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Testicular infarction due to acute epididymitis is a rare but serious complication caused by inflammation that impairs blood flow to the testis. Epididymitis, frequently associated with bacterial infections, usually presents with scrotal pain and swelling, and is commonly managed with a brief course of antibiotics. However, in severe cases, it can progress to ischemia and infarction. This report describes a 46-year-old male with type 2 diabetes who presented with a 1-week history of left testicular pain and swelling. An initial ultrasound confirmed epididymitis, but despite intravenous antibiotic treatment, his symptoms worsened by the second day. Repeat imaging revealed the absence of blood flow, consistent with testicular infarction. This case underscores the importance of timely diagnosis and intervention to prevent such complications.

Rare complications of acute epididymitis include ischemia and infarction of the testicles. Both clinically and radiologically, it is challenging to distinguish testicular torsion. In this article we have tried to expand the library of digital images of radiological diagnostic methods used for fast and accurate differential diagnostics. This case emphasizes the significance of a comprehensive radiological assessment and how a multidisciplinary approach is necessary to guarantee an accurate diagnosis. A 24-year-old man experienced severe left testicular pain and came to the hospital 2 weeks later. At the radiology department, he reported that he had for some time painful ejaculations, pain during intercourse (dyspareunia), scrotal redness/swelling, genital inflammation, chills, swollen inguinal lymph nodes, dysuria, and scrotal pain. All diagnostic procedures were performed, first ultrasonography and then magnetic resonance imaging, as required by the urologist. The imaging studies revealed left testicular ischemia, and based on the referred clinical history, a chronic orchid-epididymitis was suspected. Thus, the condition was resolved, not with a left orchidectomy but with medical therapy because the ischemia area was not too large. The patient also had a left varicocele. Images acquired with different magnetic resonance imaging sequences were carefully examined. A rare instance of epididymal orchitis is described as a potentially dangerous complication of epididymitis and must be considered if sudden, severe scrotal pain is experienced to avoid severe consequences. This case can help with optimal patient management and prevent unnecessary interventions.

Infection of the scrotum and its contents is the most common cause of acute scrotum. Imaging plays an important role in evaluating disease extent, severity and its complications. Sonography is the modality of choice for imaging the acute scrotum. This pictorial review discusses the varied clinical and imaging features of scrotal infections and their complications, with correlative CT, when available. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous inflammation (XGI) is a rare, benign inflammatory condition of unclear pathogenesis, characterised by infiltration and subsequent destruction of normal tissue by lipid-laden macrophages together with lymphocytes and plasma cells. A 56-year-old gentleman was referred to the urology department of our hospital due to concerns that his right testicle felt firmer than his left over the preceding six months. He was investigated and subsequently underwent a right sided orchidectomy. The overall histopathological findings were consistent with chronic xanthogranulomatous epididymitis with testicular outflow tract obstruction and cystic ectasia of the rete testis and testicular parenchyma.

In this review, two cases of testicular tuberculosis (TB) are presented, and another 58 cases published in PubMed between January 1, 2012, and July 31, 2023, are reviewed. Testicular TB remains a disease mainly of the developing world, with one notable exception – the infections caused as a result of Bacillus Calmette–Guérin infusion immunotherapy for bladder cancer. Its clinical course is subacute; however, it might get disseminated and become life–threatening; therefore, prompt diagnosis is very important. The diagnosis can be quite challenging, and testicular tissue is the sample with the highest diagnostic yield, either for microbiological or histopathological diagnosis. On the other hand, its treatment follows the standard guidelines for TB treatment; however, the avoidance of an unnecessary orchiectomy is important.

