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Objective: To observe the clinical efficacy of traditional Chinese medicinal (TCM) compress combined with herbal fumigation in the treatment of acute epididymitis., Methods: This study included 74 cases of acute epididymitis treated in our hospital from December 2021 to December 2023. Using the single blind and random number methods, we divided the patients into a trial (n = 37) and a control group (n = 37). On the basis of routine medication with antibiotics, we treated the patients in the trial group by TCM compress combined with herbal fumigation and those in the control group by dyed pure water compress combined with herbal fumigation. At 3, 7 and 14 days of treatment, we obtained the pain scores and maximum epididymal diameters from the patients and compared them between the two groups before and after treatment., Results: There were no statistically significant differences between the control and trial groups in the baseline pain scores (6.79 vs 6.85, P>0.05) and maximum epididymal diameters of the patients (［1.61 ± 0.39］ vs ［1.59 ± 0.42］ cm, P>0.05) or in the pain scores after 3 days of treatment (4.63 ± 0.95 vs 4.45 ± 1.87, P>0.05). Compared with the controls, the patients of the trial group showed significantly lower pain scores (3.78 ±1.03 vs 1.02±0.36, P<0.05) and a higher overall effectiveness rate (75.68% vs 91.89%, P<0.05) at 7 days, and markedly shorter maximum epididymal diameters at 3 days (［1.45 ± 0.38］ vs ［1.23 ± 0.72］ cm, P<0.05) and 7 days (［1.21 ± 0.29］ vs ［0.98 ± 0.15］ cm, P<0.05). No statistically significant differences were observed between the control and trial groups in the pain scores (0.79 ± 1.12 vs 0.67 ± 0.86, P>0.05), maximum epididymal diameters (［0.94 ± 0.33］ vs ［0.92 ± 0.21］ cm, P>0.05) or overall effectiveness rate (91.89% vs 97.30%, P>0.05) after 14 days of treatment., Conclusion: On the basis of routine medication with antibiotics, TCM compress combined with herbal fumigation can effectively relieve pain, reduce local swelling, accelerate recovery and shorten the course of treatment in patients with acute epididymitis, and is therefore worthy of clinical promotion and application.

Objectives: To determine the earliest noticeable manifestation and diagnosis in patients diagnosed with tuberculosis (TB) epididymitis/epididymo-orchitis incidentally and to analyze their responses to surgical and medical treatment., Methods: Patients who underwent surgery for the preliminary impression of chronic epididymitis/epididymo-orchitis or epididymal/testicular tumor from 2000 to 2019 were included in the study. The clinical presentations, laboratory data, radiological examinations, and operative findings were analyzed retrospectively. The outcomes were assessed by the responses to anti-TB chemotherapy and post treatment radiographic evaluations., Results: All of our 25 patients with a mean age of 60.6 years were diagnosed incidentally with TB epididymitis (48.0%) and TB epididymo-orchitis (52.0%) according to the histopathological findings from their surgeries. The presence of a palpable scrotal mass (76.0%), was the major presentation. Nineteen (76.0%) patients had undergone complete chemotherapy after the surgery and 15 (78.9%) patients showed complete recovery. Four (21.1%) patients had unfavorable outcomes, 3 had TB autonephrectomies and 1 required re-surgery years after complete chemotherapy. Of the 3 (12.0%) patients who did not receive chemotherapy after their surgeries, 1 had a TB relapse in the spine and lung and 1 developed bladder cancer years later., Conclusion: Tuberculosis epididymitis/epididymo-orchitis is difficult to diagnose. However, some clinical clues can assist including aged patients, extragenital TB histories, poor responses to antibiotic treatment and scrotal skin lesion. Complete anti-TB chemotherapy is mandatory even after the total removal of TB lesion. Supplemental surgical interventions can be considered when the symptoms are not relieved after chemotherapy. Lifespan follow-up is recommended due to high relapse rate., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Testicular appendage torsion (TAT) is a medical emergency that presents as an acute scrotum, usually in children and preadolescents. In previous reports of TAT, most cases have been treated conservatively, but some necessitate surgical treatment. Our aim was to examine the incidence, clinical examination findings, etiology, and treatment of TAT., Methods: We retrospectively reviewed records of all patients with TAT (aged ≤15 years) treated at the Juntendo University Urayasu Hospital between January 2012 and September 2020. Surgical treatment was performed when a diagnosis of testicular torsion could not be completely ruled out or if pain recurred after conservative treatment. Patients with a hard scrotum or scrotal erythema were hospitalized for conservative treatment. Data regarding age, diagnosis, blood test results, and clinical findings were analyzed., Results: Among 101 boys with TAT, the median age was 10 years. The incidence of TAT varied significantly according to age and was highest among patients aged 8-11 years. Sixty-seven boys (66.3%) underwent inpatient surgical treatment, 10 boys (9.9%) received inpatient conservative treatment, and 24 boys (23.8%) received outpatient conservative treatment. The median duration of hospitalization was significantly shorter among those who underwent surgery (2.0 days) than among those who received inpatient conservative treatment group (3.5 days)., Conclusions: Operations were short, uncomplicated, and safe; they shortened the hospital stay; and they would certainly prevent recurrence of TAT and testicular torsion on one side. Furthermore, we recommended that TAT patients presenting with signs of severe inflammation, such as hard scrotum or scrotal erythema, receive early surgical treatment to minimize duration of hospitalization., (© 2021 Japan Pediatric Society.)

