Epididymitis Research Articles

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

BK Nephropathy in Renal Transplant Patients with Epididymo-Orchitis

: The patient was a 10-year-old male that was transplanted six months prior to this study. He was admitted because of epididymo-orchitis, pyuria, glucosuria, and rising blood urea nitrogen (BUN) and creatinine (Cr). BK viruria copy number was 50,000,000. In renal biopsy examination, acute cellular rejection was reported. The diagnosis was BK virus epididymo orchitis with BK allograft nephropathy. His treatment was started by discontinuation of tacrolimus and mycophenolate and starting of leflunomide and low dose prednisolone. After improvement of renal dysfunction and BK load, the treatment regimen was changed to cyclosporine and sirolimus. Renal function after the one-year follow up did not change and remained in a good condition.

A Clinical Study and Management of Inguino-scrotal Swellings In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely.&#x0D; Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome.&#x0D; Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results.&#x0D; Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

Long term follow up of proximal hypospadias repair-urethral stricture should be excluded in adults who present with epididymo-orchitis.

Epididymo-orchitis (EO) is a well-known complication of urinary tract infections (UTI) in children. This is commonly seen in children who had hypospadias repair or in those who had surgery for anorectal malformation especially when it results in urethral stricture. However EO occurring as a complication of urethral stricture in adults operated for hypospadias in childhood is not well documented in the literature. This is a retrospective review of four adults who had proximal hypospadias repair in childhood. All four men presented to us with EO. They were thoroughly investigated to rule out presence of urethral stricture. Three patients had urethral stricture of which two responded well to dilatation and one required cystoscopy and visual internal urethrotomy. The fourth patient did not have urethral stricture. EO in this patient is thought to be due to excessive straining during micturition causing reflux into seminal vesicles. Urethral stricture should be excluded in any adult who had a hypospadias repair and presents with EO. Urethral strictures after hypospadias surgery respond well to dilatation and to endoscopic urethrotomy.

Segmental testicular infarction. Report of two clinical cases and literature review

Segmental testicular infarction is rare. To the best of our knowledge forty cases are reported in literature. We present two cases of segmental testicular infarction with different etiology. The first case was observed after herniorrhaphy and varicocelectomy. The second one occurred after acute epididymitis. Both cases have been treated without radical orchiectomy. We have also reviewed the pertinent literature in terms of differential diagnosis, etiology and management, with particular regard to testicular sparing.

Clinical characteristics of testicular microlithiasis in children

Objective To improve the understanding of the implications of testicular microlithiasis(TM) in paediatric patients by summarizing the clinical characteristics of TM. Methods One hundred and eighteen boys diagnosed as TM based on ultrasound between March 2006 and December 2014 at Shengjing Hospital Affiliated to China Medical University were retrospectively reviewed.Demographic data, imaging data, indications for ultrasound, associated inguinoscrotal pathologies and follow-up data were collected. Results There were 118 cases of patients aged from 0.25 to 14.00 years(averaging 7.98 years). The indication for ultrasound included health check(22 cases), testicular discomfort(28 cases), small testes(6 cases), scrotal mass(10 cases), with history of cryptorchidism(36 cases), with history of hydrocele(15 cases). Concomitant diseases included congenital anomaly of testis in 44 cases[cryptorchidism(34 cases), testicular absence(4 cases), testicular hypoplasia(6 cases)], hydrocele of tunica vaginalis or hernia(15 cases), testicular epididymitis(12 cases), varicocele(6 cases), epididymal cyst(5 cases), testicular teratomas(2 cases), adrenal cortical hyperplasia(1 case), testicular torsion(1 case), and none associated disease(32 cases). Bilateral TM was in 87 cases(the typical TM in 38 cases, limited TM in 49 cases), while unilateral TM was in 31 cases(the typical TM in 8 cases, limited TM in 23 cases). Fifty-three cases were followed up for 1 month to 36 months(averaging 12.5 months), and the condition was stable, no testicular malignancy was observed during follow-up. Conclusions The TM in children is not a rare disease.The etiology of TM is not clear and there are no special clinical symptoms.TM is often associated with testicular abnormality in pediatric patients and the correlation between children′s TM and adult testicular tumor can not be determined yet.The distribution and involving degree of TM is stable in the short term with infrequent testiculoma, but an appropriate follow-up scheme is required, especially during and after puberty. Key words: Child; Testis; Microlithiasis; Sonography

Auditing the use and assessing the clinical utility of microscopy as a point-of-care test for Neisseria gonorrhoeae in a Sexual Health clinic.

