Cases Of Epididymitis Research Articles

Surgery versus antibiotics in pyocele: a case report

BackgroundEpididymitis has several etiologies that can be related to infectious and non-infectious causes, autoimmune conditions, aseptic causes, and even certain pharmaceutical medications (amiodarone and chemotherapeutic agents). Some cases of epididymitis are complicated with pyocele formation that requires emergent surgical intervention to prevent testicular gangrene. This report describes the case of a 66-year-old male who developed severe bilateral epididymitis complicated by bilateral pyocele and ensuing sepsis. Astonishingly, the condition resolved completely without surgical intervention.Case presentationWe are presenting a case of a non-sexually active male who developed bilateral severe epididymitis complicated by pyocele that led to the development of septic shock. Further history revealed that the patient was not sexually active with male or female partners and denied any form of trauma. Physical examination demonstrated scrotal swelling and erythema on inspection and severe tenderness on palpation. Digital rectal examination as well as abdominal examinations was unremarkable. Laboratory investigations disclosed severe leukocytosis with a neutrophil predominance (39,000 K/UL, normal range 4500–11,000 K/UL), as well as an elevation of systemic inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein. Urine culture was positive for Escherichia coli. Ultrasound revealed bilateral epididymitis and pyocele. This patient was managed with a course of meropenem, resolving the epididymitis and pyocele without the need of surgical intervention.ConclusionsSurgical intervention is considered the standard of care and the approved management for pyocele to avoid further complications such as Fournier’s gangrene. However, this patient was treated solely with antibiotics, and his condition was stabilized without the need of surgical intervention that would result in additional cost and length of stay for the patient. This case raises further questions regarding the potentially better bioavailability of this antibiotic in the scrotum compared to elsewhere in the body and the potential for a non-surgical alternative approach in the management of patients with pyocele and requires further research.

ROLE OF TRANS RECTAL AND SCROTAL ULTRA SONOGRAPHY IN MALE INFERTILITY.

Introduction: Infertility is known as major problem as life crisis for many couples. Investigation of male infertility isassuming greater importance with male factors implicated as it caused half of the infertile couples. Infertility is defined as infertility is a disease of reproductive system defined by failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is also define as failure of couple to conceive after 12 months of regular intercourse without the use of contraception in women <35 years; and regular intercourse after 6 months without the use of contraception in women ≥ years. A recent report on the status of infertility in India, states that nearly 50% of infertility is related to the reproductive anomalies or disorders in the male. Male infertility include as pretesticular, testicular and post testicular causes. Common causes may be due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. Testicular causes are mainly cryptorchidism, varicocele exposure to gonadotoxins and post testicular causes which included disorders and obstruction of ejaculation and erectile dysfunction. There are many studies which found that sperm count of less than 10 million per milliliter is also suboptimal for fertility; however there is no cut off value of sperm count that is diagnostic of infertility. The common investigations done in evaluating fertility is Ultrasound examinations of scrotum and semen analysis. Ultrasound is a very useful modality for assessing the testicular size which is also related to condition like epididymo-orchitis, varicocele and undescended testis. Aim: The main aim of this study is to deteremine the used of ultra sonography in the evaluation of male infertility and to compared with clinical and surgical findings. All the patients were referred to the Department of Radiology for Material and Methods: transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated. In this study all male patients with infertility and abnormal semen analysis and with the case of infertility with coincident scrotal findings on clinical examination were included. Transrectal ultrasound was done by positioned in left lateral decubitus position. On each side testis and epididymis was identified as completely as possible and compared for symmetry, size, texture and vascularity. In this study patients with abnor Result: mality were found in highest number on clinical palpation and ultrasound was varicocele. In 36 cases Varicocele was detected on clinical examination and 48 cases in ultrasound. In 18 cases Hydrocele wasdetected in clinical examination and Ultrasound. In 10 cases epididymal cysts were detected in clinical findings and 12 cases were found in Ultrasound Findings whereas 6 cases of epididymitis was found in ultrasound and only 2 case in clinical examination. Therefore the total number of abnormalities was found by ultrasound which was significantly greater as compared to physical examination. The p-value was 0.001 which shows statistically significant. Transrectal ultrasound ena Conclusion: bles high resolution imaging of prostate, seminal vesicles and distal vas deferens and is implicated in diagnosing the cause of obstructive azoospermia. Therefore Imaging plays an important complementary role to clinical examination and laboratory analyses for the detection of precise anatomy and level of abnormality. Hence transrectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and pathological conditions can be detected on ultrasound compared to clinical palpation