The epididymis is a tubular structure connecting the vas deferens to the testis. This organ consists of three main regions-caput, corpus, and cauda-that face opposing immunological tasks. A means of combating invading pathogens is required in the distally located cauda, where there is a risk of ascending bacterial infections originating from the urethra. Meanwhile, immune tolerance is necessary at the caput, where spermatozoa with immunogenic neo-antigens originate from the testis. Consistently, when challenged with live bacteria or inflammatory stimuli, the cauda elicits a much stronger immune response and inflammatory-inflicted damage than the caput. At the cellular level, a role for diverse and strategically positioned mononuclear phagocytes is emerging. At the mechanistic level, differential expression of immunoprotective and immunomodulatory mediators has been detected between the three main regions of the epididymis. In this review, we summarize the current state of knowledge about region-specific immunological characteristics and unveil possible underlying mechanisms on cellular and molecular levels. Improved understanding of the different immunological microenvironments is the basis for an improved therapy and counseling of patients with epididymal infections., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Pleuger, Silva, Pilatz, Bhushan and Meinhardt.)

A 17-year-old man with a history of imperforate anus presented to clinic with recurrent epididymitis. A fluoroscopic voiding cystourethrogram demonstrated urethra-ejaculatory duct reflux. A narrowing was also noted in the distal prostatic urethra with dilation of the proximal urethra. Subsequent cystoscopy revealed a patent urethra with a hypertrophic external sphincter as the culprit. Pelvic floor physical therapy was undertaken with resolution of urinary symptoms and testicular pain., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To study the protective effect of a scrotal rapid recovery dressing device, scrotal girdle, on the scrotum of the patient with acute epididymitis, so as to improve the prognosis and the patient's satisfaction., Methods: A total of 120 patients with acute epididymitis were treated in our hospital from December 2018 to November 2019, 60 with the scrotal girdle plus local cold compress in addition to antibiotics administration (the scrotal girdle group) and the other 60 with antibiotics only (the control group), all for 6 days. Then, comparisons were made between the two groups of patients in the improvement of scrotal swelling, total effectiveness rate and the patients' satisfaction with therapeutic outcomes., Results: After 6 days of treatment, the patients in the scrotal girdle group, compared with the controls, showed significantly lower scrotal swelling scores (1.01 ± 0.34 vs 1.38 ± 0.20, P < 0.05), a higher total effectiveness rate (83.33% vs 65%, P < 0.05) and higher satisfaction with the therapeutic outcomes (86.67% vs 56.67%, P < 0.05)., Conclusions: For the treatment of acute epididymitis, the application of the scrotal girdle for protection can significantly relieve scrotal pain and discomfort, improve the therapeutic effect and patients' satisfaction, and enhance the patients' recovery and quality of life.

Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay., Methods: We conducted a prospective study (April 2017-November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes., Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months-16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0-135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67-24.5) h; via GP to paediatric ED was 2.58 (0.75-25.5) h; via local ED to paediatric ED was 2.25 (1-7.75) h; and directly to paediatric ED was 0.45 (0-1.42) h., Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base., (© 2019 Royal Australasian College of Surgeons.)

