Testicular Symptoms Research Articles

Enhancing Men's Awareness of Testicular Diseases (E-MAT) using virtual reality: A randomised pilot feasibility study and mixed method process evaluation.

Testicular cancer is among the most common malignancies in men under the age of 50 years. Most testicular symptoms are linked to benign diseases. Men's awareness of testicular diseases and testicular self-examination behaviours are suboptimal. In this pilot feasibility study and process evaluation we examine the feasibility of conducting a future definitive randomised controlled trial (RCT) to test the effect of the Enhancing Men's Awareness of Testicular Diseases using Virtual Reality intervention (E-MATVR) compared to the Enhancing Men's Awareness of Testicular Diseases using Electric information control (E-MATE). The study protocol is registered on ClinicalTrials.gov (NCT05146466). Male athletes, engaged in Gaelic games, and aged 18 to 50 years were included. Recruitment was via FacebookTM, XTM (formerly TwitterTM), and posters. Participants were individually randomised to either E-MATVR or E-MATE. Data were collected at baseline (T0), immediately post-test (T1), and three months post-test (T2) using surveys. Qualitative interviews were conducted with participants and researchers. Data were collected from 74 participants. Of those, 66 were retained. All E-MATVR participants and most E-MATE participants (n = 33, 89.2%) agreed/strongly agreed that the device was easy to use and that they were engaged to learn by the device. Most E-MATVR participants (n = 34, 91.9%) and all E-MATE participants agreed/strongly agreed that the time it took them to complete the intervention was reasonable. All 74 participants were extremely satisfied/somewhat satisfied with their overall participation in the study. E-MATVR was described as interactive, easy, fun, and close to real life. Initial difficulty using VR equipment, nausea, and technical issues were identified as challenges to engaging with E-MATVR. Recommendations were made to make VR more accessible, shorten the survey, and incorporate more interactivity. Across all participants, mean testicular knowledge scores (range 0-1) increased from 0.4 (SD 0.2) at T0 to 0.8 (SD 0.2) at T1. At T2, overall mean scores for participants were 0.7 (SD 0.2). Mean knowledge scores did not differ by trial arm at any timepoint. At T2, all E-MATVR participants and 29/32 E-MATE participants (90.6%) reported purposefully examining their testes within the past three months. Findings are promising, highlighting the feasibility of using VR to promote young athletes' awareness of testicular diseases. Considering the strengths, limitations, and lessons learned from this study, some modifications are required prior to conducing an RCT. These include but are not limited to shortening survey questions, incorporating more interactivity and visual content, and targeting more heterogenous male-dominated environments.

Testicular Angiomyolipoma: A Case Report and Review of the Literature

Angiomyolipoma (AML) is a benign mesenchymal tumor, that is composed of thick-walled blood vessels, smooth muscle cells and adipose tissue. They are commonly seen in kidneys, testicles are not a typical location for AML’s; many solid testicular tumors are germ cell malignancies. Here we report the sixth testicular AML case in the literature, to our knowledge. An 80-year-old male undergone bilateral orchiectomy with the diagnosis of local invasive prostate cancer, without any testicular symptoms. Pathological analysis demonstrated a tumor, involving nearly the whole left testicle, composed of muscle cells, vessels and fat tissue, diagnosed as testicular AML. In this article our case is reported and we also make a literature review about testicular AML’s.

Promoting 'testicular awareness': Co-design of an inclusive campaign using the World Café Methodology.