Abstract Background Pulmonary abscesses resulting from epididymitis caused by extended spectrum β-lactamase-producing hypervirulent Klebsiella pneumoniae (ESBL-hvKp) in a nondiabetic patient are extremely uncommon. The infection caused by this disseminated drug-resistant bacteria, which is generally considered an intractable case, poses a potential challenge in clinical practice. Case presentation In this case report, we present the clinical course of a 71-year-old male patient with epididymitis, who subsequently developed cough and dyspnea following anti-infection treatment. Imaging examinations revealed severe pneumonia and pulmonary abscess. The infection of ESBL-hvKp in the epididymis led to bacteremia and subsequent lung lesions. Due to poor response to anti-infection therapy, the patient required an extended duration of anti-infection treatment and ultimately chosed to discontinue treatment. Conclusions Acute epididymitis caused by ESBL-hvKP infection can result in the spread of the infection through the bloodstream, leading to severe pneumonia and lung abscess. Given the critical condition of the patient, even with active anti-infection treatment, there is a risk of treatment failure or potentially fatal outcomes.

Objective: We aimed to describe the clinical, epidemiological, and laboratory characteristics of patients with Brucella epididymoorchitis (BEO) and reveal the effectiveness of the treatment options and recurrence rates after treatment. Methods: The information of 42 BEO patients who were followed and treated in a tertiary training and research hospital between January 2013 and January 2023 was accessed by scanning the patient files retrospectively. Epididymoorchitis diagnosis was based on physical examination findings (testicular swelling, pain, rash) and/or by ultrasonography in patients with a standard tube agglutination test (STA) ≥1/160 and a positive rose-Bengal (RB) test or Brucella bacteria growth in blood cultures. Results: Forty-two patients with brucellosis-associated epididymoorchitis were included in the study. STA>1/160, and RB tests were positive in all patients. While the incidence of BEO among all patients was 10.9%, the incidence of BEO among male patients was 16.1%. The rate of unilateral testicular involvement in the patients was 92.86%, and the rate of bilateral testicular involvement was 7.14%. Pain accompanied testicular growth in 66.6% of the patients. Most patients (76.19%) were detected during the acute brucellosis period. Doxycycline (DOK) and rifampicin (RIF) combination was given to 13 patients, DOK and streptomycin (SM) combination to 22 patients, DOK and gentamicin (GEN) combination to 5 patients, and DOK, RIF and SM combination to two patients. The relapse rate was 4.76% in the patient group treated with DOK and RIF; relapse was not observed in the group of patients treated with DOK and aminoglycoside (SM or GEN). Conclusion: BEO is a complication of brucellosis. It can be treated successfully through early diagnosis, appropriate antimicrobial treatment for six weeks, and practices that increase patient compliance with treatment. Treatment combinations containing aminoglycosides are statistically superior in preventing relapses than combinations containing RIF. [ABSTRACT FROM AUTHOR]

Brucella ovis is an etiologic agent of ovine epididymitis and brucellosis that causes global devastation in sheep, rams, goats, small ruminants and deer. There are no cost‐effective methods for the worldwide eradication of ovine brucellosis. B. ovis and other protein targets from various Brucella species are currently in the pipeline for high‐throughput structural analysis at the Seattle Structural Genomics Center for Infectious Disease (SSGCID), with the aim of identifying new therapeutic targets. Furthermore, the wealth of structures generated are effective tools for teaching scientific communication, structural science and biochemistry. One of these structures, B. ovis leucine‐, isoleucine‐, valine‐, threonine‐ and alanine‐binding protein (BoLBP), is a putative periplasmic amino acid‐binding protein. BoLBP shares less than 29% sequence identity with any other structure in the Protein Data Bank. The production, crystallization and high‐resolution structures of BoLBP are reported. BoLBP is a prototypical bacterial periplasmic amino acid‐binding protein with the characteristic Venus flytrap topology of two globular domains encapsulating a large central cavity containing the peptide‐binding region. The central cavity contains small molecules usurped from the crystallization milieu. The reported structures reveal the conformational flexibility of the central cavity in the absence of bound peptides. The structural similarity to other LBPs can be exploited to accelerate drug repurposing. [ABSTRACT FROM AUTHOR]