We assessed whether urethral microscopy was performed as per clinic protocol for male clinic attendees reporting contact with Neisseria gonorrhoeae (GC), urethral symptoms or given a diagnosis of epididymo-orchitis (EO) over a 12-month period (9732 patients). Prevalence of gonorrhoea in the contacts, urethral symptoms and EO groups was 50, 12.7 and 1.6%, respectively. Microscopy was performed reliably for contacts (96%), those with discharge/dysuria with evidence of urethritis on examination (98%), but not those with EO (43%). We explored the clinical utility of microscopy as a point-of-care test for identifying urethral GC in each subgroup, using the APTIMA Combo 2 CT/GC nucleic acid amplification test as the comparator (1710 patients). Sensitivity of microscopy for each subgroup was good; there was no statistical difference between subgroup sensitivity using Fisher's exact test. Microscopy is valuable to ensure prompt diagnosis and contact tracing. All GC contacts were treated 'epidemiologically'; however, half of GC contacts did not have GC. Microscopy identified the majority of GC cases, including amongst contacts (71% of heterosexual contacts, 66% of contacts reporting sex with men). We propose that epidemiological treatment for GC contacts should be reconsidered on the grounds of antibiotic stewardship, favouring use of microscopy to guide treatment decisions.

Epididymo: Orchitis in an Adult with Scrub Typhus

Introduction: Scrub typhus is a re-emerging Rickettsial infection presenting with protean manifestations and increasingly reported from all over the country. It is an important cause of acute febrile illness. Case Report: A middle aged adult male presented with complaints of fever, abdominal pain and pain in the testes of about two weeks duration. On examination patient was toxic, icteric, had inguinal and cervical lymphadenopathy, hepatosplenomegaly and unilateral tender testes and epididymis. All common causes of FUO (viz) Malaria, Typhoid fever; Dengue and Brucellosis were ruled out by laboratory tests. Serology for Scrub typhus was positive. The patient responded in 24 hours to Doxycycline thus clinching the diagnosis. Conclusion: This case is reported because of the unusual complication of epididymo orchitis in an adult due to Scrub typhus.

O36 Management of acute epididymo-orchitis – supporting two services

IntroductionThe mismanagement of acute epididymo-orchitis (EO) can have significant sequelae. Guidelines exist for the management of EO and we audited practice across two departments (Urology and Genito-Urinary Medicine [GUM]) within...

Sweet's syndrome with idiopathic epididymitis.

Sweet's syndrome with idiopathic epididymitis.

What are the differences between older and younger patients with epididymitis?

PurposeAccording to the aging of society and the spread of antibiotic-resistant strains, it is worth considering the different aspects of epididymitis (EP) in older and younger patients, even though the etiology and therapeutic strategies of this disease are considered to be established. Thus, we investigated how age affects EP-related symptoms.Materials and MethodsData were gathered from 7 hospitals in Hyogo, Japan, and the correlations of age (older or younger) with urine findings such as pyuria or bacteriuria and EP-related symptoms such as fever were investigated.ResultsIn all 308 cases with full data for evaluation, there were 66 febrile (38℃ or higher) cases (21.4%) and bacteriuria was seen in 158 cases (51.3%). In the multivariate analysis, older age (65 years or older) was significantly correlated with the presence of pyuria (p=0.0156). Regarding the relationship between urine findings and EP-related symptoms, pyuria was significantly related to fever (37℃ or higher; p=0.0159).ConclusionsOur data showed that older patients with EP had pyuria significantly more often than did younger patients, which correlated with EP-related symptoms (fever). These data suggest that age-specific guidelines may be necessary.

