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Epididymoorchitis is a relatively common urologic condition involving the scrotum which presents with unilateral pain and swelling. It is typically treated with antibiotics but can progress to complications such as scrotal pyocele. Global testicular infarction is an exceedingly rare but devastating complication of epididymoorchitis. Grey scale and color Doppler ultrasound demonstrate testicular hypovascularity with subsequent hypoechoic changes of the testicular parenchyma. Scrotal MRI shows T2 hyperintense changes through the testicle with nonenhancement of the testicular parenchyma post contrast, consistent with infarction. The cause of global infarction in epididymitis is uncertain but may be due to mixed arterial and venous insufficiency. This case illustrates a 41-year-old male that developed acute left testicular pain. Initial ultrasound showed an enlarged left testicle with hyperemia. The patient's symptoms progressed and a scrotal MRI demonstrated a lack of left testicular enhancement consistent with global infarction, as well as an adjacent pyocele. Keywords: Epididymitis, Global infarction, Orchitis, Epididymoorchitis, Pyocele

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., Highlights • Doppler ultrasonography is used to characterize epididymal and testicular flow. • Reversal of testicular diastolic flow does not always lead to testicular infarction. • Epididymoorchitis may present as reversal of testicular diastolic flow. • Scrotal exploration is recommended for reversal of testicular diastolic flow.

We report a case of isolated tuberculous epididymoorchitis developing in a patient after haematopoietic stem cell transplantation (HSCT). Forty-four-year-old male was admitted to the hospital with scrotal pain and swelling 6 months after an allogeneic HSCT using a fullymatched sibling donor because of his acute myeloid leukemia. There were scrotal tenderness, thickening and erythema on the right side. Brucella standard tube agglutination test was negative. Increased scrotal skin thickening, edema in the right epididymis and increased testicular vascularization were detected on ultrasonography. He was readmitted to our hospital with recurrent scrotal pain after 3 months of partial improvement with oral ciprofloxacin administered for a diagnosis of right epididymoorchitis. Pelvic magnetic resonance imaging revealed bilateral epididymoorchitis and scrotal abscess. Acid fast bacilli were detected on Ehrlich-Ziehl-Neelsen staining of the content of abscesses drained under local anesthesia. Mycobacterium tuberculosis complex was isolated on the 24th day of quadruple anti-tuberculosis therapy. Scrotal fistula developed on the first month of therapy which healed spontaneously after discontinuation of immunosuppressive agents. Full recovery was achieved after six months of antituberculosis therapy. As a result, tuberculous epididymoorchitis should be kept in mind in the presence of chronic epididymoorchitis developing in patients receiving immunosuppressive therapy.

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, epid-idymo-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

WOS: 000346337000011, PubMed ID: 24831227, 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

WOS: 000232489600010 PubMed: 16215312 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 epididymoorchitis due to brucellosis was 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 (c) 2005 S. Karger AG, Basel.

A bibliographical research evidences that morphofunctional changes of the drainage system of the testis afflicted with its surgical diseases influence negatively on spermatogenesis. Modern methods of correcting testicular surgical diseases require further updating and scientific substantiation., Литературное исследование свидетельствует, что морфофункциональные изменения дренажной системы яичка при его хирургических заболеваниях отрицательно влияют на сперматогенез. Современные методы коррекции хирургических заболеваний яичка требуют дальнейшего усовершенствования и научного обоснования., Літературне дослідження свідчить, що морфофункціональні зміни дренажної системи яєчка при його хірургічних захворюваннях негативно впливають на сперматогенез. Сучасні методи корекції хірургічних захворювань яєчка потребують подальшого удосконалення та наукового обґрунтування.

Epididymoorchitis caused by Brucella species is a rareinfection. Although the most common genitourinary involvementof brucellosis is epididymoorchitis, other findingsmay also occur. Clinical and serological data aresufficient for the diagnosis. We present a-34-year-oldmale admitted to our outpatient clinic with right testicularswelling and pain, high fewer, malaise, arthralgia, myalgiafor ten days and hospitalized with prediagnosis epididymoorchitis.Testicle ultrasonography showed hipoechoicright testicular mass. Tumor markers were measured andfound within the normal limits. Doxycycline and rifampicinwere administered for six weeks and recovered uneventfully.Brucella epididymoorchitis should be kept in mindfor the etiology of epididymoorchitis resistant to standardtherapeutic approach especially in our country where Brucellosisis endemic. J Clin Exp Invest 2012; 3(1): 117-120

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.

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 Brucellosis 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.

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.