Background Study design Objective Materials and methods Results Discussion and conclusion Microsurgical vasoepididymostomy is an effective surgical method for treating epididymal obstructive azoospermia but the surgical outcomes can be affected in some non‐vasectomized epididymal obstructive azoospermia patients with concurrent vas‐deferens obstruction. This study aimed to explore the clinical characteristics and surgical outcomes in non‐vasectomized epididymal obstructive azoospermia patients with versus without concurrent vas‐deferens obstruction.Retrospective study.To explore the clinical characteristics and surgical outcomes in non‐vasectomized epididymal obstructive azoospermia patients with versus without concurrent vas‐deferens obstruction, aiming to identify predictive factors for concurrent vas‐deferens obstruction and evaluate the efficacy of microsurgical vasoepididymostomy in patients with epididymal obstructive azoospermia and concurrent short‐segment vas‐deferens obstruction.A retrospective analysis of 225 epididymal obstructive azoospermia cases was conducted at the First Affiliated Hospital of Fujian Medical University from November 2016 to March 2023. All patients underwent a comprehensive preoperative evaluation. During surgery, the vas deferens were assessed to determine the presence and extent of obstruction. Depending on the obstruction length, either a standard microsurgical vasoepididymostomy was performed, or the obstructed segment was resected followed by microsurgical vasoepididymostomy. If the remaining length post‐resection was insufficient for anastomosis, the procedure was discontinued. Data on patient clinical characteristics, operative findings, and outcomes were collected and analyzed. Logistic regression was used to identify predictive factors for concurrent vas‐deferens obstruction, and comparative analysis assessed patency and pregnancy rates between patients with and without concurrent vas‐deferens obstruction.Of the 225 patients in the study, 77 (34.22%) presented with epididymal obstructive azoospermia and concurrent vas‐deferens obstruction. Logistic regression analysis revealed that “the history of epididymitis” was a significant predictive factor for epididymal obstructive azoospermia patients with concurrent vas‐deferens obstruction (odds ratio = 9.06, p < 0.001). The average length of vas deferens obstruction amenable to microsurgical vasoepididymostomy post‐resection was 1.31 ± 0.54 cm (range from 0.50 to 2.50 cm). In contrast, cases unsuitable for microsurgical vasoepididymostomy presented an average obstruction length of 15.26 ± 5.79 cm (p < 0.001). The patency rates were 82.17% in epididymal obstructive azoospermia patients without concurrent vas‐deferens obstruction and 74.14% in those with concurrent vas‐deferens obstruction. The pregnancy rates followed a similar trend, at 34.11% and 34.48%, respectively. These differences were not statistically significant (p > 0.05 for both). However, epididymal obstructive azoospermia patients with vas‐deferens obstruction exhibited a decreased likelihood of bilateral microsurgical vasoepididymostomy (p < 0.001).Our study identifies a noticeable occurrence of concurrent vas‐deferens obstruction in non‐vasectomized epididymal obstructive azoospermia patients, with approximately one‐third of the cases (34.22%) exhibiting vas‐deferens obstruction during surgical interventions. Notably, a small fraction (6.67%) of these individuals chose not to proceed with any microsurgical vasoepididymostomy, even on one side, due to the extensive length of the obstruction. Through logistic analysis, we have demonstrated that “the history of epididymitis” is a critical predictive factor for the presence of vas‐deferens obstruction, underscoring its significance in preoperative evaluations. Furthermore, our research confirms that microsurgical vasoepididymostomy is still an effective treatment for epididymal obstructive azoospermia patients with concurrent short‐segment vas‐deferens obstruction, achieving significant patency and favorable pregnancy rates compared to those patients without vas‐deferens obstruction. These insights are pivotal for enhancing surgical strategies and improving fertility outcomes in this patient cohort. [ABSTRACT FROM AUTHOR]