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

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

Cost-Effectiveness Analysis of Michigan’s School-Wide Sexually Transmitted Disease Screening Program in Four Detroit High Schools

PurposeThe Michigan Department of Health and Human Services, in collaboration with St. John Providence Health System, initiated voluntary school-wide sexually transmitted disease (STD) screenings in four Detroit public high schools. We sought to assess the cost-effectiveness of the STD screening program from 2010 to 2015, with a focus on chlamydia. MethodsThe costs and effectiveness of the school-based screening were compared with those of a “no school screening” scenario using a healthcare system perspective. A decision tree model was constructed to project cases of chlamydia, epididymitis, and pelvic inflammatory disease (PID) in each of the two scenarios among students tested positive and their partners. Health effects were measured as cases of PID prevented, and quality-adjusted life-years (QALYs) gained. Cost estimates included program costs, chlamydia testing/treatment costs in the absence of school screening, and treatment costs for epididymitis, PID, and PID sequelae. The incremental cost-effectiveness ratio (ICER) was measured as cost/QALY gained. Multivariate sensitivity analyses were conducted on key parameter estimates and assumptions used. ResultsUnder base-case assumptions, at a total program cost of $333,848 over 5 years, the program prevented an estimated 1.9 cases of epididymitis and 17.3 cases of PID, resulting in an ICER of $38,235/QALY gained (yearly ICER ranging from $27,417 to $50,945/QALY). Of 10,000 Monte Carlo simulation runs, the yearly ICER remained ≤$50,000/QALY in 64%–98% of the simulation runs. ConclusionsWe found favorable cost-effectiveness ratios for Michigan's school-wide STD screening program in Detroit. School-based STD screening programs of this type warrant careful considerations by policy makers and program planners.

ROLE OF SONOGRAPHY IMAGING IN MALE INFERTILITY

Introduction: Infertility is known as major problem as life crisis for many couples. Investigation of male infertility is assuming greater importance with male factors implicated as it caused half of the infertile couples. Infertility is defined as infertility is a disease of reproductive system defined by failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is also define as failure of couple to conceive after 12 months of regular intercourse without the use of contraception in women <35 years; and regular intercourse after 6 months without the use of contraception in women ≥ years. A recent report on the status of infertility in India, states that nearly 50% of infertility is related to the reproductive anomalies or disorders in the male. Male infertility include as pretesticular, testicular and post testicular causes. Common causes may be due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. Testicular causes are mainly cryptorchidism, varicocele exposure to gonadotoxins and post testicular causes which included disorders and obstruction of ejaculation and erectile dysfunction. There are many studies which found that sperm count of less than 10 million per milliliter is also suboptimal for fertility; however there is no cut off value of sperm count that is diagnostic of infertility. The common investigations done in evaluating fertility is Ultrasound examinations of scrotum and semen analysis. Ultrasound is a very useful modality for assessing the testicular size which is also related to condition like epididymo-orchitis, varicocele and undescended testis.
 Aim: The main aim of this study is to deteremine the used of ultra sonography in the evaluation of male infertility and to compared with clinical and surgical findings.
 Material and Methods: All the patients were referred to the Department of Radiology for transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated. In this study all male patients with infertility and abnormal semen analysis and with the case of infertility with coincident scrotal findings on clinical examination were included. Transrectal ultrasound was done by positioned in left lateral decubitus position. On each side testis and epididymis was identified as completely as possible and compared for symmetry, size, texture and vascularity.
 Result: In this study patients with abnormality were found in highest number on clinical palpation and ultrasound was varicocele. In 18 cases Varicocele was detected on clinical examination and 24 cases in ultrasound. In 9 cases Hydrocele was detected in clinical examination and Ultrasound. In 5 cases epididymal cysts were detected in clinical findings and 6 cases were found in Ultrasound Findings whereas 2 cases of epididymitis was found in ultrasound and only 1 case in clinical examination. Therefore the total number of abnormalities was found by ultrasound which was significantly greater as compared to physical examination. The p-value was 0.001 which shows statistically significant.
 Conclusion: Transrectal ultrasound enables high resolution imaging of prostate, seminal vesicles and distal vas deferens and is implicated in diagnosing the cause of obstructive azoospermia. Therefore Imaging plays an important complementary role to clinical examination and laboratory analyses for the detection of precise anatomy and level of abnormality. Hence transrectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and pathological conditions can be detected on ultrasound compared to clinical palpation.
 Keywords: Infertility, Sonography, Transrectal, Testicular

