Scrotal Infection Research Articles

(025) Laparoscopic Assisted Reservoir Removal of an Infected Inflatable Penile Prosthesis in a Patient with Ipsilateral Inguinal Hernia Mesh Implant

Abstract Introduction Infection is a devastating complication of penile prosthesis implantation ranging from 0.33 to 11.4%. 1 Although a salvage procedure is an option in case of infection, the rule of thumb is to remove all device components. 2 Special considerations and pre-operative planning are essential for better outcome in the management of such condition. We are presenting a video case presentation demonstrating the use of laparoscopic assisted approach to aid in the extraction of the reservoir of an infected penile prosthesis from a patient who had ipsilateral inguinal hernia mesh implant Objective To demonstrate the feasibility and efficacy laparoscopic assisted approach in the removal of difficult to extract inflatable penile prosthesis (IPP) reservoir. Methods A 72-year-old gentleman with past medical history of Diabetes and hypertension presented to our clinic 3 weeks after an IPP insertion that was done in another center. He was complaining of right inguinal bulge and scrotal pain. The bulge developed suddenly without any preceding event. Examination confirmed a prosthesis reservoir herniation in to the right groin. Plan CT abdomen& pelvis confirmed the diagnosis. In three days, the herniated reservoir was managed by inguinal exploration, repositioning of the same reservoir in the right Retzius space and posterior inguinal canal wall repair using a mesh. The patient was discharged on post-operative day 1 in a stable condition, but unfortunately, he developed persistent scrotal pain that progressed into an overt scrotal infection over the early follow up period. During the examination, a scrotal collection was observed, swap was taken from the draining pus and results showed moderate growth of pseudomonas aeruginosa. On the other hand, the inguinal scar showed good healing with no tenderness, indicating the presence of an intact and non-infected inguinal mesh. Therefore, the decision was made to remove all components of the prosthesis without removing the mesh. Considering the anticipated challenges associated with removing the reservoir of the IPP through a scrotal approach, a decision was made to incorporate an additional laparoscopic-assisted abdominal approach for reservoir removal. Results Removal of the IPP cylinders and pump was performed through a scrotal incision, then a laparoscopic assisted abdominal approach was used successfully to remove the reservoir. After the IPP explant procedure, patient had an uneventful smooth recovery at the two and four weeks follow up visits, he was advised to use Vacuum erection device (VED) to alleviate possible penile fibrosis/shortening. A penile prosthesis reimplantation procedure was planned in a 6 months period Conclusions Laparoscopic assisted approach for penile prosthesis reservoir extraction is a feasible and safe technique that can be used in anticipated cases of difficult reservoir extraction. Pre-operative assessment, planning and counselling are crucial in obtaining a favorable outcome in such complex cases. Disclosure No.

No Detectable Association Between Virtual Setting for Vasectomy Consultation and Vasectomy Completion Rate.

The COVID-19 pandemic has fueled widespread incorporation of telehealth into urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual vs in-person consultation. All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations without option for in-person visit due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-square test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. Four hundred ninety-one patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. One hundred ninety-seven (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in person. Three hundred seventy (75.4%) of all patients seen for consultation (both virtual and in person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (P = .91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their preoperative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation.

A review of prevention and management of castration complications

SummaryDespite castration being one of the most frequently performed elective equine surgical procedures, complication rates are high and range from severe life‐threatening conditions to mild complications that are of no consequence to the horse. This article will briefly review strategies to prevent complications and surgical castration techniques before reviewing, in‐depth, the following complications: excessive scrotal swelling and seroma formation, scrotal infection, septic funiculitis, septic peritonitis, haemorrhage, evisceration, omental prolapse, pyrexia, tetanus, penile trauma, hydrocele, signs of colic and continued stallion‐like behaviour. Whilst this list of complications can be daunting, an understanding of male anatomy, castration techniques and an awareness of possible complications can reduce both the incidence and mortality of complications, should they occur. This article will consider castrations performed in both a hospital and field setting and will review complication prevention, surgical techniques of castration and the management of intraoperative and postoperative complications.

MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE

You have accessJournal of UrologyCME1 Apr 2023MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE Ari Bernstein, Hunter Hernandez, Ethan Zhu, Bryce Saba, Eli Rapoport, and Bobby Najari Ari BernsteinAri Bernstein More articles by this author , Hunter HernandezHunter Hernandez More articles by this author , Ethan ZhuEthan Zhu More articles by this author , Bryce SabaBryce Saba More articles by this author , Eli RapoportEli Rapoport More articles by this author , and Bobby NajariBobby Najari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has fueled widespread incorporation of telehealth into Urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual versus in-person consultation. METHODS: All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-squared test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. RESULTS: 491 patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. 197 (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in-person. 370 (75.4%) of all patients seen for consultation (both virtual and in-person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (p=.91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their pre-operative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. CONCLUSIONS: Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ari Bernstein More articles by this author Hunter Hernandez More articles by this author Ethan Zhu More articles by this author Bryce Saba More articles by this author Eli Rapoport More articles by this author Bobby Najari More articles by this author Expand All Advertisement PDF downloadLoading ...

Coronavirus Disease Patients with Acute Testicular Infection: Ultrasound Imaging Findings

Introduction: Objectives: Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in SAIMS Indore, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation. Methods: We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups. Results: A total of 150 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the non- severe COVID-19 group (P = .037). Conclusions: This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.

Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data.

BackgroundDuring the Coronavirus Disease 2019 (COVID‐19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID‐19 infection and scrotal infection are associated.Materials and methodsPatients with a COVID‐19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data.ResultsThe median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo‐orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group.ConclusionsEven if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID‐19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.

The argument against screening for bladder cancer in neuro-urological patients.

The objective of this article was to present the case against screening people with neuro-urological disease for bladder cancer. Literature around bladder cancer in neuro-urological patients (primarily spinal cord injured patients [SCI]) was identified. Bladder cancer is more common among patients with spinal cord injury, although the absolute risk is still low (between 0.3 and 0.6%). It is generally an aggressive disease, with atypical pathologic subtypes, and a high risk of mortality. It usually presents 15-30years after SCI, and chronic inflammation of the bladder (due to catheters and urinary infections) may be risk factors. The debate about whether these patients should be screened for bladder cancer has persisted in the literature, and many physicians have justified a yearly cystoscopy as means of screening for bladder cancer. However, when examining the limited direct evidence of screening for bladder cancer, and the requirements for a screening test, it does not appear that bladder cancer screening is a rationale undertaking due to the low incidence, and unclear natural history. However, urologists should continue to be vigilant and appropriately investigate patients with high-risk symptoms such as hematuria, frequent UTIs, scrotal infection, or urethral discharge. The current literature does not support screening patients with SCI for bladder cancer; however, physicians should have a high-evel of suspicion for symptoms suggestive of bladder cancer, and evaluate these at-risk patients promptly.

Ultrasound Imaging Findings of Acute Testicular Infection in Patients With Coronavirus Disease 2019: A Single-Center-Based Study in Wuhan, China.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in Wuhan, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation. We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups. A total of 142 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the nonsevere COVID-19 group (P = .037). This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.

