case presentationA 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department.ConclusionsBiopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.

Clinical characteristics of testicular torsion and factors influencing testicular salvage in children: A 12-year study in tertiary center

BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents. Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion. AIM To predict the possibility of testicular salvage (TS) in patients with testicular torsion in a tertiary center. METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University. Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion. The data included clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, age, presenting institution status, and follow-up results. RESULTS Our study included 75 patients. TS was possible in 57.3% of all patients; testicular torsion occurred mostly in winter, and teenagers aged 11-15 years old accounted for 60%. Univariate logistic regression analyses revealed that younger age (P = 0.09), body mass index (P = 0.004), torsion angle (P = 0.013), red blood cell count (P = 0.03), neutrophil-to-lymphocyte ratio (P = 0.009), and initial presenting institution (P &lt; 0.001) were associated with orchiectomy. In multivariate analysis, only the initial presenting institution predicted TS (P &lt; 0.05). CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion. Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.