Analysis of the success rate and complications of three different approaches for endoscopic access in seminal vesicle surgery

Objective To analyze the success rate and complications of three different approaches of endoscopic approach in seminal vesiculoscopy (SVS). Methods The clinical data of 120 patients underwent SVS in our hospital from October 2015 to October 2017 were retrospectively analyzed, including 24 cases of hemospermia, 74 cases of obstructive azoospermia (including 13 cases of prostate cyst) and 22 cases of regional spermatocystitis. The success rate and complications of different approaches were compared. Results The operation time of 120 patients in the whole group was 28-76 min, with an average of (41.84±6.58) min, and the total success rate was 96.67% (116/120). Of the 120 patients, 39 patients underwent direct ejaculation through the ejaculatory duct, 49 patients underwent direct prostatic utricle, and 28 patients underwent transrectal ultrasound (TRUS) guided prostatic utricle, and 4 patients failed. Among of the 24 cases of hemospermia, 22 cases (91.67%) after 7 days showed semen of dark red, after 30 days showed normal color of semen and after 3 months of follow-up, no recurrence was found in cases of obstructive azoospermia. Among of the 74 cases (including 13 cases of prostate cyst), 69 cases (93.24%) were found sperm lotion in the seminal vesicle, 55 (74.32%) cases showed normal semen sperm after operation of 7 days, 45 cases (60.81%) were found sperm at 6 months after operation. No recurrence was found in 22 cases of cystospermitis after 3 months of follow-up. The follow-up results after operation found that 4 cases of epididymitis, 9 cases of watery semen, without urinary incontinence, retrograde ejaculation and rectum, prostate injury and other complications. Conclusions Directly through the ejaculatory ducts and the prostate capsule are taken into the conventional way of SVS, guided by TRUS into the prostate capsule can effectively reduce the failure rate of surgery, prevent the complications of urinary incontinence, retrograde ejaculation and rectum, prostate injury prevention after operation, so it has certain safety. Key words: Genital Diseases, Male; Seminal Vesicles; Surgical Procedures, Minimally Invasive; Postoperative Complications

Analysis of risk factors for epididymitis after transurethral resection of prostate

Objective To investigate the risk factors associated with epididymitis after transurethral resection of prostate. Methods A retrospective analysis of 352 patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of prostate in X′an Aerospace General Hospital from January 2015 to December 2017 was performed. There were 14 cases of epididymitis and 338 cases of non-epididymitis. Measurement data were expressed as (±s), t test was used for comparison between groups; count data was expressed by rate (%), and chi-square test was used for comparison between groups. Univariate and multivariate logistic regression analyses were used for factors that may lead to post-urethral epididymitis. Results Univariate logistic regression analysis showed that preoperative leukocytic positive, urine glucose positive and prostate volume had significant effects on postoperative epididymitis (P<0.05). Multivariate logistic regression analysis showed that prostate volume increased (OR=0.182, P=0.005) was an independent risk factor for postoperative epididymitis. Conclusion The enlargement of prostate volume is an independent risk factor for postoperative epididymitis. For large-volume prostate surgery, the purpose of relieving obstruction can be achieved. Key words: Prostatic hyperplasia; Epididymitis; Risk factors; Transurethral resection of prostate