Background: Previous reviews report relatively low rates of post-operative complications for acute scrotal exploration. The aim of this study was to evaluate the re-presentation to hospital in boys with previous acute scrotal pathology, reviewing contralateral symptoms, post-operative complications, testicular torsion following fixation and failure of conservative management of testicular appendage (TA) torsion., Methods: All boys under 16 years presenting to our unit with an acute scrotum from January 2008 to December 2012 (5-year period) were identified. A retrospective review of clinical records was performed., Results: A total of 683 boys presented over this 5-year period, with an overall re-presentation rate of 10%. Seventeen (25%) re-presentations were metachronous. Post-operative complication rate was 2.2%. Testicular torsion rate following orchiopexy was 0.3% (1/292). Thirty-three percent of those managed conservatively for TA torsion returned with ongoing pain; 80% underwent scrotal exploration on return. Eight boys returned following excision of a torted TA with contralateral torted TA confirmed, accounting for 2.6% (8/308) of boys with a torted TA at first presentation. This gives a number-needed-to-treat of 39 for bilateral scrotal exploration and prophylactic excision of contralateral non-torted TA, to prevent one boy from returning to hospital with a metachronous presentation., Conclusion: Further prolonged follow-up is needed to adequately assess recurrence rates of testicular torsion following orchiopexy to validate routine orchiopexy. Post-operative complication rates equal that of the return rate for a contralateral torted TA; this needs to be considered in proceeding to bilateral scrotal exploration on finding a torted TA at initial presentation., (© 2017 Royal Australasian College of Surgeons.)

Background: Epididymitis is a common disease in non-specific infections of the male reproductive system. According to the clinical incidence of acute epididymitis and chronic epididymitis, which is more common in chronic epididymitis. There are many clinical trials confirmed that acupuncture treatment can relieve pain and improve symptoms of epididymitis to some extent. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture for epididymitis., Methods and Analysis: We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis., Ethics and Dissemination: This systematic review will evaluate the efficacy and safety of acupuncture for epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial., Registration Number: PROSPERO CRD42018111348.

Syphilis is notorious and a great imitator of all diseases. It is a chronic bacterial infection, caused by the sexually transmitted spirochete, Treponema pallidum. Though it has drastically reduced in prevalence, its recent resurgence (especially with HIV disease) is worrying. Without treatment, the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. The disease may occur in any organ, including the testis, and is commonly mistaken for malignancy. We report a case of scrotal abscess consequent on epididymo-orchitis, confirmed by histopathological examination to be syphilitic in origin, in an immunocompromised HIV-positive patient.

Introduction: Paediatric recurrent epididymitis is frequently observed in several urogenital conditions, and may result in deterioration of long-term fertility. The management of recurrent epididymitis is still a therapeutic challenge for paediatric urologists, and as yet there is no consensus for treatment., Objective: To present a minimally invasive endoscopic approach for the treatment of recurrent epididymitis (more than three episodes)., Patients and Methods: Eleven boys were referred with a history of recurrent epididymitis in a context of urogenital malformations. All children underwent endoscopic transurethral injection. Dextranomer/hyaluronic acid was injected around the ejaculatory ducts at the verumontanum (Summary Fig.). The medical records and outcomes of the patients were retrospectively reviewed., Results: Of the 11 boys, two (18%) had a history of bladder exstrophy, three (27%) anorectal malformation, two (18%) peno-scrotal hypospadias, two (18%) posterior urethral valves, one (9%) seminal vesicle cyst, and one (9%) urethral stricture. The median age at injection was 3.75 years (range 8 months-14.7 years). Endoscopic injection effectively prevented recurrence in eight patients (73%) with a mean follow-up of 3 years (range 6 months-8.8 years). The mean injected volume was 0.7 ml/session. No perioperative complications were recorded. Vas clipping was performed in three patients after unsuccessful injections., Discussion: The current discussion for management of recurrent epididymitis is mainly based on vas clipping. Endoscopic injection in the verumontanum could offer several potential advantages over vas clipping; moreover, it is easy to perform for an urologist who usually uses endourological approaches. It is believed that only Kajbafzadeh et al. have reported their experience with endoscopic injection in the verumontanum in seven patients with structural anomalies, and they had a 42% success rate. Similarly, the current study did not observe perioperative or postoperative complications., Conclusion: In this series, endoscopic injection of the verumontanum was considered to be a safe and effective treatment in almost 73% of children with recurrent epididymitis. It did not result in perioperative complications and not contraindicate a subsequent surgical procedure such as vas clipping., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