EXTENSIVE DVT IN A YOUNG MALE WITH PERSISTENT SCROTAL INFECTIONS

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Deep vein thrombosis (DVT) in young adults is uncommon but can be associated with significant morbidity. DVT is often idiopathic but genetic risk factors may play a role. We report a case of extensive DVT of the common iliac veins, inferior vena cava (IVC) and renal veins in a young man without common risk factors. CASE PRESENTATION: 19 year old African American male was admitted in October 2019 with scrotal pain, dyspnea, palpitations, fatigue, fever with chills and non-bloody diarrhea. He was on antibiotics 3 weeks prior to admission for recurrent scrotal infection. In July 2019, he had left sided scrotal pain and swelling treated with incision and drainage followed by multiple antibiotic courses. The patient had no prior history of venous thromboembolism, smoking, or family history of blood clots. Physical exam findings showed ill looking male with mild hypotension and scrotal ulcerations. Labs were significant for lactic acidosis, acute kidney injury, anemia and coagulopathy. Scrotal Ultrasound showed no abscess or torsion. Computed Tomography (CT) of abdomen and pelvis revealed extensive thrombosis of the renal veins, inferior vena cava (IVC) and common iliac veins, along with bilateral lower lobe pulmonary emboli and small pulmonary infarctions. Echocardiogram did not show any right heart strain. He was started on systemic anticoagulation, broad-spectrum antibiotics, intravenous fluids and vasopressor therapy. Vascular surgery and interventional radiology were consulted. Mechanical thrombectomy of the IVC was performed with extensive thrombi removal and restoration of IVC patency. His wound cultures grew Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa resistant to fluoroquinolones. On discharge, he was treated with apixaban for 3 months and aspirin for 4 weeks with a close outpatient follow-up in 1 month. DISCUSSION: DVT in young male is uncommon with a wide differential. Scrotal ulcers can be associated with local thrombosis and extension into the iliac veins based on the anatomic drainage. Management of extensive thrombosis of the venous system can be challenging. CONCLUSIONS: Combination of mechanical thrombectomy and anticoagulation with antiplatelet therapy was effectively utilized to address the extensive thrombosis. Drainage and medical management of scrotal ulcers addressed the underlying etiology of the thrombosis. Reference #1: Cushman, M. (2007). Epidemiology and Risk Factors for Venous Thrombosis. Seminars in Hematology, 44(2), 62–69. doi:10.1053/j.seminhematol.2007.02.004 DISCLOSURES: No relevant relationships by Asok Dasgupta, source=Web Response No relevant relationships by Reed Geisler, source=Web Response No relevant relationships by Ty Gilkey, source=Web Response No relevant relationships by Chelsea Leipold, source=Web Response No relevant relationships by Nicholas Romano, source=Web Response No relevant relationships by Paresh Timbadia, source=Web Response

Incidence and clinical outcome of Cryptococcosis in a nation with advanced HIV surveillance program

Background Cryptococcosis is a major opportunistic invasive mycosis that mostly affects immunocompromised patients. Methods This was an observational study of all culture-confirmed cases of cryptococcosis conducted in the State of Qatar from January 2005 to December 2016. Cryptococcus fungi were identified using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). Results Fourteen culture-confirmed cases of cryptococcosis were identified during the study period. Four patients had a Human Immunodeficiency Virus (HIV) infection with low CD4 count and five were receiving immunosuppressant medications. The rest of the patients were apparently immuno-competent. The central nervous system was the most common site of infection (57%) followed by bloodstream infection (36%) and pneumonia (14%). One patient had a cryptococcal scrotal infection. Twelve isolates were Cryptococcus neoformans and 2 were Cryptococcus laurentii. All isolates were within the wild type ECV values to amphotericin B and fluconazole. Only 2 patients with bloodstream infection (HIV negative) died. The rest were cured of the infection. Conclusion Cryptococcosis is a rare fungal disease in the State of Qatar, mostly diagnosed in Asian immigrants. The central nervous system is the most common site of infection. The presence of the fungus in the blood carries a high mortality.

Update on voiding dysfunction managed with suprapubic catheterization.

As the population ages the prevalence of long-term urinary catheters, especially in the elderly, is going to increase. Urinary catheters are usually placed to manage urinary retention or incontinence that cannot be managed any other way. There is significant morbidity associated with an indwelling catheter. The commonest problems are catheter blockages, infection and bladder stones. These will occur with a similar incidence with either a suprapubic or a urethral catheter. Urethral complications such as strictures, scrotal infection and erosion are less common with suprapubic catheterization (SPC). However the benefit of having a SPC needs to be balanced against the risks involved in inserting the catheter suprapubically. Patient reported symptoms show that a SPC is more comfortable and better tolerated than a urethral catheter. However there needs to be more research into developing better catheters that reduce the frequency of urinary infections and blockages and hence catheter morbidity.

Efficacy of the Artificial Urinary Sphincter ZSI 375 for Treatment of Post-Radical Prostatectomy Incontinence in Patients with Intrinsic Sphincter Deficiency: A Preliminary Study

