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A 65-year-old male patient presented with complaints of swelling and pain over the right inguinoscrotal region for the past two weeks. The patient had no significant previous medical history and no past surgical history. There was no history of vomiting or diarrhea. Local examination revealed a warm, tender swelling in the right inguinoscrotal region. Blood investigations showed neutrophilic leukocytosis with normal liver and renal function tests. An abdominal and scrotal ultrasound (USG) was performed, which revealed right epididymoorchitis with a multiloculated septated collection within the scrotal sac suggestive of pyocele. The spermatic cord structures were thickened, indicating funiculitis [Table/Fig-1]. The patient underwent a right high orchidectomy, and the postoperative period was uneventful. Histopathology of the specimen showed features of acute inflammation. Seven months following the surgery, he noticed a serous discharge from the right inguinal region with mild swelling and pain at the postoperative site. No definite spermatozoa were identified in the discharge. He was referred for a plain Computerised Tomography (CT) abdomen to the radiology department. Since there was a small opening in the right inguinal region from which discharge was seen, non-ionic water-soluble iodinated contrast was injected through the opening, and a CT fistulogram was performed. The CT fistulogram demonstrated contrast opacification of a tubular structure reaching up to the right seminal vesicle, suggestive of the vas deferens. Hence, a diagnosis of vasocutaneous fistula was made [Table/Fig-2]. Magnetic Resonance Imaging (MRI) screening was also performed, confirming the CT findings [Table/Fig-3]. The prostate and the rest of the abdominal organs were normal. The patient was advised to undergo surgery, and sinus tract excision was performed. The patient is doing well with no evidence of discharge at the postoperative site.

A 28-year-old male patient presented with right-sided scrotal swelling and pain for the past two months. He had a history of loss of appetite and weight, as well as fever for the past ten days. He had no comorbidities. Complete blood count and blood chemistry, including fasting blood glucose, renal, and liver function tests, were normal. Scrotal ultrasound revealed an enlarged right testis and epididymis with heterogeneous echotexture in the right testis and multiple small hypoechoic lesions within it. There was also a focal fluid collection with septations in the right scrotal sac, adjacent to the epididymis [Table/Fig-1]. Increased vascularity in the testis and epididymis indicated inflammation. These ultrasound findings suggested right epididymo-orchitis with an abscess in the extra testicular space of the right scrotal sac, near the epididymis. Abdominal ultrasound was normal. Chest X-ray revealed multiple miliary nodules in both lung fields and a small left-sided pleural effusion, which was confirmed on chest CT [Table/Fig-2a,b]. Contrast-enhanced magnetic resonance imaging of the brain showed multiple small enhancing lesions in the bilateral cerebral and cerebellar hemispheres, as well as the brainstem, with smooth leptomeningeal enhancement. These findings were suggestive of multiple tuberculomas with meningitis [Table/Fig-2c,d]. The patient later underwent drainage of right scrotal abscess and right epididymo-orchidectomy, as the epididymis had sloughed off due to infection [Table/Fig-3]. Mycobacterium tuberculosis was detected in the pus sample using the Mycobacterium tuberculosis DNA test, with no resistance to rifampicin. The patient responded well to antitubercular therapy and is currently being followed up.

Brucellosis is a worldwide zoonotic disease caused by Brucella spp. Human infection often results from direct contact with tissues from infected animals or by consumption of undercooked meat and unpasteurised dairy products, causing serious economic losses and public health problems. The male genitourinary system is a common involved system in patients with brucellosis. Among them, unilateral orchitis and epididymitis are the most common. Although the clinical and imaging aspect of orchi-epididymitis caused by brucellosis have been widely described, the cellular and molecular mechanisms involved in the damage and the immune response in testis and epididymis have not been fully elucidated. In this review, we first summarised the clinical characteristics of Brucella epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of Brucella epididymoorchitis, we mainly discussed the process of Brucella invading testis and epididymis in temporal and spatial order, including i) Brucella evades innate immune recognition of testicular PRRs；ii) Brucella overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) Brucella breaks through the blood-testis barrier with the help of macrophages, and inflammatory cytokines promote the oxidative stress of Sertoli cells, damaging the integrity of BTB; iv) Brucella inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by Brucella at the tissue level. This review will enable us to better understand the pathogenesis of orchi-epididymitis caused by brucellosis and shed light on the development of new treatment strategies for the treatment of brucellosis and the prevention of transition to chronic form. Facing the testicle with immunity privilege, Brucella is like Bruce Lee in the movie Game of Death, winning is survival while losing is death. We summarized the clinical features and pathological changes of Brucellaepididymoorchitis. Our research reveals the pathogenesis of Brucella epididymoorchitis, which mainly includes the subversion of testicular immune privilege by Brucella and a series of destructive reactions derived from it. As a basic framework and valuable resource, this study can promote the exploration of the pathogenesis of Brucella and provide reference for determining new therapeutic targets for brucellosis in the future. [ABSTRACT FROM AUTHOR]

An acute scrotum is a common clinical scenario prompting urologic involvement. Scrotal ultrasonography with Doppler is the main imaging modality utilized for the evaluation of an acute scrotum and can help distinguish testicular torsion from epididymoorchitis, two common causes of testicular pain. Testicular infarction is a rare but potential complication of epididymoorchitis. We report a case of epididymoorchitis presenting with reversal of testicular diastolic flow concerning for impending testicular infarction but with a non-ischemic testis on scrotal exploration and repeat scrotal ultrasonography post-operatively.