Testicular cancer is the most common cancer in men aged 15-44 years in many countries. Most men with testicular cancer present with a lump. Testicular symptoms are more likely to occur secondary to benign diseases like epididymo-orchitis, a common sexually transmitted infection. Gender and sexual minorities are at an increased risk of testicular diseases and health disparities. The aim of this study was to co-design an inclusive community-based campaign to promote testicular awareness. This study uses the World Café methodology. Participation was sought from Lesbian, Gay, Bisexual, Transgenderand Queer+ friendly organisations, testicular cancer survivors, health policy makers, media and marketing expertsand graphic designers. Participants engaged in three rounds of conversations to co-design the campaign. Data were collected using drawing sheets, artefact cards, sticky notes, coloured markersand a voice recorder. Deductive thematic analysis was conducted. Seventeen individuals participated in the study. Six themes emerged from the analysis as follows: (i) online communication; (ii) offline communication; (iii) behavioural targeting and education; (iv) campaign frequency and reach; (v) demographic segmentation; and (vi) campaign identity. The use of social media for campaign delivery featured strongly in all conversations. Participants also recommended offline communication using posters and radio/television advertisements to scale up the campaign and achieve wider reach. Advertisements to overcome embarrassment surrounding testicular health were particularly recommended. Participants emphasised that campaign delivery must be dynamic whilst ensuring that the health-promoting messages are not diluted or lost. They stressed the importance of being inclusive and tailoring the campaign to different age groups, gender identitiesand sexual orientations. Study recommendations will be used to design and deliver the campaign. Future research will be needed to evaluate the feasibility, acceptability, costand effect of the campaign on promoting testicular awareness and early detection of testicular diseases. A participatory research approach was used to co-design the campaign with members of Lesbian, Gay, Bisexual, Transgenderand Queer+ (LGBTQ+) friendly organisations, LGBTQ+ student bodies, LGBTQ+ staff networks, LGBTQ+ sports clubs, men's health organisations, testicular cancer survivors, health policy makers, media and marketing expertsand graphic designers.

Enhancing men's awareness of testicular diseases: A feasibility trial and process evaluation

Abstract Background Testicular cancer is the most common cancer in men aged 18 to 44 years. Symptoms of testicular cancer can mimic those of benign diseases like epididymitis and torsion. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. Athletes involved in field games like hurling are at risk for testicular trauma and diseases. The aim of the enhancing men's awareness of testicular diseases (E-MAT) study was to explore the feasibility of conducting a definitive trial to test the effect of E-MATVR (intervention; virtual reality [VR] game) compared to information delivered electronically E-MATE (control; information in PDF format) on testicular knowledge and self-examination among athletes. Methods In total, 74 participants were recruited from nine Gaelic Athletics Association (GAA) sports clubs in County Cork in Ireland using social media posts and posters. Participants were individually randomised to either E-MATVR or E-MATE. Outcomes were measured at T0 (baseline), T1 (immediately post-test) and T2 (3 months post-test). Results Testicular awareness increased significantly between T0 and T1 (p = 0.01) in both groups. Testicular awareness further increased at T2 for E-MATE participants. All participants in E-MATVR (n = 37, 100%) agreed that the VR headset was easy to use and that they were engaged to learn, while almost all E-MATE participants (n = 33, 89%) agreed with these statements. Most participants in both arms agreed that the time it took to complete the intervention was reasonable (p = 0.036). All participants were either extremely satisfied or somewhat satisfied with their overall experience of participating in the study. Conclusions VR may be effective in enhancing men's awareness of and help-seeking intentions for testicular diseases. A future definite trial is warranted to test the effect of E-MATVR. Key messages • VR may be effective in promoting the wellbeing of hard-to-reach populations, particularly among young men, to help raise awareness and promote testicular self-examination and early help-seeking. • VR may help detect testicular diseases early, reduce treatment costs, and improve overall health outcomes.

Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation

Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men’s awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men’s awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MATVR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MATE (control; same information as E-MATVR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial. Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MATVR and E-MATE, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.

