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We report a case of a 48‐year‐old man with testicular infarction caused by epididymo‐orchitis (EO). Multimodal ultrasound showed extensive necrosis of the testis, and the patient underwent right orchiectomy. Postoperative pathology confirmed extensive necrosis of the testis. After 3 months of follow‐up, the examination of scrotal ultrasound showed that the left testis and epididymis had no obvious abnormality. [ABSTRACT FROM AUTHOR]

Vaso-occlusive crisis is a sequela of sickle cell disease that can lead to severe pain and infarction at the location of occlusion. In men, genitourinary complications include priapism, hematuria, and very rarely, testicular infarction. Few cases have been previously reported in the literature, but in all of those cases, partial or complete orchiectomy was performed. We report the first known case of segmental testicular infarct secondary to sickle cell disease treated with medical management without need for surgical intervention.

Feysel Hassen Issack,1 Nahom Tadesse Bogale,1 Samater Mohammed Hassen,1 Abdulhafiz Idris Ibrahim,2 Abdurahman Mohamed Abdi,1 Tariku Mulatu Bore,3 Isak Omer Answar4 1Urology Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 2Department of Radiology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 3Department of Pathology, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia; 4Department of Pathology, University of Gondar, College of Medicine and Health Sciences, Gondar, EthiopiaCorrespondence: Feysel Hassen Issack; Nahom Tadesse Bogale, Urology Unit, Department of Surgery, Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, PO Box:1020, Jigjiga, Ethiopia, Tel +251932511145, Email feyselh@gmail.com; Tadnahi2@gmail.comBackground: Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis in developing countries. Isolated genital TB is rare, but testicular infarction is an unusual complication of delayed management, in which surgical intervention is warranted.Case Presentation: A 29-year-old male non-smoker presents with painful left scrotal pain of 21 days. Initially managed with intravenous antibiotics, the disease progressed and resulted in testicular infarction. Left orchiectomy was performed, and the specimen was sent for histopathological examination, which revealed features consistent with a testicular tuberculous abscess.Conclusion: Tuberculous epididymo-orchitis (TBEO) with testicular infarction was unusual. It is prudent to consider this in patients presenting with long-standing urinary symptoms, particularly in those unresponsive to the initial antibiotic therapy. It requires a high index of suspicion, especially in TB endemic areas.Keywords: tuberculosis, acute scrotum, epididymo-orchitis, genitourinary tuberculosis, testicular infarction, orchiectomy

Epididymal orchitis is a common urological condition for which medical management is the primary treatment strategy. Although Pseudomonas aeruginosa is a common cause of nosocomial urinary tract infections, it rarely causes acute epididymal orchitis in adolescence and is difficult to treat. Furthermore, it may progress to potentially fatal complications such as global testicular infarction and late atrophy. Urinary tract infection(s) can harm the gonads and is a well-known cause of male infertility. This case study involved a 13-year-old boy with acute epididymal orchitis caused by P. aeruginosa infection, which led to testicular infarction. Testicular volume, and anti-sperm antibody, reproductive hormone, and serum inhibin B levels were monitored for six months, which revealed that left testicular volume was 1/20 of that of the right. Anti-sperm antibodies were negative, oestradiol level was elevated, but serum inhibin B level declined. This case report emphasises the importance of early treatment by implementing the use of antibiotic(s) to maximise the opportunity for testicular rescue. Testicular function on the healthy side must be monitored when testicular necrosis is detected.

Introduction Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy. Material and methods A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy. Results Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications. Conclusions Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians. [ABSTRACT FROM AUTHOR]

Epididymo-orchitis (EO) is a common urologic condition that rarely requires surgical intervention. Global testicular infarction is an exceedingly uncommon complication of EO and is thought to occur when severe epididymal edema compresses testicular vessels. We present a rare case of global testicular infarction secondary to epididymo-orchitis in a 17-year-old boy. Predicting which cases of EO will progress to testicular ischemia is challenging, as no clear risk factors have been identified. Early recognition of testicular compromise requires a high degree of clinical suspicion and may provide the opportunity for testis-sparing intervention. [ABSTRACT FROM AUTHOR]

Acute testicular pain with no arterial flow on Doppler ultrasonography is highly consistent with testicular torsion. In adults, there are rare etiologies of testicular infarction other than torsion, including infection, vasculitis, and trauma. We describe a 41-year-old man with type 2 diabetes complicated by severe vasculopathy and positive SARS-CoV-2 status presenting with acute right testicular pain. Surgical exploration and pathology were concerning for arteriosclerosis and vasculitis. These observations suggest that medically complex patients presenting with acute testicular pain in the setting of COVID-19 infection could be at risk for ischemia; causes of testicular pain beyond torsion should be considered.