Using ultrasound findings and clinical characteristics, we constructed and validated a new nomogram for distinguishing epididymal tuberculosis from nontuberculous epididymitis, both of which share similar symptoms. We retrospectively examined data of patients with epididymal tuberculosis and nontuberculous epididymitis hospitalized between January 1, 2013, and March 31, 2023. Eligible patients were randomly assigned to derivation and validation cohorts (ratio, 7:3). We drew a nomogram to construct a diagnostic model through multivariate logistic regression and visualize the model. We used concordance index, calibration plots, and decision curve analysis to assess the discrimination, calibration, and clinical usefulness of the nomogram, respectively. In this study, 136 participants had epididymal tuberculosis and 79 had nontuberculous epididymitis. Five variables—C-reactive protein level, elevated scrotal skin temperature, nodular lesion, chronic infection, and scrotal skin ulceration—were significant and used to construct the nomogram. Concordance indices of the derivation and validation cohorts were 0.95 and 0.96, respectively (95% confidence intervals, 0.91–0.98 and 0.92–1.00, respectively). Decision curve analysis of this nomogram revealed that it helped differentiate epididymal tuberculosis from nontuberculous epididymitis. This nomogram may help clinicians distinguish between epididymal tuberculosis and nontuberculous epididymitis, thereby increasing diagnosis accuracy. [ABSTRACT FROM AUTHOR]

Background: Region‐specific immune environments in the epididymis influence the immune responses to uropathogenic Escherichia coli (UPEC) infection, a relevant cause of epididymitis in men. Toll‐like receptors (TLRs) are essential to orchestrate immune responses against bacterial infections. The epididymis displays region‐specific inflammatory responses to bacterial‐derived TLR agonists, such as lipopolysaccharide (LPS; TLR4 agonist) and lipoteichoic acid (LTA; TLR2/TLR6 agonist), suggesting that TLR‐associated signaling pathways could influence the magnitude of inflammatory responses in epididymitis. Objectives: To investigate the expression and regulation of key genes associated with TLR4 and TLR2/TLR6 signaling pathways during epididymitis induced by UPEC, LPS, and LTA in mice. Material and methods: Epididymitis was induced in mice using UPEC, ultrapure LPS, or LTA, injected into the interstitial space of the initial segment or the lumen of the vas deferens close to the cauda epididymidis. Samples were harvested after 1, 5, and 10 days for UPEC‐treated animals and 6 and 24 h for LPS‐/LTA‐treated animals. Ex vivo epididymitis was induced by incubating epididymal regions from naive mice with LPS or LTA. RT‐qPCR and Western blot assays were conducted. Results: UPEC infection up‐regulated Tlr2, Tlr4, and Tlr6 transcripts and their associated signaling molecules Cd14, Ticam1, and Traf6 in the cauda epididymidis but not in the initial segment. In these epididymal regions, LPS and LTA differentially modulated Tlr2, Tlr4, Tlr6, Cd14, Myd88, Ticam1, Traf3, and Traf6 expression levels. NFKB and AP1 activation was required for LPS‐ and LTA‐induced up‐regulation of TLR‐associated signaling transcripts in the cauda epididymidis and initial segment, respectively. Conclusion: The dynamic modulation of TLR4 and TLR2/TLR6 signaling pathways gene expression during epididymitis indicates bacterial‐derived antigens elicit an increased tissue sensitivity to combat microbial infection in a spatial manner in the epididymis. Differential activation of TLR‐associated signaling pathways may contribute to fine‐tuning inflammatory responses along the epididymis. [ABSTRACT FROM AUTHOR]

Background: Among the most commonly known causes of hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated hematospermia in patients with acute epididymitis. Objectives: To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters. Materials and methods: Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated hematospermia (= no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated. Results: Of 324 patients with acute epididymitis, 50 patients (15%) had self‐reported hematospermia. This occurred with a median of 24 h before the onset of scrotal symptoms and was associated with significantly elevated prostate‐specific antigen levels compared to 274 patients without hematospermia (3.1 vs. 1.8 ng/ml, p < 0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p = 0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha‐glucosidase and zinc (always p < 0.01). Discussion and conclusion: In sexually active patients who develop acute epididymitis, self‐reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated hematospermia developed epididymitis within the next 4 weeks. [ABSTRACT FROM AUTHOR]