2,3,7,8-tetrachlorodibenzo-p-dioxin induces multigenerational testicular toxicity and biosynthetic disorder of testosterone in BALB/C mice: Transcriptional, histopathological and hormonal determinants

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a potent environmental contaminant, is an endocrine disrupter with a proven reproductive toxicity in mammals. However, its effects on male fertility across generations are still elusive. The current work evaluates the toxicity of dioxin on male reproductive system in two separate groups of BALB/C mice; a group of pubertal males directly exposed to TCDD (referred to as DEmG), and a group of indirectly exposed males (referred to as IDEmG) comprises of F1, F2 and F3 males born from TCDD-exposed pregnant females. Both groups were exposed to 25 μg TCDD/kg body weight for a week. Our data show that males of TCDD-DEmG exhibited significant alterations in the expression of certain genes involved in the detoxification of TCDD and the biosynthesis of testosterone. This was accompanied with testicular pathological symptoms, including a sloughing in the germinal epithelium and a congestion of blood vessels in interstitial tissue with the presence of multinuclear cells into seminiferous tubule, with a 4-fold decline in the level of serum testosterone and reduced sperm count. Otherwise, the male reproductive toxicity across F1, F2 and F3 generations from TCDD-IDEmG was mainly characterized by: i) a reduce in body and testis weight. ii) a decrease in gene expression of steriodogenesis enzyme, e.g., AhR, CYP1A1, CYP11A1, COX1, COX2, LOX5 and LOX12. iii) a remarked and similar testicular histopathology that found for DEmG, iv) a serious decline in serum testosterone. v) a decreased male-to-female ratio. vi) a low sperm count with increasing abnormalities. Thus, pubertal or maternal exposure to TCDD provokes multigenerational male reproductive toxicity in mice, ultimately affecting the spermatogenesis and suggesting that the hormonal alternation and sperm abnormality are the most marked effects of the indirect exposure of mammalian male to TCDD.

In vitro evidence against productive SARS-CoV-2 infection of human testicular cells: Bystander effects of infection mediate testicular injury.

The hallmark of severe COVID-19 involves systemic cytokine storm and multi-organ injury including testicular inflammation, reduced testosterone, and germ cell depletion. The ACE2 receptor is also expressed in the resident testicular cells, however, SARS-CoV-2 infection and mechanisms of testicular injury are not fully understood. The testicular injury could be initiated by direct virus infection or exposure to systemic inflammatory mediators or viral antigens. We characterized SARS-CoV-2 infection in different human testicular 2D and 3D culture systems including primary Sertoli cells, Leydig cells, mixed seminiferous tubule cells (STC), and 3D human testicular organoids (HTO). Data shows that SARS-CoV-2 does not productively infect any testicular cell type. However, exposure of STC and HTO to inflammatory supernatant from infected airway epithelial cells and COVID-19 plasma decreased cell viability and resulted in the death of undifferentiated spermatogonia. Further, exposure to only SARS-CoV-2 Envelope protein caused inflammatory response and cytopathic effects dependent on TLR2, while Spike 1 or Nucleocapsid proteins did not. A similar trend was observed in the K18-hACE2 transgenic mice which demonstrated a disrupted tissue architecture with no evidence of virus replication in the testis that correlated with peak lung inflammation. Virus antigens including Spike 1 and Envelope proteins were also detected in the serum during the acute stage of the disease. Collectively, these data strongly suggest that testicular injury associated with SARS-CoV-2 infection is likely an indirect effect of exposure to systemic inflammation and/or SARS-CoV-2 antigens. Data also provide novel insights into the mechanism of testicular injury and could explain the clinical manifestation of testicular symptoms associated with severe COVID-19.

Bilateral Testicular Torsion: A Systematic Review of Case Reports.

Bilateral testicular torsionis a rare but serious condition characterized by twisting both testicles around their respective spermatic cords, leading to reduced blood flow and potential loss of the testicles. Treatment of this condition may involve surgical detorsion of the affected testicles and fixation to prevent recurrence and, in some cases, removal of severely damaged testicles. In April 2023, a systematic review of case reports was performed to examine the presentation, clinical features, diagnostic process, and management of bilateral testicular torsion. Our search encompassed the following databases: PubMed, ScienceDirect, and Google Scholar. Out of 340 studies, only eight cases met our criteria. However, this review discusses bilateral testicular torsion symptoms, investigation, and outcome.