We present an unusual case of sudden onset of pain in the left testis in a patient with a previous medical history of right orchiectomy due to hemorrhagic infarction. A partial orchiectomy was performed with complete removal of the lesion and reconstruction of the testicular parenchyma. Histopathological assessment confirmed segmental testicular infarction without the presence of malignancy. The patient subsequently received anticoagulant therapy.

A 26-year-old man with symptomatic SARS-CoV-2 infection developed a sudden-onset acute testicular pain. The echo-doppler images showed massive testicular infarction, so orchiectomy was performed. On gross examination, the surgical specimen showed complete testicular necrosis and diffuse thickening of the testicular coverings. Under the microscope, a severe obliterative arteritis was evidenced. SARS-CoV-2 spike antibody was detected by immunohistochemistry in the arterial endothelium. Electron microscopy displayed intracytoplasmic spiky viral particles in endothelial cells. The patient was treated with corticoids and was asymptomatic at last contact.

Testicular torsion during infancy (<1 year) is known to be a rare event with relatively few studies on the subject in the published scientific literature. We reviewed the experience of infant scrotal exploration within a paediatric surgical network of four centres serving an approximate paediatric population of 1.8 million. To review current practice of scrotal explorations in infancy and explore areas for improvement. Retrospective review of emergency operations for acute scrotum between January 2016 and December 2018. Data are presented as median (range) and compared using non-parametric tests. P < 0.05 was regarded as significant. A total of 560 paediatric scrotal explorations were performed. Of these, 25 (4%) were under one year at the time of surgery, median 4 months (1 day-5 months) (Fig. 1). The most common diagnosis was "epididymitis" (11/25, 44%). Testicular torsion was found in 28% (7/25), increasing to 66% (4/6) in those under one month. Of those with confirmed testicular torsion, three (43%) underwent a primary orchiectomy with contralateral fixation and three (43%) detorsion and bilateral fixation, with all three cases found to have testicular atrophy at follow-up. The final case was of metachronous torsion, with the initial presentation not operated on and the subsequent presentation undergoing detorsion and fixation. This was the only case of testicular salvage in our series. There were no underlying urological issues in any patient and no reported complications or ongoing urological issues post-surgery. The rate of follow-up was 17/25 (68%). We present one of the only clinical series to focus on acute scrotum in the under one year old and not just the neonatal period. Testicular torsion remains a rare event in this age group but invariably leads to testicular loss. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive autoinflammatory condition. Recognised features include vasculitis predominantly affecting medium sized vessels, livedoid skin rash, central and peripheral nervous system involvement, variable degrees of immunodeficiency, and marrow failure, amongst other clinical presentations. We present the case of a six year old male with DADA2 who presented with acute testicular ischaemia secondary to vasculitis, the first such description in DADA2. Case presentation A six year old male presented acute right-sided testicular pain. His history included transient infantile neutropenia, resolved hepatosplenomegaly, and longstanding livedo racemosa, leading to screening and confirmation of DADA2 caused by homozygous c.139G > C (p.G47R) mutation of ADA2. As his only clinical feature was that of mild livedo racemosa with normal laboratory parameters at diagnosis, he was being actively monitored prior to starting any treatment. At a routine clinic follow-up a 24 h history of testicular pain was noted on systems review. He was afebrile, and his only physical signs were that of moderate livedo racemosa, and tenderness of the right testicle. Laboratory parameters revealed C-reactive protein (CRP) 8 mg/L (reference range [RR]

Segmental testicular infarction is rare, and the etiology is mostly idiopathic. We report a case series of four young patients, one of them with metachronous bilateral disease, presenting with an acute scrotum and treated with a testis-sparing approach, if feasible, after a negative intraoperative biopsy. Etiology, differential diagnosis, and management are reviewed. To be aware of clinical and imaging features of this benign testicular pathology, it is crucial to avoid unnecessary orchiectomies to preserve vital testicular tissue left.