Role of trans rectal and scrotal ultra sonography in male infertility

Introduction: Investigation of male infertility is assuming greater importance with male factors implicated as the cause in up to half of the infertile couples. This prospective cross-sectional study aims to establish the role of transrectal and scrotal ultrasonography in male infertility. Besides routine investigations trans rectal and scrotal ultra sonography was performed to detect testicular and post-testicular etiology or abnormality. Aims: The aim of this cross-sectional study was to determine the role of transrectal and scrotal ultrasonography in the evaluation of male infertility and to compare the findings of ultrasonography with clinical and surgical findings. Material and Methods: The prospective cross-sectional study was carried out on 50 patients visiting the ultrasound section of Rajindra Hospital; Patiala with complaint of infertility over the span of 2 years. All the patient undergoes transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated. Results: Ultra sonographic findings of scrotum in 50 patients reveals 24 cases of varicocele, 7 cases of epididymal cysts, 8 cases of hydrocele, 3 cases of epididymitis, 2 cases of cryptorchidism, 2 cases of testicular microlithiasis and 1 case of bilateral testicular cyst. Apart from the patient who had cryptorchidism, the testis of all the patients were normal in size, site, shape and echo pattern. The clinical palpation when compared to ultrasound was found to be have a sensitivity of 58.33% and a specificity of 92.31%. The positive predictive value was found to be 87.50% and negative predictive value 70.59%. Conclusion: Trans rectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and substantially more pathological conditions can be detected on ultrasound compared to clinical palpation.

Retrospective Review of Gonococcal and Chlamydial Cases of Epididymitis in two Canadian STI Clinics, 2004–2014

Retrospective Review of Gonococcal and Chlamydial Cases of Epididymitis in two Canadian STI Clinics, 2004–2014

Actinobaculum schaalii causing epididymitis in an elderly patient

Actinobaculum schaalii is a Gram-positive coccoid rod that causes various infections in humans and is easily overlooked in cultures. A. schaalii has long been thought to be of low prevalence and limited invasive potential, causing benign cystitis in elderly patients with underlying urological conditions. Here, we report the first case of epididymitis caused by this bacterium.

A Two-Year experience with bedside emergency ultrasonography for acute scrotal pain in the emergency department