The article presents a case study of a disseminated tuberculosis presenting as scrotal swelling in a 28-year-old male patient. Topics discussed include the unusual presentation of tuberculosis as scrotal swelling, the diagnostic findings of scrotal ultrasound and MRI, and the successful management with antitubercular therapy and surgical intervention.

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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. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology. Methods: Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student's t test, and ANOVA were used for analysis. Results: Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers ( p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025). Conclusion: ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup. [ABSTRACT FROM AUTHOR]

Brucella epididymoorchitis (BEO) had been reported up to 20% of patients with brucellosis. Althought it has a good response to spesific antibiotherapy, the delay in diagnosis and in treatment may result in necrosis and abscess formation. Ultrasonography is the basic imaging method for screening of scrotal diseases such as BEO. In literature, there are many studies which present sonographic and magnetic resonance imaging (MRI) features of scrotal and testicular lesions. However, there is no any sufficient publication in which the findings of BEO have been defined on MRI examination. In this report, we presented a patient who had unilateral necrotizian epididymoorchitis and testicular abscess resulted from brucellosis with MRI findings and we also discussed the contribution of MRI to the management of the disease. [ABSTRACT FROM AUTHOR]

Fungal infection of the urinary tract is a relatively rare condition. The incidence ranges from 1-2.2 %. Patients who are critically ill, on long-term antimicrobial treatment, who have an indwelling catheter or suffer from diabetes mellitus, are more susceptible to getting fungal infection. Complications of fungal infection of the bladder include emphysematous cystitis, fungus balls (Bezoars and mycetomas), obstructive uropathy, pyelonephritis, papillary necrosis, intrarenal and perinephric abscesses, prostatitis and epididymo-orchitis. The main treatment includes antifungal agents such as fluconazole and surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract: Testicular problems in children may be both congenital and acquired. These problems are often difficult to diagnose and carry significant sequelae if untreated. Early surgical consultation is often needed for correction of the problem. This article reviews the pathophysiology of the most common pediatric testicular abnormalities with emphasis on the diagnostic modalities employed and current treatment alternatives. [Copyright &y& Elsevier]

Mycobacterium marinum is the most frequent non-tuberculous Mycobacterium in humans. We report the first ever described case of epididymoorchitis resulting from hematogenous spread of M. marinum from hand oligoarthritis. This was initially mistaken for rheumatoid disease and methylprednisolone-induced immunosuppression led to hematogenous spread of infection to the testis and epididymis. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: We describe the clinical characteristics, treatment and long-term outcome of 19 patients with Brucella epididymoorchitis treated at the Department of Urology. Materials and Methods: Between 1998 and 2005, a total of 19 cases with epididymoorchitis due to Brucella melitensis were diagnosed at our hospital. The diagnosis of Brucella was made by isolating Brucella species from blood culture or epididymal aspiration or by standard tube agglutination testing and slide agglutination testing together with clinical findings. Results: Seven cases (36.8%) had undulant fever. Brucella species was isolated from blood cultures in 11 patients and from epididymal aspiration in 3 patients. Rose Bengal tests were positive in all patients. Total recovery was obtained in 12 cases with a 6-week treatment. Five patients (26.3%) did not respond to therapy and another 2 (10.5%) relapsed. Conclusions:Brucella orchitis should be considered in the differential diagnosis of scrotal pathologies where Brucella is endemic. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Some of testicular tumor cases can present with symptoms like epididymo-orchitis and this condition can cause delay in the diagnosis of testis tumor. Even though scrotal Doppler ultrasound has high sensitivity (up to 100%) in the diagnosis of testicular lesions; it alone may not be sufficient in the differential diagnosis of benign and malign lesions. The delay of the diagnosis can cause progression of stage and consequently worsening prognosis. In this case, it was aimed to present a case that is thought to be testicular tumor according to Elastography which applies with clinical features like epididymo-orchitis and cannot be diagnosed with B-mode scrotal Doppler ultrasound. [ABSTRACT FROM AUTHOR]

Summary: Background: Epididymoorchitis is the most frequent genitourinary complication of brucellosis. Methods: This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement. Results: Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9±7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6–8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis. Conclusions: Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man. [Copyright &y& Elsevier]