The feasibility and effect of transutricular seminal vesiculoscopy via submucosal tunnel

Objective To investigate the feasibility and effect of transutricular seminal vesiculoscopy via submucosal tunnel. Methods We retrospectively analyzed clinical data of 23 cases who received transutricular seminal vesiculoscopy via submucosal tunnel from October 2011 to March 2016. Patients' age was 22-46(30.0±6.3) years old, history was 1-120(35.5±34.7) months long. Preoperative diagnosis included hemospermia(4 cases), obstructive azoospermia(14 cases), hemospermia and obstructive azoospermia(2 cases), seminal vesicle stone(1 case), prostate cyst(1 case), and pelvic neoplasm(1 case). We used 8/9.8F ureteroscope as seminal vesiculoscope. After entering the prostatic utricle, the seminal vesiculoscope got into the submucosa tunnel via guidance of zebra wire at the points of 5 and 7 o'clock. Then clockwise, counterclockwise and deep extension were made, side wall of ejaculatory duct was uncovered gradually. The seminal vesiculoscope finally got into the ejaculatory duct and seminal vesicle. After then, we could conduct examination and treatment through vesiculoscopy. Results 19 of 23(82%) patients received seminal vesiculoscopy successfully, the other 4 patients failed on account of critical adhension. Time of fellow-up was 1-55(35.7±15.0) months, 14 of 16(87.5%) patients who received successful surgery got relief of various degree. No incontinence, retrograde ejaculation occurred during follow-up. One patient suffered epididymitis, but got relief after antibiotic therapy. Conclusion Transutricular seminal vesiculoscopy via submucosal tunnel was a feasible choice to conduct seminal vesiculoscopy. Key words: Seminal vesiculoscopy; Prostatic Utricle; Obstructive azoospermia; Hemospermia

Ameliorating Effect of Ginseng on Epididymo-Orchitis Inducing Alterations in Sperm Quality and Spermatogenic Cells Apoptosis following Infection by Uropathogenic Escherichia coli in Rats.

Epididymo-orchitis (EO) potentially results in reduced fertility in up to 60% of affected patients. The anti-inflammatory effects of Korean red ginseng (KRG) and its ability to act as an immunoenhancer in parallel with the beneficial effects of this ancient herbal medicine on the reproductive systems of animals and humans led us to evaluate its protective effects against acute EO. This animal experimental study was conducted in the Department of Anatomical Sciences, Faculty of Medicine, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran during 2013-2015. We divided 50 Wistar rats into five following groups (n=10 per group): i. Control-intact animals, ii. Vehicle-phosphate buffered saline (PBS) injection into the vas deferens, iii. KRG-an intraperitoneal (IP) injection of KRG, iv. EO-an injection of uropathogenic Escherichia coli (UPEC) strain M39 into the vas defer- ens, and v. EO/ KRG-injections of both UPEC strain M39 and KRG. The treatment lasted seven days. We then evaluated sperm parameters, number of germ cell layers, Johnson's criteria, germ cell apoptosis, body weight and relative sex organs weight. Acute EO increased the relative weight of prostate and seminal vesicles (P≤0.05). It also reduced sperm quality such as total motility, sperm concentration (P≤0.01), and the percentage of normal sperm (P≤0.001). Moreover, acute EO decreased Miller's (P≤0.05) and Johnsen's scores and increased apoptotic indexes of spermatogenic cells (P≤0.001). KRG treatment decreased prostate weight gain (P≤0.05) and improved the percentage of sperm with normal morphology, total motility (P≤0.01), and progressive motility (P≤0.05). The apoptotic indexes of spermatogenic cells reduced (P≤0.001), whereas both Johnsen's (P≤0.01) and Miller's criteria increased in the KRG-treated EO testis (P≤0.05). Consequently, KRG ameliorated the devastating effects of EO on the sperm retrieved from either epididymis or testicle in rats.

Co-administration of ginseng and ciprofloxacin ameliorates epididymo-orchitis induced alterations in sperm quality and spermatogenic cells apoptosis following infection in rats.