Study objectives: Acute scrotal pain is a modestly common emergency department (ED) complaint. Because of increasing limitations in imaging services, emergency physicians are using their bedside ultrasonographic skills for more difficult diagnoses such as scrotal pain. We describe the practice pattern and sensitivity of bedside ED ultrasonography performed by emergency physicians for acute scrotal pain during a 2-year period. Methods: This was a retrospective quality assurance study performed at an urban ED with a residency program, an active ultrasonographic education program including an emergency ultrasonographic fellowship. The facility has an annual census of 75,000 patients. The ED quality assurance log was searched for all scrotal ultrasonographic studies performed for complaints of scrotal pain presenting within 24 hours of onset. A 12-MHz linear array transducer with pulsed wave and power Doppler capability was used to scan the scrotum. Diagnoses were verified by radiology ultrasonography, nuclear medicine, surgical evaluation, and patient follow-up. Descriptive statistics, sensitivity, and specificity with 95% confidence intervals (CIs) were calculated. Results: Eight emergency physicians performed a total of 146 scrotal ultrasonographic studies. Comparison with follow-up data with emergency physician ultrasonographic results yielded a sensitivity of 95% (95% CI 0.78% to 0.99%) and a specificity of 94% (95% CI 0.72% to 0.99%). Diagnoses included 14 (10%) testicular torsions, 41 (28%) cases of epididymitis, 16 (11%) cases of orchitis, 6 (4%) testicular fractures from trauma, 8 (6%) hernias presenting as acute scrotal pain and swelling, 21 (14%) hydroceles without other pathology, 7 (5%) cases of torsion of the appendix testes, 9 (6%) scrotal infections including Fournier's gangrene, and 24 (16%) normal examinations on which no pathology was noted. Conclusion: Emergency physicians using bedside emergency ultrasonography encounter a variety of causes of acute scrotal pain and are accurate in their diagnosis compared with traditions imaging and surgical services. Most important, they appear able to differentiate between surgical emergencies such as testicular torsion and other etiologies that require medical or supportive treatment. Study objectives: Acute scrotal pain is a modestly common emergency department (ED) complaint. Because of increasing limitations in imaging services, emergency physicians are using their bedside ultrasonographic skills for more difficult diagnoses such as scrotal pain. We describe the practice pattern and sensitivity of bedside ED ultrasonography performed by emergency physicians for acute scrotal pain during a 2-year period. Methods: This was a retrospective quality assurance study performed at an urban ED with a residency program, an active ultrasonographic education program including an emergency ultrasonographic fellowship. The facility has an annual census of 75,000 patients. The ED quality assurance log was searched for all scrotal ultrasonographic studies performed for complaints of scrotal pain presenting within 24 hours of onset. A 12-MHz linear array transducer with pulsed wave and power Doppler capability was used to scan the scrotum. Diagnoses were verified by radiology ultrasonography, nuclear medicine, surgical evaluation, and patient follow-up. Descriptive statistics, sensitivity, and specificity with 95% confidence intervals (CIs) were calculated. Results: Eight emergency physicians performed a total of 146 scrotal ultrasonographic studies. Comparison with follow-up data with emergency physician ultrasonographic results yielded a sensitivity of 95% (95% CI 0.78% to 0.99%) and a specificity of 94% (95% CI 0.72% to 0.99%). Diagnoses included 14 (10%) testicular torsions, 41 (28%) cases of epididymitis, 16 (11%) cases of orchitis, 6 (4%) testicular fractures from trauma, 8 (6%) hernias presenting as acute scrotal pain and swelling, 21 (14%) hydroceles without other pathology, 7 (5%) cases of torsion of the appendix testes, 9 (6%) scrotal infections including Fournier's gangrene, and 24 (16%) normal examinations on which no pathology was noted. Conclusion: Emergency physicians using bedside emergency ultrasonography encounter a variety of causes of acute scrotal pain and are accurate in their diagnosis compared with traditions imaging and surgical services. Most important, they appear able to differentiate between surgical emergencies such as testicular torsion and other etiologies that require medical or supportive treatment.

Cost-effectiveness analysis of screening adolescent males for Chlamydia on admission to detention.

Chlamydia trachomatis infections can lead to serious and costly sequelae. Because chlamydia is most often asymptomatic, many infected youth do not seek testing. Entry to a detention system provides an opportunity to screen and treat many at-risk youth. GOAL The goal of this study was to determine the cost-effectiveness of screening male youth for chlamydia on entry to detention. Incremental cost-effectiveness of 3 chlamydia screening strategies was compared for a hypothetical cohort of 4000 male youth per year: 1) universal chlamydia screening using a urine-based nucleic acid amplification test (NAAT), 2) selective NAAT screening of urine leukocyte esterase (LE)-positive urines, and 3) no screening. The model incorporated programmatic costs of screening and treatment and medical cost savings from sequelae prevented in infected males and female partners. The analysis was conducted from the healthcare system perspective. Chlamydia prevalence in the sampled population of 594 was 4.8%, and the average number of female sexual partners/infected male was 1.6. Universal NAAT screening was the most cost-effective strategy, preventing 37 more cases of pelvic inflammatory disease (PID) and 3 more cases of epididymitis than selective screening and saving an additional 24,000 dollars. The analysis was sensitive to NAAT cost, LE sensitivity, rate of PID development, PID sequelae cost, and number of female partners. Universal screening remained the most cost saving for prevalence as low as 2.8% or higher. Universal chlamydia screening of adolescent males on entry to detention was the most cost-effective strategy. Savings are primarily the result of the prevention of PID in recent and future partners of index males. Screening detained male youth using a urine-based NAAT provides a public health opportunity to significantly reduce chlamydia infections in youth at risk for sexually transmitted diseases.

