Epididymitis Research Articles

MP-11.05 Epididymitis in Children: New Insights on an Old Problem

Unlike in adults, epididymitis (EP) in children is commonly considered to be related to anatomical abnormalities. Few studies review the epidemiology of the disease in relation with the etiology in children. Our study describes the presenting characteristics of epididymitis over 18 years in pediatric population in Salt Lake City, Utah, USA.

A case of acute epididymo–orchitis due to Pseudomonas aeruginosa presenting as ARDS in an immunocompetent host

Acute eididymo–orchitis is the most common cause of intrascrotal inflammation, and retrograde ascent of pathogens is the usual route of infection. Here we intend to present a case of young boy, not sexually active, suffering from acute epididymo–orchitis due to Pseudomonas aeruginosa presented with acute respiratory distress syndrome. Proper timely diagnosis of the primary cause and prompt treatment including support with non invasive ventilation lead to a favourable outcome in the same case.

Sigmoid carcinoma presenting as epididymo–orchitis

Sigmoid carcinoma presenting as epididymo–orchitis

Henoch-Schönlein purpura with epididymitis in an adult

Henoch-Schönlein purpura with epididymitis in an adult

Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience

the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of > 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of > 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.

Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience

Objectivethe different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. Material and methodsin this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of ≥ 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Resultsfourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of ≥ 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. Conclusionin brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.

Acute scrotum in children: Role of nuclear testicular scanning in diagnosis

Nuclear scanning with Tech 99m pertechnitate has evolved as a major diagnostic tool for evaluating the paediatric patients with acute scrotum. It is simple, quick and accurate for differentiating the patients with testicular torsion from other causes of acute scrotum.Between march 2001 and march 2007,we prospectively studied 148 patients with acute scrotum;out of whom 91 patients were subjected to nuclear scanning.10 patients(9.9%)were diagnosed as having testicular torsion which was confirmed on surgical exploration(accuracy 100%).one patient had epididymo orchitis and one patient had missed torsion..79 patients had normal scan;All the patients with normal scan were managed conservatively with no adverse sequelae on follow up.

Sterility as Unique Symptom of Tuberculous Epididymo-orchitis

Objective: To study the rare tuberculous epididymo-orchitis causing infertility. Design: Surgical specimens received at a Reference Laboratory serving the Igbo ethnic group in Nigeria were analyzed as regards tuberculosis during a period of 30 years. Results: One hundred cases involving peripheral lymph nodes, 30 cases of peritoneal disease and 24 cases affecting the genitalia were accessed during the 1970s. Thereafter, only one case was found to be due to sterility. Conclusion: In all probability, if the sexual history can be included routinely as part of the complete medical evaluation, this symptom may be found to be commoner in Nigeria and other areas of the world where TB is a health problem. Keywords : Tuberculosis, epididymis, testis, sterility, epidemiology. Journal of College of Medicine Vol. 13 (2) 2008: pp. 126-127

Orchitis, epididymitis and pampiniform phlebitis in a stallion

Orchitis, epididymitis and pampiniform phlebitis in a stallion

Clinical Presentation of Acute Scrotum in Young Males

The purpose of this study was to assess the clinical presentation and ultrasonographic findings of acute scrotum in young males. A total of 87 patients (<or= 25 years old) with presentation of acute scrotum were retrospectively analyzed in Kaohsiung Medical University Hospital. The patients were divided into three groups according to their final diagnosis: 41 patients with testicular torsion (TT), eight patients with torsion of the testicular appendage (TTA), and 38 patients with epididymo-orchitis (EO). The mean ages of the TT group (14.0 +/- 5.7 years) and EO group (16.6 +/- 7.6 years) were higher than that of the TTA group (10.0 +/- 3.5 years) (p = 0.02). White blood cell count (> 10,000 cells/microL) was not found to be statistically different among groups. Pyuria was found in 10 (26%) patients with EO. Color Doppler ultrasound has high sensitivity (87.9%) and specificity (93.3%) rates to differentiate TT from other causes of acute scrotum. In cases with a lower risk of TT, we suggest that a technically adequate color Doppler ultrasound may be arranged to help differentiate diagnoses and prevent needless surgery. The importance of emergent management for acute scrotum should also be impressed upon the public through education to avoid delayed presentation to medical facilities.