Korean red ginseng (KRG) may be a beneficial adjuvant along with ciprofloxacin to ameliorate devastating effects of epididymo-orchitis (EO) on male fertility. This study intends to assay the effects of KRG and ciprofloxacin on sperm quality and spermatogenic cells apoptosis in EO rats. We divided 54 adult rats into nine groups (n=6 rats per group): control (CO), sham-operated (SH), EO (E); ciprofloxacin (C), EO-ciprofloxacin (EC), KRG (G), EO-KRG (EG), ciprofloxacin-KRG (CG) and EO-ciprofloxacin-KRG (ECG). We administered ciprofloxacin and KRG 48hr after the Escherichia coli (E. coli) injection for 10days. Bilateral orchiectomy was performed after one sperm cycle (14days) following the last treatment with ciprofloxacin and KRG. Total and progressive motility of E, C and EC groups decreased. However, motility is improved in CG and ECG in comparison with these groups. The E group induced negative changes in the architecture of testes tissue and dramatic increase in apoptosis indices. Interestingly, co-administration of ciprofloxacin and KRG has dramatically improved Miller's and Johnsen's scores and decreased the apoptosis indices of animals in the ECG group. Combined treatment of ciprofloxacin and KRG may improve the quality of spermatozoa and attenuated apoptosis indices in the ECG group.

Epididymo-orchitis in an extremely preterm infant

Abstract Epididymo-orchitis (EO) is a rare condition in the neonatal period. An underlying uropathy is variably associated with EO in published cases and more frequently seen in older children. In this case report, a male baby born at 26 weeks gestation had confirmed congenital Escherichia coli septicemia. The E. coli was sensitive to gentamicin, and he was treated with 10 days of intravenous gentamicin and cefotaxime, with normalization of markers of infection. He did not have a urinary catheter at any stage. He developed recurrent E. coli septicemia 19 days after ceasing antibiotics, in association with a tender scrotal swelling. A urine culture could not be obtained prior to commencing intravenous antibiotics. Surgical exploration revealed a right pyocele and a viable right testis. He was treated with 2 weeks of intravenous piperacillin and tazobactam and a further 2 weeks of oral amoxycillin and clavulanic acid. Urological investigations were normal. No further episodes of EO occurred, and follow-up showed normal testicular growth. This case adds weight to existing literature which suggests hematogenous spread as the most frequent cause of neonatal EO, without urinary tract abnormality. EO as cause of recurrent sepsis in the neonate after apparently adequate treatment of antecedent blood born infection is highlighted. Surgical exploration confirmed diagnosis, and evacuation of the pyocele assisted resolution of systemic sepsis and decompressed the testis.

Acute Scrotum during the First Year of Life

Objective: The aims were to characterize spermatic cord torsion (SCT), to compare it with other causes of acute scrotum during the first year of life and to describe the distinctive features of each causative group. Material and Methods: Ninety-one consecutive neonates (44) and infants (47) were operated on for acute scrotum and the definitive diagnoses for the testicles thus confirmed. The duration of the symptoms and the physical findings were recorded. The histopathology of the removed testicles was studied and bacterial cultures were obtained from patients with epididymitis (ED). Results: Thirty-five boys (39%) had SCT, and incarcerated inguinal hernia (IH) and epididymitis were found in 22 (24%) and 21 (23%) cases, respectively. Torsion of the testicular appendage (TAT) was only seen once. A dark, hard testicle was observed in 91% of the SCT patients, but erythema and tenderness were infrequent. 30 out of 39 (77%) patients had SCT during the neonatal period, including 15 cases in which torsion had occurred prenatally. Only four testicles (11.4%) with SCT were salvaged. Conclusions: The cause of acute scrotum during the first month of life was mostly SCT, while ED was seen more frequently between the ages of 3 and 6 months. A dark, hard testicle was a common finding in the SCT patients, while swelling and erythema were typical of ED. Neonatal SCT has a poor prognosis.