Assessment of acute scrotum by Doppler color flow imaging: A report of four cases.

We used an Aloka SSD-2000 ultrasound unit with a 5 MHz convex scanner to assess one case of torsion of the spermatic cord, one case of orchitis, and two cases of epididymitis. Color flow imaging showed absence of blood flow signals in the testis in the case of torsion of the spermatic cord, while blood flow signals in the scrotum were significantly increased in the cases of orchitis and epididymitis. Blood flow signals decreased after chemotherapy. Color flow imaging may thus prove useful in the diagnosis and follow-up of patients with acute scrotum.

Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography.

Acute scrotal pain is not a rare emergency department (ED) complaint. Traditional reliance on medical history and physical examination can be precarious as signs and symptoms can overlap in various etiologies of acute scrotal pain. To determine the accuracy with which emergency physicians (EPs) using bedside ultrasonography are able to evaluate patients presenting to the ED with acute scrotal pain. The study was performed at an urban community hospital ED with a residency program and an annual census of 70,000. A retrospective chart review identified 36 patients who presented with complaints of acute scrotal pain and were evaluated by EPs using bedside ultrasound. A 5.0- or 7.5-MHz linear-array transducer with color and power Doppler capability was used to scan the scrotum. Patients were seen between July 1998 and September 1999. Diagnoses were verified by radiology or surgery. Sensitivity and specificity with 95% confidence intervals were calculated. The EP ultrasound examinations agreed with confirmatory studies for 35 of 36 patients, resulting in a sensitivity of 95% (95% CI = 0.78 to 0.99) and a specificity of 94% (95% CI = 0.72 to 0.99). Diagnoses included three testicular torsions, six cases of epididymitis, four cases of orchitis, one testicular fracture, three hernias, three hydroceles, and 15 normal examinations. One case of epididymitis was misdiagnosed as an epididymal mass. This study suggests that EPs using bedside ultrasonography are able to accurately diagnose patients presenting with acute scrotal pain. In addition, they appear able to differentiate between surgical emergencies, such as testicular torsion, and other etiologies.

Refractory Epididymitis and Ejaculatory Duct Obstruction

Ejaculatory duct obstruction is a relatively uncommon entity that is occasionally found at evaluation for infertility. Often thought to be exceedingly rare, it has been discovered more frequently due to the availability of transrectal ultrasonography. I report on a patient who presented for evaluation of hematospermia in whom refractory epididymitis with ipsilateral ejaculatory duct obstruction was successfully treated by transurethral unroofing of the seminal vesicle. A review of the literature for the last 20 years failed to reveal similar cases of epididymitis treated by unroofing an obstructed ejaculatory duct.

Transurethral resection in children with urethral stricture and occlusion.

Technical considerations of urethral surgery in children are critical because of the small size and delicacy of the urethra. From 1984 to 1989, children ages 4 to 14 years with serious traumatic urethral strictures (n = 5) or occlusion (n = 5) were treated. For anterior lesions, transurethral resection (TUR) with a Storz urethroresectoscope (10F-15F) was used to excise all scar tissue after the stenotic tract had been incised or dilated. For lesions in the posterior urethra, the bladder was opened or the cystostomy tract dilated, allowing the operator's index finger to be passed to the posterior end of the lesion while an assistant's finger was inserted into the patient's rectum. A sharp-tip 4F sound was then guided up the urethra into the bladder, the lesion was dilated, and the scar tissue was excised. With an average of 24.4 months of follow-up, success was achieved in all patients, requiring one session in seven patients and two or three sessions in the others. Recurrences in three patients were cured by repeat TUR. There were three cases of epididymitis and two of scrotal edema. This procedure is recommended as the treatment of choice for children with urethral strictures or occlusions. Thorough clearance of scar tissue is valuable to enhance the cure rate.