Objectives: To evaluate the efficacy of the ZSI 375 artificial urinary sphincter (AUS) (Zephyr Artificial Sphincter, Geneva, Switzerland) for the treatment of patients with post-radical prostatectomy urinary incontinence. Methods: This was a retrospective, non-randomised, multicentre study open to patients with moderate-to-severe urinary incontinence due to intrinsic sphincter deficiency after radical prostatectomy. Efficacy and safety was evaluated on continence status, complications, and surgical revision. Results: Twenty-seven patients were recruited between September 2013 and April 2016 and followed up to April 2017. Mean age was 67.70 years old (range: 55–78). Twenty-six patients (96.30%) presented with incontinence post-radical prostatectomy and one patient (3.70%) after post-radical prostatectomy plus adjuvant radiotherapy. Follow-up ranged from 12 months–42 months (mean: 27.11). The success rate was 88.90% after 12 months follow-up, 94.12% after 24 months follow-up and 83.33% after 36 months follow-up. Three patients (11.11%) presented with a scrotal infection, two patients (7.41%) suffered a urethral erosion, and two patients (7.41%) had a mechanical failure. The revision rate was 22.22% (six patients). Conclusion: The follow-up time of this preliminary clinical study was long enough to demonstrate that the ZSI 375 AUS offers a good rate of continence to patients with urinary stress incontinence.

Is the ligation of hernial sac necessary in herniotomy for children? A randomized controlled trial of evaluating surgical complications and duration.

Background:Herniotomy is a common operation done by pediatric surgeons. Recent studies have shown that high ligation in herniation in adult is not necessary, but this method was not fully evaluated in children. We compared non-ligation with high-ligation sac in herniotomy in terms of surgical complications and duration.Materials and Methods:This randomized controlled trial study was done on 104 children with inguinal hernia at Al-Zahra Hospital, Isfahan, Iran, between 2011 and 2013. Patients were equally randomized to undergo herniotomy with ligation of sac at the internal ring level or to undergo herniotomy without sac ligation. Patients were followed up just after the operation, and in the 1st, 6th, and 12th weeks postoperation to discover early (scrotal hematoma, edema, wound infection, and postoperation fever) and late (adhesion and recurrence) complications. Also, duration of operation was recorded for each group.Results:The incidence of early complications (nine cases in high-ligation and eight cases in non-ligation group) was the same in both groups (P = 0.402). No late complication was observed in any group. The mean duration of operation in high-ligation group (18.84 ± 5.47 min) was significantly shorter than non-ligation group (21.46 ± 9.03 min) (P < 0.001).Conclusion:Complications are the same in herniotomy with or without ligation of the sac, but the duration of the non-ligation procedure is shorter than that of high-ligation. We suggest that herniotomy without sac ligation in children be the procedure of choice to save time and also to prevent any other possible complications such as nerve damage, spermatic cord injury, or peritoneal tearing.

Genitourinary brucellosis: results of a multicentric study

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n = 327, 83.8%), as epididymo-orchitis (n = 204, 58%), orchitis (n = 112, 31.8%) and epididymitis (n = 11, 3.1%). In female patients, pyelonephritis (n = 33/38, 86.8%) was significantly higher than in male patients (n = 11/352, 3.1%; p< 0.0001). The mean blood leukocyte count was 7530 ± 3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p< 0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

The filarial dance sign in scrotal filarial infection: A case report

We describe a case of the filarial dance sign (FDS) in the epididymal region of a 22-year-old migrant worker from India who presented with a tender right scrotal swelling. Sonographic examination revealed multiple cystic lesions in the paratesticular region. The FDS was visualized within one of the cystic lesions. FDS is diagnostic of lymphatic filariasis in the appropriate clinical context.

Comparison of brucella and non-specific epididymorchitis: gray scale and color Doppler ultrasonographic features