Testicular Torsion in Children. Diagnostic and Prognostic Potential of Ultrasonography

Introduction: Testicular torsion is the most urgent case in pediatric andrology that requires emergency care due to the high sensitivity of testicular tissue to hypoxia.Objective: To determine statistically significant parameters indicating diagnostic significance of some ultrasonographic testicular torsion symptoms in children.Materials and methods: Ultrasonography was performed in 202 children with testicular torsion (main group) and 449 patients (control group) aged from 2 months to 17 years 11 months and 28 days. During statistical processing we determined the mean values, their standard deviation, sampling errors, significance of differences in the mean values, correlation coefficient and did ROC analysis. For an objective ultrasonographic assessment of testicular shape, we implemented the coefficient of rounding – ko = (testicular length – testicular thickness) / testicular length – and the parameter Δko calculated as the difference between ko for the affected side and the contralateral one.Results and discussion: Testicular torsion was more common in children above 12 years of age (84.7%). The ko was 0.160 ± 0.007 in the group of children with testicular torsion and 0.037±0.003 in the control group (t = 16.92, p >> .001). The ROC analysis proved the Δko to be highly informative: AUC was 0.886. The Δko was 0.130 ± 0.008 for patients with favorable treatment outcomes and 0.19 ± 0.01 (p < 0.001) for those with unfavorable outcomes. In most cases (71), the whirlpool sign was visualized with preserved blood flow. In such a case, the probability of the favorable treatment outcome was 74.6%. The whirlpool sign visualization was significantly less common (31 cases) without Doppler ultrasonography; favorable treatment outcomes were achieved in 54.8%. Of 22 patients with the undetected whirlpool sign, favorable treatment outcomes were possible only in 40.9%.Conclusions: The coefficient of rounding ko can be used as an auxiliary criterion for the early diagnosis of testicular torsion. With Δko = 0.08, the sensitivity of the parameter in respect of testicular torsion is 79.2%, and specificity is 85.7%. With Δko = 0.16, the specificity of the parameter is almost 100% with a 45.0% decrease of the sensitivity. Whirlpool sign detection using color Doppler ultrasonography is a positive prognostic factor.

Orchialgia After Living Donor Nephrectomy: An Underreported Entity.

Background.Laparoscopic donor nephrectomy (LDN) offers advantages to the donor. The reported incidence of testicular pain after LDN varies in the literature ranging from 3% to 55%.Methods.A survey was sent to 322 male LDN patients who donated from February 5, 2009, to February 5, 2019. The survey assessed if the donor had testicular pain or saw an additional medical professional after donation.Results.Of the 322 surveyed, 147 (46%) responses were received. Of those who had a left nephrectomy, 39% had testicular pain; 23.8% of those patients had testicular swelling in addition. Of those who had pain, laterality of kidney donated did not impact if the patient had pain, pain onset, pain level, or pain duration. Of those who donated their right kidney, 35% had testicular pain, and 16.7% of those patients reported testicular swelling in addition. Twenty-seven symptomatic patients sought additional medical care for the testicular symptoms postdonation. Seven (25%) had hydroceles, 2 (7%) had testicular cysts, 1 had a urinary tract infection, and 16 (59%) had reassurance or no additional procedures provided.Conclusions.Our results suggest that orchialgia is not as uncommon as previously thought and may be one of the most common minor complications experienced by male donors.

Isolated epididymal tuberculosis: case report and review of literature

<p>Ethiopia is one of the countries with high burden of pulmonary tuberculosis and the number of cases of extra pulmonary is increasing. However, diagnostic evidence to initiate anti-tuberculosis treatment among extra pulmonary tuberculosis (EPTB) cases is not well known. We presented here a case of isolated tuberculosis epididymitis with scrotal sinus after developing nonspecific testicular symptoms for more than 2 months and review the literature. Tuberculous epididymitis is a form of urogenital tuberculosis that is particularly rare and has the same clinical manifestation that mimics other more common infectious causes of epididymitis, leading to delay in diagnosis. So, one should maintain a high-index of suspicion to accurately diagnose tuberculous epididymitis in individuals presenting with suggestive signs and symptoms.</p>

The effect of the COVID-19 pandemic on patients with testicular germ cell tumor.