A 19-Year Review of Paediatric Patients with Acute Scrotum

The aim of the study was to compare incidence, symptoms and signs of spermatic cord torsion to those of other conditions causing acute scrotum. Records of 388 consecutive boys under 17 years of age treated for acute scrotum at The Hospital for Children and Adolescents in Helsinki in 1977-1995 were reviewed. During the period studied all patients with acute scrotum underwent urgent surgery to ensure accurate diagnosis and treatment. The duration and characteristics of the symptoms, clinical findings prior to operation and the age of the patients were registered. Scrotal explorations revealed 100 cases (26%) of spermatic cord torsion (SCT), 174 cases (45%) of torsion of the testicular appendage (AT), 38 cases (10%) of epididymitis (ED), 32 cases (8%) of incarcerated inquinal hernias and 44 (11%) other conditions. During the first year of life SCT was the most common cause of acute scrotum, another peak incidence being in adolescence. Almost half of the boys with AT were nine to 12 years of age (median 11). Except for infants, the patients' acute symptoms were pain (SCT 88%, AT 94%, ED 76%). Swelling in the hemiscrotum was found in 44% of SCT, in 39% of AT and in 88% of ED cases. Epididymitis was also accompanied by erythema (37%), but infrequently with fever (in 16%). Erythema was found also in AT (32%), but the "blue dot sign" was found positive in only 17 (10%) of the boys with AT. Three quarters of the boys who were operated on within six hours from onset of symptoms had testicle torsion. All testicles were saved when detorsion was performed within six hours, but salvage was possible in only half of the cases when symptoms had lasted more than six but less than 12 hours. The high probability of SCT among those admitted to an emergency department within six hours from the onset of the symptoms justifies immediate surgical exploration.

Tuberculous epididymo-orchitis masquerading as paratesticular sarcoma in childhood- A case report

Testicular involvement is a rare complication of tuberculosis. Among children the disease is often misdiagnosed and confusedwith paratesticular sarcoma. A six-year old boy presented with painful testicular mass. The histology showed a granulomatous inflammation and acid fast bacilli consistent with tuberculosis. Tuberculous epididymo-orchitis should be considered in the differential diagnosis of any testicular enlargement in children living in tuberculosis endemic areas. Keywords : testis; histology; childhood African Journal of Paediatric Surgery Vol. 4 (2) 2007: pp. 106-107

Cysts of the ejaculatory system: a report of two cases

We report two cases of rare cystic dilatations of the ejaculatory system. In case 1, a 6-month-old boy was referred to us for the management of recurrent epididymo-orchitis (E-O) complicating open drainage and a colostomy was performed elsewhere for a purulent rectal discharge thought to be rectal duplication. Diagnostic imaging showed a retrovesical cyst. Urethrocystoscopy showed a swelling of the verumontanum. No fistula was seen between the cyst and rectum on colonoscopy. At laparotomy, both ejaculatory ducts and seminal vesicles were found to be fused into a mass with cystic dilatation of the ejaculatory duct. Intraoperative histopathology of the cyst identified a metaplastic epithelial lesion. The cyst was excised with bilateral vasoligation. Since surgery, 8 years ago, urination and defecation have been normal. In case 2, a 4-month-old boy presented with fever and a swollen right scrotum. Ultrasonography showed a retrovesical cyst. Right grade IV vesicoureteral reflux diagnosed on voiding cystourethrography was treated by ureter reimplantation (Cohen) but complicated by recurrent E-O. Urethrocystoscopy with retrograde contrast via the utriculus showed that the cyst opened on the verumontanum, that both ejaculatory ducts opened into the cyst, and there was reflux into the right vas deferens. Right vasoligation alone was performed through a scrotal approach. Although the cyst was not excised, there has been no recurrence of E-O nor enlargement of the cyst for 6 years. Cysts of the ejaculatory system should be considered in the etiology of recurrent E-O in prepubertal children and a high index of awareness is recommended.