There is no clear consensus regarding investigating for accompanying genitourinary anomalies (GUAs) in patients with prepubertal acute epididymitis (AE). Moreover, risk factors for the recurrence and the need for a surgical intervention have never been discussed. The purpose of this study was to evaluate the different clinical courses of prepubertal AE based on knowledge of preexisting GUAs. Between January 2005 and December 2014, AE was diagnosed in 189 pediatric patients <10 years old. Clinical characteristics and treatments were retrospectively analyzed. The median age at first AE was 64.3 months. A GUA was detected prior to the development of AE in 49 patients (known GUA group) including 34 with hypospadias. Among the other 140 patients (unknown GUA status group), six patients were diagnosed with a GUA after the first AE episode. In the known GUA group, 35 patients (71.4%) experienced recurrence and the only risk factor associated with recurrence was the presence of cystic dilated prostatic utricle (p = 0.013). In the unknown GUA status group, the risk factors for an existing GUA were being <1-year-old (p<0.001) and positive urine culture (p = 0.015). Only nine patients (6.4%) in this group experienced recurrence. Vasectomy was recommended for patients with recurrent AE with an accompanying GUA and performed in 19 patients (10.1%). Most GUAs are diagnosed prior to AE development. Clinicians should consider different treatment approaches based on whether the AE patient has been diagnosed with a GUA previously, because the clinical characteristics and the recurrence rate are significantly different.

Objectives: To explore the variation in diagnostic testing and management for males diagnosed with three testicular conditions (testicular torsion, appendix testis torsion, epididymitis/orchitis) using a large pediatric health care database. Diagnostic testing is frequently used in evaluation of the acute scrotum; however, there is likely variability in the use of these tests in the emergency department setting., Methods: We conducted a cross-sectional study of males with the diagnoses of testicular torsion, appendix testis torsion, and epididymitis/orchitis. We identified emergency department patients in the Pediatric Health Information Systems (PHIS) database from 2010 to 2015 using diagnostic and procedure codes from the International Classification of Diseases Codes 9 and 10. Frequencies of diagnoses by demographic characteristics and of procedures and diagnostic testing (ultrasound, urinalysis, urine culture and sexually transmitted infection testing) by age group were calculated. We analyzed testing trends over time., Results: We identified 17,000 males with the diagnoses of testicular torsion (21.7%), appendix testis torsion (17.9%), and epididymitis/orchitis (60.3%) from 2010 to 2015. There was substantial variation among hospitals in all categories of testing for each of the diagnoses. Overall, ultrasound utilization ranged from 33.1-100% and urinalysis testing ranged from 17.0-84.9% for all conditions. Only urine culture testing decreased over time for all three diagnoses (40.6% in 2010 to 31.5 in 2015)., Conclusions: There was wide variation in the use of diagnostic testing across pediatric hospitals for males with common testicular conditions. Development of evaluation guidelines for the acute scrotum could decrease variation in testing., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background/purpose: To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement., Methods: Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period., Results: Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%)., Conclusion: In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days., (Copyright © 2016. Published by Elsevier B.V.)

Epididymitis is one of the most frequent causes of acute scrotum during childhood. Unlike in adults, ascending bacterial infections are rarely the underlying cause of the condition in children. Antibacterial treatment in accordance with a prior antibiogram is possible in the presence of leukocyturia and significant bacteriuria. For the remaining cases, there are no definite criteria allowing for a decision on acute antibacterial treatment. The fact that antibacterial treatment is still initiated in cases of epididymitis in the clinical routine setting is based on the assumption of a possible infection rather than being based on facts. This dilemma will probably not be entirely resolved until adequate diagnostic markers for the different trigger mechanisms of epididymitis have been found., Competing Interests: Interessenskonflikt: Nein., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: To identify predictive factors for the severity of epididymitis and to develop an algorithm guiding decisions on how to manage patients with this disease., Methods: A retrospective study was carried out on 160 epididymitis patients at Keio University Hospital. We classified cases into severe and non-severe groups, and compared clinical findings at the first visit. Based on statistical analyses, we developed an algorithm for predicting severe cases. We validated the algorithm by applying it to an external cohort of 96 patients at Tokyo Medical Center. The efficacy of the algorithm was investigated by a decision curve analysis., Results: A total of 19 patients (11.9%) had severe epididymitis. Patient characteristics including older age, previous history of diabetes mellitus and fever, as well as laboratory data including a higher white blood cell count, C-reactive protein level and blood urea nitrogen level were independently associated with severity. A predictive algorithm was created with the ability to classify epididymitis cases into three risk groups. In the Keio University Hospital cohort, 100%, 23.5%, and 3.4% of cases in the high-, intermediate-, and low-risk groups, respectively, became severe. The specificity of the algorithm for predicting severe epididymitis proved to be 100% in the Keio University Hospital cohort and 98.8% in the Tokyo Medical Center cohort. The decision curve analysis also showed the high efficacy of the algorithm., Conclusions: This algorithm might aid in decision-making for the clinical management of acute epididymitis., (© 2016 The Japanese Urological Association.)