The aim of this study was to investigate the effects of the COVID-19 pandemic on the referral, diagnosis, treatment, and follow-up of germ cell tumor (GCT). A retrospective single-center analysis of all patients who underwent diagnostic and surgical procedures due to GCT was performed from September 2018 to September 2021. 65 patients were enrolled into the study by dividing them into two groups as before pandemic (Pre-CovGCT) and during the pandemic (CovGCT). 33 patients in the Pre-CovGCT group and 32 patients in the CovGCT group were evaluated and compared. A significant increase was observed for symptom duration (p = 0.018), the duration between diagnosis and surgical procedure (p = 0.028), and occult metastasis risk of stage 1 tumors (p = 0.05) during the pandemic period. The duration of symptoms and the duration between the diagnosis and surgical procedure were prolonged in GCT patients diagnosed during the pandemic. Furthermore, an increased risk of occult metastasis has been observed in stage 1 GCT patients. We underline the importance of raising the awareness of patients about admission to the hospital without delay in the presence of testicular cancer symptoms and recommend to be careful not to delay the treatment process.

Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation.

Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men's awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MAT VR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MAT E (control; same information as E-MAT VR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial. Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MAT VR and E-MAT E, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.

HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL CHARACTERIZATION OF ADULT TESTES EXPOSED TO DICLOFENAC SODIUM: THE ACUTE EXPOSURE SYNDROME

Background: Diclofenac sodium is a non-steroidal anti-inflammatory medication with prostaglandin synthesis inhibiting properties. It has long been used to treat a variety of testicular problems and symptoms. However, the use of NSAIDs for specific disorders has generated some concerns due to their ability to trigger apoptosis in a variety of cells. Objective: The goal of this study was to discover if Diclofenac sodium had any effect on the reproductive function of the testes. Methods: Ten male Wistar rats (160 – 200g weight) were randomly distributed into two groups designated as groups A and B respectively. The rats in group A were injected with physiological saline while the rats in group B were given 5mg/kg Diclofenac sodium (IM) for three days. Twenty-four hours (24hrs) after the administration of the last respective dose, the rats were euthanized using Ketamine (10mg/kg IM). The testes were excised, fixed in Bouin’s fluid (48hrs), and subsequently processed according to the general techniques of tissue processing and microtomy as described by Bancroft and Gamble. Serial sections (5µm thickness) of the paraffin-embedded testicular tissue were obtained for the individual stains to be carried out. Results: Diclofenac sodium caused a considerable (p<0.05) loss in body weight of the experimental rats, as well as a significant (p<0.05) reduction in their sperm counts and motility, with an increase in the number of immotile sperm cells. When compared to the control group, rats given Diclofenac sodium showed a significant decrease in testicular carbohydrate, as well as decreased Ki67 and increased Cyclin D1 expression. Conclusions: Our data support the hypothesis that acute injection of Diclofenac sodium at a dose of 5 mg/kg for three days produces testicular injury and inhibits reproductive functioning. This paper discusses the immunohistochemistry effects of diclofenac sodium on testes.

Oxidative Stress and Carcinogenic Effect of Formaldehyde Exposure: Systematic Review and Analysis