531Chronic epididymitis — Management among urologists in Switzerland

531Chronic epididymitis — Management among urologists in Switzerland

Clinical Predictors for Differential Diagnosis of Acute Scrotum

Accurate and early diagnosis of acute scrotum is of the utmost importance to avoid testicular loss and/or needless surgery. The aim of this study is to analyze the clinical presentation and physical examination parameters together with the results of imaging studies in order to find out predictors for the differential diagnosis of acute scrotum with special emphasize on testicular torsion (TT). Patients who were treated for acute scrotum in our unit from 1970 up to and including 2000 were reviewed retrospectively. The study group was subdivided into three groups: "testicular torsion (TT)", "torsion of testicular appendage (TTA)", and "epididymoorchitis (EO)" group according to the diagnosis confirmed by radiologic and surgical findings. Presence and/or absence of various parameters related to clinical presentation, physical examination, and results of imaging studies were analyzed by statistical means in each group. One hundred and sixty children with a mean age of 12.2 years formed the study group. The mean duration of symptoms was 15 hours. No significant difference was noted between the three groups with regard to mean age and duration of symptoms. Nuclear scintigraphy and Doppler ultrasound were used as diagnostic aids in 50 and 66 children, respectively. Clinical presentation parameters including the presence of a) previous trauma, b) pain attacks, and c) nausea and vomiting, had the highest sensitivity, specificity, positive and negative predictive values in the TT group and the lowest values in the EO group. In contrast, the EO group had the highest statistical values with regard to presence of dysuria and micturition disorders. Physical examination parameters consisting of a) elevation, b) transverse location of testis, c) anterior rotation of epididymis, and d) absence of cremasteric reflex had the highest statistical values in the TT group. Contrary to this, imaging studies had the highest specificity and positive predictive values in the TTA group and the lowest values in the TT group. Previous history of trauma and pain attacks, presence of nausea and vomiting, and absence of urinary complaints are the main predictors of TT. Elevation and transverse location of testis with an anteriorly rotated epididymis associated with loss of ipsilateral cremasteric reflex strongly indicate TT. Although accuracy of imaging studies is higher for the differential diagnosis of TTA and EO, there is a considerable risk of misdiagnosis. Therefore, differential diagnosis of acute scrotum, particularly TT, still remains a clinical diagnosis, and clinical parameters deserve more importance in surgical decision making.

Epididymitis is Often Post-Infectious

Epididymitis is Often Post-Infectious

529 Impact on male fertility in a mouse experimental acute epididy mitis model due to chlamydia trachomatis

529 Impact on male fertility in a mouse experimental acute epididy mitis model due to chlamydia trachomatis

The incidence and investigation of acute scrotal problems in children.

The true incidence of the various causes of acute scrotum in children is unclear; epididymo-orchitis (EO) is thought to be uncommon. Investigation for underlying urological abnormality in children with EO is recommended. To determine the incidence of the various pathologies in boys presenting to the emergency department with an acute scrotal condition and assess the value of further investigation of the urinary tract in a subgroup of boys with EO, a retrospective review of 100 consecutive patients admitted with a diagnosis of testicular pain was performed. Seventy had torsion of an appendix testis (TAT) and 12 had torsion of the testicle (TT). Ten boys were admitted with 11 episodes of EO; 7 had other pathologies including incarcerated hernia, varicocoele, and idiopathic scrotal oedema. The diagnosis of EO was made at operation in all 11 episodes. Escherichia coli was cultured in 4 patients; none were found to have underlying urinary tract abnormality. TAT was thus commonest causes of the acute scrotum. EO is not rare in infants, the incidence in this study being equal to the of TT. Subsequent urological investigation did not disclose any underlying abnormality. However, based on the current published literature futher investigation is recommended in selected cases.

Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000.

A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.

The role of ultrasound in scrotal trauma.

We reviewed the sonograms of 16 cases with scrotal trauma and documented the spectrum of abnormalities that may be present in sonography after a scrotal injury. The sonographic findings included scrotal hematoceles, post-traumatic epididymitis, epididymal hematoma, testicular hematoma and/or infarction, testicular rupture, testicular swelling and hyperemia. Ultrasound is able to distinguish intratesticular and extratesticular lesions. The integrity of the testis could be evaluated as well. It should be the imaging modality of choice for the evaluation of scrotal trauma.