Introduction: The aim of this study was to analyze management and outcomes of treatment in patients with acute scrotum., Material and Methods: From January 1990 until January 2015 case records of 558 patients who underwent surgery for acute scrotum were retrospectively reviewed. Mean age was 12 years old. Each patient was analyzed for following parameters: history data, localization of pain, physical examination, operating results and the results of follow up, age, etiology, and the time from initial symptoms to surgery., Results: Scrotal explorations revealed 142 cases (25%) of spermatic cord torsion, 344 (62%) torsion of the testicular appendage, 54 (10%) epididymitis, 10 (2%) testicular trauma and 8 cases (1%) of other conditions. Two peaks of incidence of spermatic cord torsion were found, the first during first year of life and the second between 13 and 15 years of life. In patients with spermatic cord torsion, median duration of symptoms in the group of salvaged testes was 6 hours; while in the group of patients who underwent orchiectomy was 46 hours. Of the total number of patients with spermatic cord torsion 40 patients (28%) underwent orchiectomy while 102 testicles (72%) were saved. There were no major complications. Acute scrotum is significantly more common in the winter. Torsion of the testis has the highest incidence in January and August., Conclusion: Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. It is of great importance that the patient seeks immediate medical attention. If the patient arrived within 6 hours the testicle can be saved.

In April 2013, the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2015 CDC sexually transmitted diseases (STDs) treatment guidelines. The advisory group examined recent abstracts and published literature addressing the diagnosis and management of sexually transmitted infections. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard., Objective: To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance., Materials and Methods: The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed., Results: One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %., Discussion: There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role., Conclusions: Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.

Objective: To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis., Material and Method: Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis., Results: The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy., Conclusion: Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

We present a case of a 54-year-old man who had a history of poorly controlled diabetes and end-stage renal failure on haemodialysis. He presented with an acute left groin swelling that was diagnosed to be a rare occurrence of spermatic cord abscess. Two months prior to this, he had had an episode of bacterial epididymo-orchitis that was treated with oral antibiotics. An urgent CT of the abdomen and pelvis was performed to rule out incarcerated inguinal hernia. The spermatic cord abscess was initially managed with appropriate intravenous antibiotics and ultrasound-guided percutaneous drainage. When the pus eventually accumulated in the scrotum, an open incision and drainage of the scrotum was also performed. He achieved complete resolution after 2 months., (2014 BMJ Publishing Group Ltd.)

Introduction: The aim of this study was to review the published evidence on the pathogenesis and management of acute epididymitis (AE) in prepubertal boys after the authors encountered an unexpectedly large number of such cases in their institution., Methods: Using MEDLINE(®), a literature search was performed for articles in English with the words "pre-pubertal" OR "boys" OR "p(a)ediatric" OR "children" AND "epididymitis" OR "epididymo-orchitis"., Results: The literature suggests that it is rare to find a bacterial infection or anatomical anomaly as a cause for AE in this population. A postviral infectious phenomenon is the most likely explanation. The management should be supportive and antibiotics reserved for those with pyuria or positive cultures. Urodynamic studies and renal tract ultrasonography have been advocated for those with recurrent epididymitis., Conclusions: AE in prepubertal boys is more common than believed previously. A careful history for recent viral illnesses should be included. Antibiotics, urinary tract imaging and functional studies should be used in selected cases.