Background: Evaporation of formaldehyde from embalmed cadavers cause terrific systemic hazards, from which the most frequently reported, is respiratory and testicular symptoms. Day-dependent exposure to formaldehyde can cause contact dermatitis, congenital defects like low birth weight and isolated heart disease, cytotoxicity in the respiratory tract in the form of acute lung injury, nasal obstruction, pulmonary edema, and cancer. The histopathologic and morphometric alterations in testis have a strong link with exposure duration periods and highly linked to decrease the function of both sertoli and leydig cells. Several findings ensured such exposure significantly causes and triggers tremendous health effects, but a conclusive review of findings and recommendations related to its oxidative stress and carcinogenic potential on multiple study subjects on the respiratory system and testis are lacking. This study is initiated to shade light on the risk of exposed individuals, warrant caution to those individuals and provide protective measurements in the dissection room. Methods: We performed a systematic review using databases of Google Scholar, PubMed Central, Scopus, Medline Cochrane, and Web of Science. The search yielded 66 scientific articles out of which 26 were included in the discussion of the oxidative stress and carcinogenic effect of formaldehyde exposure on the respiratory system and testis. Results: The review of the animal and human findings has shown significant oxidative stress and carcinogenic potential of formaldehyde exposure and anti-inflammatory responses of some novel agents. The effects of formaldehyde exposure depend on the lining tissue type, formalin concentration in embalming fluids, length of exposure, ways of exposure, animal type, sexual category, and a mixture of other aldehydes. Conclusion: Formaldehyde causes dose-dependent oxidative stress, which is generally known to be detrimental to respiratory and testicular tissues. Formaldehyde has day-dependent carcinogenic effect in the upper respiratory tract. The possible negative manifestation of oxidative stress is due to the altered levels of trace elements in formalin treated testicular tissues and the most viable consequence of formaldehyde in testis tissue architecture is due to its potential to stimulate the reactivity of trace elements. From the review, it was concluded that females as the most sensitive, 20 minutes as the least exposure duration and 0.08 milligram per kilogram (mg/kg) as the least toxic dose of formaldehyde exposure. Regardless of the high potential of formaldehyde related tissue lesion, the reversible effects of some novel agents such as vitamin E, fish omega-3, melatonin, rose oils, flavonoids, polyphenols, Caffeic Acid Phenethyl Ester/CAPE, garlic aqueous extract were observed in reversing of the destructive property of formaldehyde. Despite complete prevention is not possible, exposed personnel should be cautious of the deleterious effects associated with occupationally exposed formaldehyde vapor.

Brucellar epididymo-orchitis: a retrospective study of 25 cases

Objective: Brucellosis is a multisystemic disease which may affect all organs. Epididymo-orchitis is the most common form of genitourinary involvement. The aim of this study was to present our eight-year experience regarding the management of patients with brucellar epididymo-orchitis (BEO).Materials and method: The medical records of male brucellosis patients treated in two centers, between 2010 and 2018 were analyzed retrospectively. The diagnosis of epididymo-orchitis was made when the patients had scrotal pain, swelling, and enlarged tender testicles and/or epididymis on clinical examination. Brucellosis was diagnosed with a positive standard tube agglutination test or a positive blood culture.Results: Brucellosis was diagnosed in 996 male patients. Of these patients, 25 had a diagnosis of BEO (2.5%). All BEO patients suffered from enlarged painful testicles, however, testicular complaints were the only presentation symptoms in three of them. All patients received medical treatment alone except one patient with testicular abscess who underwent surgical drainage besides medical treatment. All patients recovered completely and no relapses have been detected during six-month follow-up.Conclusion: Patients with epididymo-orchitis should be investigated for brucellosis especially in endemic regions. To our knowledge, BEO patients may present with isolated testicular symptoms that make a diagnostic challenge.

Indocyanine Green Fluorescence Lymphography: A New Technique to Perform Lymphatic Sparing Laparoscopic Palomo Varicocelectomy in Children.

Laparoscopic Palomo varicocelectomy is one the most common approaches adopted to treat pediatric varicocele, but postoperative hydrocele still remains a potential problem with this procedure. This study aimed to evaluate the outcome of a new technique of lymphography using indocyanine green (ICG)-enhanced fluorescence to perform lymphatic sparing laparoscopic Palomo varicocelectomy. The records of 25 patients who underwent laparoscopic left varicocelectomy in our unit from March 2017 to March 2018 were retrospectively evaluated. The average patients' age was 13.7 years (range 12-16). All patients had a high degree varicocele associated with left testicular hypotrophy and symptoms. All procedures were performed in laparoscopy using three trocars. After trocars' positioning, 2 mL of ICG solution was directly injected into the left testicle. Using ICG fluorescence, the lymphatic vessels were clearly identified and spared, and then the entire spermatic bundle was clipped and divided according to Palomo's principle. The average operative time was 18 minutes (range 10-25). No conversions to open surgery and no allergy or other adverse reactions induced by ICG were reported. At a maximum follow-up of 18 months, no recurrence of varicocele or postoperative hydrocele was recorded. Our preliminary experience showed that ICG fluorescence lymphography is a safe and effective option to perform lymphatic sparing laparoscopic Palomo varicocelectomy in children and adolescents with high degree varicocele. The intratesticular injection of ICG and use of fluorescence vision allowed identification of lymphatic vessels in 100% of cases. No allergy to ICG or postoperative hydrocele was reported in our experience.