A 26-year-old man with symptomatic SARS-CoV-2 infection developed a sudden-onset acute testicular pain. The echo-doppler images showed massive testicular infarction, so orchiectomy was performed. On gross examination, the surgical specimen showed complete testicular necrosis and diffuse thickening of the testicular coverings. Under the microscope, a severe obliterative arteritis was evidenced. SARS-CoV-2 spike antibody was detected by immunohistochemistry in the arterial endothelium. Electron microscopy displayed intracytoplasmic spiky viral particles in endothelial cells. The patient was treated with corticoids and was asymptomatic at last contact. [ABSTRACT FROM AUTHOR]

Background: Testicular infarction is a known serious complication associated with epididymitis. It is known to be idiopathic in 70% of cases but the frequency, risk factors, and management are yet to be elucidated. This paper aims to report a case of testicular infarction secondary to pyogenic epididymoorchitis caused by Pseudomonas aeruginosa. Case presentation: A 64-year-old male with a past medical history of benign prostate hypertrophy using intermittent self-catheterization and a recent history of culture-negative pyogenic epididymoorchitis treated with oral cefpodoxime was admitted to our hospital due to a 4-week history of fever, right scrotal pain, and swelling. Scrotal ultrasonography showed a hypoechoic testis without testicular torsion. He was diagnosed with testicular infarction and a scrotal abscess due to Pseudomonas aeruginosa, and was treated with cefepime along with transcutaneous drainage. Despite the antimicrobial treatment, he experienced testicular loss with necrotic tissue. Because little is known about the risk factors, clinical characteristics, management, and prognosis of testicular infarction secondary to epididymitis, we performed a systematic review of the literature. Conclusion: This is a case of testicular necrosis during the treatment of epididymitis with negative urine culture and detection of Pseudomonas aeruginosa in tissue culture. Clinicians should perform frequent blood flow evaluation to the testis for early urologic intervention.

Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of little known etiopathogenesis and idiopathic in the majority of cases. The authors report an original observation of a 23-year-old young patient with a history of untreated orchiepididymitis, which presented to the emergency department for testicular pain. The ultrasound has showed an ischemic testicle and the exploratory scrototomy objectified an epididymo-testicular necrosis associated with ischemia of spermatic cord without torsion. This case highlighted the interest of early diagnosis and effective treatment of orchiepididymitis to prevent this rare serious complication.

Segmental infarction of the testicle secondary to epididymo-orchitis is a rare condition which can be difficult to diagnose and can lead to loss of the testis. We report a case of a 72-year-old man who presented with two weeks of worsening pain of his left testis despite oral antibiotic treatment for epididymo-orchitis. A testicular ultrasound initially revealed a suspected intra-testicular abscess. Despite intravenous antibiotics, his symptoms worsened. A repeat ultrasound demonstrated an increase in size of the lesion and a decision was made to take him to theatre. Intra-operative findings instead revealed a segmental area of testicular infarction requiring debridement.

Segmental testicular infarction is rare, and the etiology is mostly idiopathic. We report a case series of four young patients, one of them with metachronous bilateral disease, presenting with an acute scrotum and treated with a testis‑sparing approach, if feasible, after a negative intraoperative biopsy. Etiology, differential diagnosis, and management are reviewed. To be aware of clinical and imaging features of this benign testicular pathology, it is crucial to avoid unnecessary orchiectomies to preserve vital testicular tissue left. [ABSTRACT FROM AUTHOR]

• A rare case of bilateral epididymo-orchitis complicated with bilateral testicular infarction. • Presentation was fever with persistent, unresolved pain and scrotal swelling. • Antibiotic therapy failed to halt disease progression of bilateral testicular ischemia. • Bilateral orchidectomy performed as both testes were not viable, resulting in castration and lifelong testosterone replacement. Testicular infarction as a result of severe epididymo-orchitis is an uncommon urological emergency, with only a handful of reported cases in literature. We report an even rarer case of bilateral epididymo-orchitis complicated with testicular infarction, resulting in bilateral orchidectomy. 49 year old gentleman presented with fever, persistent, unresolving pain and scrotal swelling of two weeks duration. Despite close clinical monitoring, timely ultrasounds of the testis and antibiotics there was an inexorable progression to bilateral testicular ischemia. This is only the second reported case of this nature in published literature. Epididymo-orchitis usually responds well to appropriate antibiotic therapy, although progression to testicular infarction is possible. Clinical presentation of persistent scrotal pain and oedema in cases of epididymo-orchitis should raise strong suspicion of testicular ischemia or infarction. Despite all efforts, progression to bilateral testicular infarction resulting in castration is a possible catastrophic outcome. [ABSTRACT FROM AUTHOR]

Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist. [ABSTRACT FROM AUTHOR]

Background: Complicated inguinal hernias pose a threat to the life of the child as well as increase the morbidity associated with management of an otherwise straightforward condition. The aim of this study was to determine the presentation, treatment and management outcome of complicated inguinal hernias in children. Materials and Methods: A retrospective study of all children 15 years and less managed for complicated inguinal hernia between 2002 and 2010. Data obtained included demographic characteristics, presentation, operative findings and outcome. Results: Complicated hernia rate was 13.9%.There were 41 children, 38 boys (92.7%) and 3 girls. Ages ranged between 4 days and 15 years (Median = 90days). Most were infants (48.8%, n = 20) and neonates accounted for 19.5% (n = 8). Median duration of symptoms prior to presentation was 18 h (range = 2-96 h). Seven patients had been scheduled for elective surgery. Hernia was right sided in 68.3% (n = 28). Symptoms included vomiting (68.3%), abdominal distension (34.1%) and constipation (4.9%); one patient presented with seizures. In 19 (46.3%) patients hernia was reducible while 22(53.7%) had emergency surgery. Associated anomalies included undescended testis (12.2%), umbilical hernia (14.6%). Intestinal resection rate was 7.3% and testicular gangrene occurred in 14.6%. Mean duration of surgery was 60.3 ± 26.7 min. Wound infection occurred in six patients (14.6%). Overall complication rate was 24.4%, 30% in infants. The mortality rate was 2.4% (n = 1). Conclusions: Morbidity associated with complicated inguinal hernia is high in neonates and infants. Delayed presentation is common in our setting. Educating the parents as well as primary care physicians on the need for early presentation is necessary.

Testicular torsion is a common differential diagnosis of acute scrotal pain along with acute epididymo-orchitis, which may lead to testicular non-viability. Doppler ultrasound and testicular scintigraphy are two routinely used modalities for the assessment of testicular viability. However, in some cases, these investigations may prove inadequate in differentiating between the two entities with widely differing management. Here, we present a case of a 52-year-old male with questionable viability of testis, who was investigated initially using testicular scintigraphy and was further subjected to a regional 18F-FDG PET/CT scan, in view of inconclusive findings with the conventional modalities. [ABSTRACT FROM AUTHOR]

A 77-year-old male underwent open repair for a right indirect inguinal hernia and complained of right scrotal pain on the third postoperative day. Color Doppler imaging revealed decreased blood flow with heterogeneous hypoechogenicity in the right testis. A Tc-99m pertechnetate testicular scan showed diffuse hyperemia and increased uptake in the right scrotum. Additional SPECT/CT revealed a photon defect in the right testicle with increased uptake in the peri-testicular area. A subsequent operation revealed a large hematoma in the right spermatic cord and consequent right testicular infarction, and right orchiectomy was performed. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis represents the most frequent surgical abdominal emergency, with a late diagnosis in 32% of the cases, with associated complications that raise the morbidity and mortality for this cause, representing one of the medical conditions with most claim for bad practice. Fournier's Gangrene represents a necrotizing fasciitis that involves perineum, scrotum and penis, predominantly with dermatological, urological and proctological origin. Nevertheless, the presence of this syndrome secondary to appendicular perforation is infrequent and few cases are reported, and is extremely rare in association with testicular infarction. Clinical case: Male 29 years old with Fournier's Gangrene and testicular infarction secondary to apendicular perforation and review of the literature. Conclusion: Fournier's Gangrene secondary to apendicular perforation represents a fatal consequence of a common illness, and objectively demonstrates the importance of consider apendicitis as a cause of Fournier's Gangrene and associated testicular infarction. [ABSTRACT FROM AUTHOR]