Objective: To investigate the clinical effect of spermatic cord seal-up injection on acute epididymitis and its mechanisms., Methods: A total of 120 cases of acute epididymitis were allocated to a trial group (n = 56), aged 18 - 78 (38.4 +/- 9.6) years, and a control group (n = 64), aged 14 -82 (41.3 +/- 7.2) years. The patients in the trial group were given seal-up injections of a mixture of lidocaine, gentamicin (or Amikacin) and dexamethasone into the spermatic cord, qd or bid, for 2 courses of 5 days each, with an interval of 3 to 5 days. Those in the control group were treated by intravenous drip of penicillin, qd, intramuscular injection of Streptomycin, bid, and oral medication of SMZCo (SMZ-TMP), bid, with the initial dose doubled. After less than 2 weeks of treatment, we compared the therapeutic effects between the two groups of patients., Results: In the trial group, 53.6% of the patients were basically cured, 37.5% obviously improved and 91.1% improved (total rate of effectiveness). The average treatment time for the improved cases was (9.2 +/- 0.5) d. In the control group, 40.6% of the patients were basically cured, 31.2% obviously improved and 71.8% improved (total rate of effectiveness). The average treatment time for the improved cases was (12.8 +/- 0.7) d. There were significant differences between the two groups in the total rate of effectiveness and the average treatment time for the improved cases (P < 0.05)., Conclusion: Spermatic cord seal-up injection for acute epididymitis deserves wide clinical application for its simple operation, good tolerance, short therapeutic course and high safety and efficacy.

Chronic Epididymitis is a relatively rare problem in boys and is often enigmatic in its etiology. It is often associated with urinary tract abnormalities in infants and prepubertal children. This report describes a rare and unusual case of a chronic epididymitis with acquired scrotal vasocutaneous urinary fistula in an 8-mo-old boy who was found to have a large prostatic utricular cyst and ectopic vas insertion. The authors discuss embryology, pathophysiology, diagnostic dilemma and different treatment options.

A 65-year-old male had undergone transurethral resection of bladder tumor (TUR-Bt) four times for recurrent bladder cancer, and each histopathological examination revealed non-invasive urothelial carcinoma, pTa, G2. To prevent further recurrence, he received eight weekly intravesical instillations of Bacillus Calmette-Guérin (BCG). Four months after the BCG therapy, he underwent cystoscopy. One week after the cystoscopy, he developed a painful and swollen left scrotum. Treatment with levofloxacin for acute epididymitis reduced the scrotal pain initially, but the pain increased and 3 months later, a fistula with suppurative discharge appeared at the bottom of the scrotum. A smear of the discharge revealed Gaffky 2, and a culture showed tubercle bacillus. Incisional drainage of the abscess and anti-tuberculosis chemotherapy for 2 months to treat tuberculous epididymitis was not completely effective. We performed a left orchiectomy with resection of the infected scrotal skin. Histopathological examination showed tuberculous epididymitis consisting of a caseating granuloma with epithelioid cells and Langhans giant cells. He received anti-tuberculosis chemotherapy for 4 months postoperatively and had no sign of recurrence 1 year postoperatively.

Purpose: Epididymo-orchitis is a devastating complication of imperforate anus. Without proper treatment the condition may result in infertility. Nevertheless, the exact etiology and optimal management of epididymo-orchitis in anorectal malformation are unknown., Materials and Methods: Retrospective review of our hospital records between 1997 and 2010 identified 6 cases of epididymo-orchitis in 82 boys with anorectal malformation. Extensive search of the literature revealed 35 additional cases. Clinical details of these 41 patients were analyzed using chi-square testing., Results: Epididymo-orchitis occurred predominantly (86%) in high or intermediate anorectal malformation with rectourinary fistula. Median age at onset of epididymo-orchitis was 6 months and there was no side predilection. Urinary tract infection was noted in 54% of patients. Persistent mesonephric duct syndrome (27%), urethroejaculatory duct reflux (22%), vasovesical ectopia (10%), neurovesical dysfunction (34%) and urethral stricture/stenosis (17%) were frequently associated risk factors for epididymo-orchitis. In 73% of patients epididymo-orchitis recurred with exclusive antibiotic treatment. Diverting colostomy was ineffective in preventing epididymo-orchitis. Division of rectourinary fistula was curative in 36% of patients, while in 34% epididymo-orchitis recurred even after division of rectourinary fistula. Division of rectourinary fistula is likely to resolve epididymo-orchitis in the absence of additional risk factors. Vasectomy was required in 22% of patients to prevent recurrence., Conclusions: In addition to rectourinary fistula, urinary reflux into the vas deferens and neurovesical dysfunction are major risk factors for epididymo-orchitis in anorectal malformation. Division of rectourinary fistula is curative in only a third of cases. In the remaining cases some form of surgical disruption of the vas deferens is needed to resolve recurrent epididymo-orchitis., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: DNA amplification assays are increasingly being used to facilitate the testing of asymptomatic individuals for urogenital Chlamydia trachomatis. The long-term clinical benefit in terms of avoided infertility and ectopic pregnancy is unknown., Methods: In 1997, 15,459 women and 14,980 men aged 21-23 years were living in Aarhus County, Denmark. A random sample of 4000 women and 5000 men was contacted by mail and offered the opportunity to be tested for C trachomatis by means of a sample obtained at home and mailed directly to the laboratory. The remaining 11,459 women and 9980 men received usual care and constituted the control population. All men and women were subsequently followed for 9 years by the use of Danish health registers. Data were collected on pelvic inflammatory disease (PID), ectopic pregnancy (EP), infertility diagnoses, in-vitro fertilisation (IVF) treatment and births in women, and on epididymitis in men. The intervention and control groups were compared using Cox regression analyses and the intention-to-screen principle., Results: Among women, no differences were found between the intervention group and the control group: HR (95% CI) for PID 1.12 (0.70 to 1.79); EP 0.97 (0.63 to 1.51); infertility 0.87 (0.71 to 1.07); IVF treatment 0.88 (0.62 to 1.26) and births 1.02 (0.95 to 1.10). In men, the HR for epididymitis was 1.25 (0.70 to 2.24)., Conclusions: A population-based offer to be tested for urogenital C trachomatis infection by the use of non-invasive samples and DNA amplification did not reduce the long-term risk of reproductive complications in women or of epididymitis in men.