An unusual cause of orchiectomy: Brucella epididymo-orchitis that does not respond to the treatment

Brucellosis is an endemic disease in Turkey, and epididymo-orchitis is a rare complication of brucellosis. A 21-year-old married male presented to infectious diseases clinic with 4 weeks history of swelling, increased temperature on right testicle and acute scrotal pain for 2 days. His physical examination pointed an epididymoorchitis within his radiologi­cal findings; patient was started on standard epididymo orchitis treatment. Upon increase in the patient’s complaint, control radiological evolution was carried out after the completion of antibiotic therapy and showed no resolution of lesions, so patient underwent surgery. Herein, a case of a brucellar epididymo-orchitis that does not respond to the treatment which was resulted in orchiectomy is presented. J Microbiol Infect Dis 2015;5(2): 89-92 Key words: Brucella, epididymo-orchitis, radiodiagnostic imaging, orchiectomy

Management of epididymo-orchitis in three different clinical settings: Streamlining pathways and improving care

Objective: This study represents the first direct comparison of management of epididymo-orchitis (EO) by Accident and Emergency (A&amp;E), Urology and Genito-Urinary Medicine (GUM) departments in a large tertiary care centre, and their compliance with international guidelines. Methods: Case notes of patients with EO who attended A&amp;E, Urology and GUM between January and June 2014 were analysed retrospectively. Results: A total of 127 men were seen (median age: 33, range: 15–79). Forty-four attended A&amp;E (median age: 35), 30 Urology (median age: 37), and 53 GUM (median age: 31). MSU was sent in 17/44 (38.6%) of A&amp;E, 11/30(36.7%) of Urology, and 35/53(66%) of GUM patients. Fifty-three of 53 (100%) of GUM, 14/44 (31.8%) of A&amp;E and four of 30 (13.3%) of Urology patients had chlamydia and gonorrhoea NAAT testing. Of these, 90.9% of A&amp;E, 93.3% of Urology and 100% of GUM patients were prescribed antibiotics. Twelve A&amp;E and one Urology patient were referred to GUM. Conversely, only three of 11 A&amp;E and zero of five GUM patients aged over 50 were referred for urological follow-up. Conclusion: The management of EO, especially in younger men at risk of STIs by A&amp;E and Urology, and older men at risk of urological problems by GUM, is an area for significant improvement. Closer co-operation between departments, unifying local management protocols, abandoning the traditional demographic divide, and ensuring effective referral pathways are essential to improving care.

P2 Epididymo-orchitis: urological condition best managed by sexual health clinicians?

Background/introduction Epididymo-orchitis (EO) is a common urological problem: men frequently present to the Emergency Department (ED), Urology or Sexual Health (SH). EO is caused by STIs (chlamydia and gonorrhoea) and uropathogens. Aim(s)/objectives The aim of this study was to audit the management of EO presenting to ED, Urology and SH locally. Methods 127 patients with EO who attended ED, Urology and SH departments between January–June 2014 were reviewed. Results 127 men were seen (median age: 33, range: 15–79). 44 attended ED (median age: 35), 30 Urology (median age: 37), and 53 SH (median age: 31). Sexual history was documented in 32/44(72.7%) of ED, 20/30(66.7%) of Urology and 53/53(100%) of SH patients. MSU was sent in 17/44(38.6%) of ED, 11/30(36.7%) of Urology, and 35/53(66%) of SH patients. 53/53(100%) presenting to SH had chlamydia and gonorrhoea NAAT-testing; 3 cases had chlamydia (5.7%) and none had gonorrhoea. 14/44(31.8%) of ED and 4/30(13.3%) of Urology patients were tested; none tested positive. 90.9% of ED, 93.3% of Urology and 100% of SH patients were prescribed antibiotics. 45/53(84.9%) seen in SH, 1/44(2.2%) in ED and 1/30(3.3%) in Urology were advised to abstain from sex. Partner notification was documented in 40/53(75.5%) of SH patients, but none in ED and Urology. 30/44(68.2%) of ED, 5/30(16.7%) of Urology, and 47/53(88.7%) of SH patients were followed up within 2 weeks post-treatment. Discussion/conclusion In the absence of torsion or surgical complications requiring hospital admission it would appear to be preferable for patients to be referred to SH for management.