Brucellosis may involve many organs and tissues. Epididymoorchitis is a focal genitourinary complication of human brucellosis. In this study, we describe our experience with the diagnosis, treatment, and final outcomes of 17 patients with epididymoorchitis out of 186 male patients with brucellosis between March 1999 and December 2003. The rate of epididymoorchitisdue to brucellosiswas 9.1%. All subjects complained about swollen, painful testicles. The duration of their complaint varied between 1 week and 2 months. Both testis and epididymis were involved in 15 patients and 2 had bilateral involvement. The patients were treated with medical treatment and a complete resolution was achieved in all of them. Patients with Brucella infection occasionally manifest genitourinary complications. Clinicians, especially those serving in endemic areas or serving patients coming from endemic areas, should consider the likelihood of brucellosis as a cause of epididymoorchitis. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Epididymoorchitis caused by Brucella species is a rare infection. In this report two cases of epididymoorchitis due to brucellosis are presented with their clinical and laboratory findings. The patients complained of fever, and painful testicles with swelling, the duration of which varied between 7 to 10 days. They had unilateral epididymoorchitis. Brucellosis was diagnosed serologically in all patients, whereas Brucella spp. was isolated from the blood culture of one patient. One patient was given rifampicin and doxycycline, and the other streptomycin, doxycycline and rifampicin. In all cases, complete resolution was achieved with medical treatment and relapse did not occur. Brucellosis should be considered in differential diagnosis of epididymoorchitis in endemic areas. [ABSTRACT FROM AUTHOR]

Brucellosis is a common zoonotic infection worldwide caused by Brucella species. Central nervous system involvement is a serious complication of brucellosis, and the clinical presentation is quite heterogeneous. The genitourinary system may be affected. Epididymoorchitis is the most common type of urinary tract involvement, which can cause serious complications. Herein, we present a case of brucellosis in a child with a rare combination of epididymo-orchitis and neurobrucellosis not encountered previously in the literature. [ABSTRACT FROM AUTHOR]

Abstract Background Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. Methods In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. Findings Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. Conclusions In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.

Behçet's disease is a systemic vasculitis affecting arterioles and venules and is characterized by recurrent oral ulcers, genital ulcers and ocular inflammation. It can involve any organ but joints, skin, central nervous system and gastrointestinal tract are the most common sites. Here we report an 11-year-old Behçet's disease patient presenting with attacks of myositis accompanied by epididymoorchiis and periodic fever attacks as well as a separate attack of thrombophlebitis. [ABSTRACT FROM AUTHOR]

Henoch-Schönlein purpura, although being a systemic vasculitis, mostly involves skin, gastrointestinal system, joints, and kidneys. Testicular involvement is a rare occurrence. A 7-year-old boy with Henoch-Schönlein purpura developed acute scrotum and was referred to rule out testicular torsion. On gray-scale ultrasonography, the testes and epididymis were slightly enlarged, and had heterogeneous and hypoechoic echotexture. The scrotal wall was thickened as well. Color and power Doppler ultrasonography revealed increased vascularity in scrotal contents. Testicular torsion was excluded and the diagnosis of testicular involvement of Henoch-Schönlein purpura was established. Color Doppler US, together with gray-scale findings, can be useful in the evaluation of Henoch-Schönlein purpura with acute scrotum, excluding testicular torsion and preventing unnecessary surgery. [ABSTRACT FROM AUTHOR]

We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products) and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucelosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.

Introduction: To assess the clinical presentation of patients who underwent surgical exploration for acute scrotum and to investigate the potentially related factors for differential dignosis., Material and Methods: We retrospectively analyzed the medical records of 97 patients who underwent surgical exploration for acute scrotum between May 2007 and July 2013. The patients were divided into two groups as follows: Group1 included patients with testicular torsion (TT) and Group 2 contained patients with acute scrotal pathologies other than TT, including torsion of the testicular appendage, epididymo-orchitis, trauma and Henoch-Schönlein purpura. The physical examination findings, colour Doppler ultrasound (CDUS) and laboratory findings for the groups were compared., Results: In total, 97 scrotal explorations were carried out for acute scrotum. Group 1 included 72 patients (74.2%) and Group 2 included 25 patients (25.8%). Group 2 was comprised of patients with torsion of the testicular appendage (n = 13), epididymo-orchitis (n = 8), testicular trauma (n = 2) and Henoch-Schönlein purpura (n = 2). In Group 1, 32 cases (44.4%) presented to a hospital less than 6 hours after onset of pain. More than half (64%) of Group 2's cases presented more than 24 hours after pain onset. Fever and pyuria appeared more frequently in Group 2 than in Group 1 and the results reached statistical significance (p = 0.001 and p = 0.044, respectively). Group 1 had more testicular tenderness than Group 2 (p <0.001). Our testicular salvage rate was 59.7%, and 40.3% of patients underwent orchiectomy., Conclusions: CDUS predicted the diagnosis of TT (sensitivity 98.6%). Furthermore, clinical findings may also play a substantial role in the differential diagnosis of acute scrotum.