Scrotal and testicular problems range from the benign and painless to the malignant and debilitating. The primary care physician should be able to triage these problems and know when to give reassurance and when to initiate a targeted workup that may lead to specialist intervention. This article focuses on scrotal pain and palpable abnormalities. Scrotal pain includes well-defined acute causes such as torsion and infection and the less well-defined chronic orchialgia. Palpable abnormalities covered here include cryptorchidism, hydrocele, spermatocele, varicocele, and testicular cancer., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to examine the diagnostic and therapeutic yield of urine tests in epididymitis in children. Recently, urine examination in prepubertal epididymitis has been described as having little value for diagnostic or treatment. Yet, although urine cultures are often sterile, in clinical practice prepubertal boys with epididymitis are often treated with antibiotics., Material and Methods: A retrospective analysis of all boys with 1-episode epididymitis presenting to a single institution over a 5-year-period was performed. Results of laboratory tests (blood, urine) were collected., Results: We found 151 consecutive patients. In 93 cases (62%), results of urine examinations were available. Only 1 patient (1%) showed bacteriuria in urine sediment, while urine culture in this patient was sterile. Urine cultures were done in 6 of 97 patients treated in hospital (6%), and all cultures were sterile. Surgical exploration was performed in 7 patients (5%); in 6 of them epididymal cultures were taken intraoperatively with negative microbiological results., Conclusion: In our group of children with epididymitis, almost all urine tests (urinalysis, urine culture) were negative. Epididymitis in prepubertal boys seems to be mostly idiopathic, and positive microbiological findings are rare. Antibiotic treatment in this age group should only be done in cases with positive urine tests.

Objective: To investigate the differential diagnosis and treatment of acute scrotum., Methods: We retrospectively analyzed the clinical characteristics of 316 cases of acute scrotum and reviewed the related literature., Results: Among the total number, there were 117 cases of acute epididymitis (37.0%), 76 acute orchitis (24.1%), 39 acute periorchitis (12.3%), 23 acute scrotal infection (7.3%), 21 testicular trauma (6.6%), 17 idiopathic scrotal edema (5.4%), 16 testicular torsion (5.1%), and 7 scrotal gangrene (2.2%). Eighty-one of them underwent surgery and 235 received conservative treatment, of whom 1 with scrotal gangrene died of toxic shock for refusing surgical drainage. Those with testicular torsion all showed positive results in Prehn's test and responded well to surgery., Conclusion: Acute scrotum is detrimental to male health, for which early diagnosis and prompt treatment are essential.

Idiopathic testicular infarction without torsion of spermatic cord is a rare condition. We present a 12-year-old boy originally suspected of acute epididymo-orchitis, but subsequently an orchiectomy was necessary owing to unpredicted testicular infarction not associated with torsion. Elevation of immunoglobulin M against mycoplasma, reduction in serum factor XIII and the presence of sufficient blood flow detected by color Doppler ultrasonography upon initial manifestation suggested that the boy was affected by epididymo-orchitis associated with Henoch-Schönlein purpura or mycoplasma infection. However, progressive testicular enlargement was observed and subsequently testicular blood flow became barely detectable. Our case indicates that the presence of sufficient blood flow upon initial diagnosis in the affected testis does not necessarily exclude infarction and continuous monitoring of blood flow may be required to avoid radical orchiectomy.