Testicular Awareness: The What, the Why, and the How

Globally, men have a lower life expectancy than women and health outcomes among men are poorer than women. Only Australia, Brazil, Iran, and Ireland possess national men’s health policies. Testicular disorders can have a negative effect on men’s health and are rarely addressed in these policies. Findings from the empirical literature on men’s awareness of testicular disorders suggest that men’s knowledge of testicular disorders is lacking and their intentions to seek timely medical attention for testicular symptoms are low. This paper aims to introduce the concept of ’testicular awareness’ and explore its implications for health research, practice, and education. The key attributes of ‘testicular awareness’ include: (i) familiarity with own testes; (ii) knowing what is normal versus abnormal; (iii) ability to detect an abnormality; and (iv) knowing own risk factors. Testicular awareness is an all-encompassing concept since it helps men become familiar with an intimate body part that is seldom discussed and enables them to detect testicular abnormalities and to seek timely medical attention for testicular symptoms, regardless of the ultimate diagnosis. Testicular awareness can be promoted using a number of strategies, such as: (i) involving men in drafting men’s health policies that address testicular awareness; (ii) partnering with men to develop and test interventions promoting testicular awareness; (iii) being cognizant of the learning needs of men who are at risk of health disparities including those with low literacy and health literacy; (iv) promoting testicular awareness in clinical practice and health education; and (v) using men’s daily spheres of information to promote testicular awareness; these include but are not limited to: workplaces, universities, gyms, and community organizations.

Enhancing Men's Awareness of Testicular Disorders Using a Virtual Reality Intervention: A Pre-Post Pilot Study.

The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low. The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes. Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2). Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2. The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.

Promoting men’s awareness, self-examination, and help-seeking for testicular disorders: a systematic review of interventions

Background: Testicular cancer (TC) is commonly diagnosed among men aged 15-40 years. The incidence of TC is on the rise. Benign testicular disorders such as testicular torsion and epididymitis can lead to testicular ischemia, sepsis, and infertility if left untreated. This systematic review aims to evaluate the effectiveness of studies promoting men's knowledge and awareness of testicular disorders and/or self-examination, behaviours and/or intentions to examine their testes, and help-seeking behaviours and/or intentions for testicular symptoms. Methods: Academic Search Complete, Medline, CINAHL, PsychINFO, ERIC, the Cochrane Library, the World Health Organisation International Clinical Trials Registry Platform, Clinicaltrials.gov, Grey Literature Report, and Open Grey were searched for studies published between November 2014 and April 2018. The methodological quality and level of evidence per outcome were assessed. Results: There were five papers included: two were experimental studies, two were systematic reviews, and one was an integrative review. The majority of the reviewed interventions were successful in increasing men's awareness of TC and self-examination. Examples include a television show featuring a celebrity with TC, a university campaign, and interactive educational sessions. The impact of the reviewed interventions on health beliefs (i.e. perceived susceptibility, severity, benefits, barriers, and self-efficacy) varied across the reviewed literature. Studies promoting help-seeking for testicular symptoms and awareness of benign testicular disorders were lacking. Conclusions: This review highlights the importance of evaluating educational interventions aimed at younger men, whilst raising their awareness of testicular disorders and increasing their help-seeking intentions for testicular symptoms. Given the lack of consensus around scheduled testicular self-examination among younger men, clinicians are encouraged to instruct men to familiarise themselves with the look and feel of their own testes and to seek timely medical attention for abnormalities. Registration: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018093671.