Clinical experience with transurethral microwave thermotherapy for chronic nonbacterial prostatitis and prostatodynia.

Chronic prostatitis and prostatodynia are troublesome disorders that are not responsive to any kind of treatment. Patients with treatment-resistant chronic nonbacterial prostatitis (n = 61) or prostatodynia (n = 17) for longer than 3 years underwent a single 1-hour session of transurethral microwave thermotherapy (TUMT) using the Prostatron. Complete symptom disappearance was obtained in 23% of patients and a partial response in 43%. Of the patients with prostatitis, 46% showed normalization and 31% an improvement of the leukocyte count in expressed prostatic secretion. In patients with prostatodynia, the corresponding figures were 35% and 41%. Most complications were temporary, but there was one case of epididymitis and one of reduction in the volume of the ejaculate. TUMT is well tolerated and safe, and it is effective in relieving the symptoms of many patients with nonbacterial prostatitis or prostatodynia. The possible adverse effects on fertility and urinary continence require further study.

B-mode real time ultrasonographic imaging of the testis and epididymis of sheep and goats

Ten male goats and five rams were examined from 11 and 15 weeks of age, respectively, for six months to study the ultrasonic appearance of normal testes and epididymides before and after puberty. Five adult rams with lesions of these organs were also examined. A portable, B-mode, real time scanner fitted with a 7.5 MHz, linear array transducer was used. The testis appeared as a homogeneous and moderately echogenic structure with a centrally located mediastinum testis represented by an hyperechogenic line in images taken in the longitudinal plane and by an almost circular spot in transverse images. The testicular capsule and skin were evident as a distinct hyperechogenic line encircling the testicular parenchyma. A thin non-echogenic layer of fluid, presumably between two layers of tunica vaginalis, was observed. The tail of the epididymis was more heterogeneous and less echogenic than the testis. The epididymal head was also less echogenic but homogeneous in texture, and the body of the epididymis was difficult to image. The pampiniform plexus was easily identified as numerous convoluted sonolucent tubular structures. The ultrasonic images of possible cases of epididymitis, spermatocele, testicular cyst and abscess and scrotal hernia are described.

The pediatric acute scrotum.

The pediatric acute scrotum can be a diagnostic dilemma. The history, physical examination, and appropriate tests are important. The correct diagnosis will be arrived at if the systematic approach is remembered (Figure 14). In cases where testicular torsion cannot be ruled out (such as an epididymitis or torsion of the appendix testis where torsion of the testis is mimicked), the patient will need scrotal exploration. It is hoped that with further availability of scanning and expertise by pediatric surgeons the false negative exploration will decrease in number. Remember, occasionally a patient will require scrotal exploration with biopsy of the epididymis to delineate the underlying cause. In most cases of epididymitis, effort should be made to identify the cause by culture of urine, urethral discharge, or appropriate fluid from the epididymis. Urological evaluation will be necessary in the younger boys, particularly those with recurrent episodes, to rule out congenital anomalies. Only by following this systematic approach can clinicians hope to preserve gonadal function and achieve best care of their patients.

Scintigraphy for the diagnosis of testicular torsion and differential diagnosis of acute intrascrotal processes.

Twenty-five patients suffering from acute painful testicular processes were subjected to scintigraphy. Testicular torsion in the early and delayed phases were diagnosed with 100% accuracy, but one out of 7 cases of epididymitis was wrongly recognized as negative. Interoperative diagnosis in two cases of hydatid torsion proved the foregoing scintigraphic finding to have been wrong. Nevertheless, scintigraphy was found to be reliable in testicular torsion diagnosis.