Objective: The aim of this study is to find out if it is possible to differentiate between brucellar and non-specific epididymorchitis by comparing ultrasonography (US) and color Doppler ultrasonography (CDUS) findings. Material and methods: Fifty-six patients diagnosed to have epididymorchitis both clinically and ultrasonographically were included to study. All of the patients were investigated serologically for brucella. Twenty-eight of those patients were admitted brucella epididymorchitis because of high agglutinations titers for brucella. The other 28 patients were admitted non-specific epididymorchitis because of normal agglutinations titers for brucella. Testicular size, echogenicity, hydrocele, internal echoes and/or septations within hydrocele, and scrotal skin thickness of normal and involved testis were compared by ultrasonography. Besides, pick systolic velocity, end diastolic velocity, resistive index and pick systolic velocity ratio values were measured by bilateral testicular color Doppler ultrasonography in both groups. When the p-value is <0.05, the difference between groups is accepted as statistically significant. Results: Thickening of scrotal skin was seen in 17 of 28 patients with brucella epididymorchitis (BEPO) (67%) and in 25 of 28 patients with non-specific epididymorchitis (NEPO) (89.2%) ( p < 0.01). There was no difference between groups regarding presence of hydrocele. However hydrocele seen in all patients was anechoic except for two patients (8.6%). Hydrocele seen in 18 of 22 patients with BEPO and hydrocele had internal echogenicity or septation ( p < 0.001). Sizes of testes and epididymis were found to be increased in involved testis compared to normal testis. Testes of all patients with NEPO were homogenous with decreased echogenicity except for five patients (17.8%). However, 23 patients with BEPO (82%) found to have heterogenous testis ( p < 0.001). Spectral measurements showed increased PSV and EDV values and decreased RI values in involved sides in both groups. There was statistical significant difference in respect to maximum and minimum flow velocity between two groups ( p < 0.05). There was no difference between the two groups regarding RI values. PSV ratio was 3.1 ± 1.3 in patients with BEPO and 2.2 ± 0.7 in patients with NEPO. Conclusion: Heterogenicity, focal echogenicity differences and hydrocele with granularity and/or septation seen in a patient presenting with scrotal infection in brucella endemic areas must rise the possibility of brucellosis rather than NEPO. By this way, effective treatment can commence immediately and complications can be avoided.

RECONFIGURATION OF THE SEVERELY FIBROTIC PENIS WITH A PENILE IMPLANT

Using evidence based methods we prospectively evaluated the impact of a new surgical procedure on penile deformity caused by severe cavernous fibrosis. In 10 patients with severe penile curvature, shortening and impaired penile rigidity due to fibrosis of the corpora cavernosa we made multiple relaxing incisions of the tunica albuginea and subsequently placed a 3-piece inflatable penile implant. Patients were evaluated before and after the procedure by the International Index of Erectile Function and several general assessment questions. Preoperatively and postoperatively we measured flaccid and erect penile length. At the 6-month followup all International Index of Erectile Function domains were significantly improved compared with preoperative values. Average penile length was increased 2.3 and 3 cm. while flaccid and erect, respectively, compared with before surgery. Complete penile straightening was achieved in 9 of 10 cases (90%). Surgical reoperation was performed in 1 patient (10%) in whom the implant was removed due to scrotal infection and in another (10%) in whom a further single relaxing incision of the fibrotic plaque was needed to attain complete penile straightening. Patients with severe penile curvature, shortening and impaired penile rigidity due to penile fibrosis may be offered this surgical alternative, which proved to be effective and safe in our preliminary series.

Idiopathic infant pyoceles

Three infants presented with acute scrotal swelling, erythema, and a tender irreducible firm mass within the scrotum. All patients were operated upon with the preoperative diagnosis of testicular torsion. At operation, grossly purulent fluid was found in a hydrocele sac. In all the cases, the testes were normal and no source of the scrotal infection was identified. A variety of bacterial organisms were cultured and responded readily to antibiotics. Follow-up has documented survival of the testes without apparent atrophy. "Idiopathic" infant pyocele is rarely described and consequently, not included in the differential diagnosis of patients with acute surgical conditions of the inguinoscrotal region.

Sterilization-attributable deaths in Bangladesh

From January 1, 1979, to March 31, 1980, 20 sterilization-attributable deaths were identified in Dacca and Rajshahi Divisions, Bangladesh. The leading cause of death from tubectomy was anesthesia overdose and from vasectomy, scrotal infection. Overall, the sterilization-attributable death-to-case rate was 21.3 deaths/100,000 procedures. The health impact of contraceptive sterilization is highly favorable: for each 100,000 tubectomies performed, the cost in lives (19) is offset by approximately 1015 maternal deaths averted.

One Thousand Vasectomies

The author reviewed a series of 223 of his patients who underwent bilateral vasectomy. The method involved resecting 2.5 cm of the vas on each side doubling back each end for 1.5 cm and double ligating the ends with nonabsorbable sutures. The ends are then replaced in the anatomical position. No sperm granulomas hematomas or scrotal infection have been noted using this technique. However the operation must be done under general anesthetic and there is more postoperative pain. By the fourth month after the operation 91% of the patients produced 2 specimens that were azoospermic. The method may be more efficient in the long run.