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.)

The aim of the study was to compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis compared to testicular torsion and torsion of the appendix testes. A retrospective review of the medical records of 66 boys presenting with clinical aspects of acute scrotum over a 3-year period was performed. Sixty-six patients were included in the study (29 with epididymitis, 8 with testicular torsion and 12 with torsion of the appendix testis, 4 with scrotal abscesses, 5 with scrotal swelling, and 1 with inflamed epididymal cyst). The duration of symptoms ranged from 6 h to 4 days with a peak on the second day. Urine cultures and viral testes were negative in all patients. Color Doppler ultrasound was diagnostic for epididymitis in 28 patients (96.6%). Systemic intravenous antibiotics were given in all 29 patients with epididymitis. No patient showed signs of testicular atrophy in the follow-up. The increasing incidence of epididymitis should question the policy of routine exploration of the acute scrotum in children. The history and physical examination cannot reliably identify those boys who can be managed conservatively. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal but it can also be misleading.

From 1963 we treated 330 patients aged from 15 to 85 years admitted to the urological clinic with acute epididymoorchitis of mild (n = 106), moderate (n = 82) and grave severity (n = 152). The diagnosis of purulent forms of epididymitis and epididymoorchitis was made basing on clinical and ultrasonic studies. Aspiration thin-needle puncture of epididymic membrane under ultrasonic control with calculation of leucocyte count was made for detection of purulent-process in 17 patients with epididymitis at the stage of diffuse inflammation. 198 patients with mild and moderate forms of acute epididymoorchitis received complex conservative treatment including laser therapy. 132 patients with severe epididymoorchitis were operated. In epididymoorchitis with total inflammatory-purulent process we made epididymectomy, in local - resection. The testis was removed in total necrosis or purulent lesion of its tissues. For comparison we analysed case histories of 150 patients with epididymoorchitis treated before 1983. Comparison of the treatment results in patients with acute inflammatory diseases of scrotal organs favours early surgical treatment.

Epididymitis is a common and morbid condition seen across a wide age range. There are multiple etiologies that may lead to inflammation of the epididymis, including infection, trauma, autoimmune disease, and vasculitis. Although there have been multiple advances in imaging of the scrotum and detection of urinary pathogens, a large portion of cases remain idiopathic. Management of epididymitis is often difficult, but relies on clinical expertise and the use of established clinical guidelines.

Background: Urinary tract infections are the most common infections seen in hospitalized patients and the second most common, after respiratory tract infections, seen in the general population. The World Wide Web can now assist healthcare professionals in finding up-to-date information on different medical conditions., Methods: We sought to identify websites that contain information on urogenital infections by using popular search engines, such as Google and Yahoo. We also reviewed the sites of major institutions, and international healthcare associations. Only those sites that were written in English, were open access, and developed by a government, academic institution or a national or international healthcare professionals association were included., Results: We selected 114 sites that provide healthcare professionals with useful information on urogenital infections based on the criteria described above., Conclusions: There are several free websites that contain worthy information on urogenital infections. The compilation of a list of Internet resources on these common types of infections may be useful to practitioners and medical students.

A 67-year-old man presented with isolated pain of the right testicle. He was admitted and treated for epididymitis. His symptoms did not improve and lower abdominal pain developed. After hypotension and severe anaemia (Hb 2.1 mmol/l) had developed, abdominal echography was carried out, revealing a ruptured abdominal aortic aneurysm. The patient underwent surgical repair with an aortic-bifemoral prosthesis and was ultimately discharged without further complications. This is the fourth report in the literature of orchidodynia as referred pain from an aneurysm of the abdominal aorta.

Pediatric surgeons and urologists are often asked to evaluate boys with acute scrotal pain and inflammation. Although there are myriad etiologies for this syndrome, testicular torsion should be at the top of the list. It is the one diagnosis that must be made accurately and rapidly if there is any hope for testicular salvage. The purpose of this article is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency.

In recent years there has been a decline in the uptake of the MMR vaccine and a significant increase the number of reported case of mumps. This condition has number of important extrasalivary manifestations including mumps epididymo-orchitits. The article reviews the pathophysiology, clinical symptoms, diagnosis, and long-term sequelae of this increasingly prevalent condition and provides a reference for all practising urologists treating this disease.