The activins (A and B) and their binding protein, follistatin, play crucial roles in development, immunoregulation and inflammation throughout the body. In the male reproductive tract of the mouse, activin A and B production is largely confined to the initial segment and proximal caput of the epididymis and the efferent ducts, under normal conditions, with very low expression in the corpus, cauda and vas deferens. However, activin A protein is present throughout the epididymis and vas deferens and is largely associated with the epithelium and interstitial macrophages. Conversely, the activin‐binding protein follistatin is produced in the distal epididymis, with very high expression in the vas deferens. Activin activity in the distal tract is inhibited by follistatin, and the activin–follistatin balance is important for regulating coiling of the duct during epididymal development. In further experiments, as described in this report, in situ hybridisation was used to localise activin A mRNA principally to cells in the periductal zone and interstitium in the efferent ducts and proximal caput. Activin B mRNA, on the other hand, was localised to periductal cells in the efferent ducts and proximal epididymis and, most notably, to epithelial cells in the initial segment. Activin A is implicated in the regulation of mononuclear phagocyte function and immune responses in the caput and stimulates the expression of the key immunoregulatory protein, indoleamine 2,3‐dioxygenase in this region. Activin A production in the corpus and cauda increases dramatically during bacterial epididymitis in mice, promoting inflammation and fibrosis and causing damage to the epithelium and obstruction of the epididymal duct. Consequently, it appears that the activin–follistatin axis is crucial for maintaining normal epididymal structure and function, but disruption of this balance during inflammation has deleterious effects on male fertility. Follistatin has therapeutic potential in ameliorating the proinflammatory and profibrotic effects of activins. [ABSTRACT FROM AUTHOR]

In this review, two cases of testicular tuberculosis (TB) are presented, and another 58 cases published in PubMed between January 1, 2012, and July 31, 2023, are reviewed. Testicular TB remains a disease mainly of the developing world, with one notable exception – the infections caused as a result of Bacillus Calmette–Guérin infusion immunotherapy for bladder cancer. Its clinical course is subacute; however, it might get disseminated and become life–threatening; therefore, prompt diagnosis is very important. The diagnosis can be quite challenging, and testicular tissue is the sample with the highest diagnostic yield, either for microbiological or histopathological diagnosis. On the other hand, its treatment follows the standard guidelines for TB treatment; however, the avoidance of an unnecessary orchiectomy is important. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this study was to investigate the relationship between left‐sided varicocele and epididymitis or epididymo‐orchitis. Materials and Methods: The study included 72 patients with left side epididymitis (EP) or epididymo‐orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP‐EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter. Results: The average age was 38 ± 8.4 years (range, 18–50 years) in Group 1, and 36 ± 9.1 years (range, 16–47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO (p < 0.001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively (p < 0.001). Conclusions: Left‐sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis. [ABSTRACT FROM AUTHOR]

Background: Mainly known as a cause of pulmonary infections or meningitis, Haemophilus influenzae has rarely been described as an etiology of urinary tract infections and even less as a cause of orchitis or epididymitis. Case report: This paper describes a rare case of a patient who presented to our emergency department with urethral discharge, swelling of the right testicle, and fever consistent with a diagnosis of urethritis and orchepididymitis. Initially, we suspected a sexually transmitted disease such as chlamydia or gonorrhea. However, the urethral smear and urine culture revealed the presence of Haemophilus influenzae as the causative agent. A first therapy with Ceftriaxone and Azithromycin followed by doxycycline did not completely resolve symptoms. A new course of antibiotherapy with Ciprofloxacin led to complete remission. Why should an emergency physician be aware of this?: Haemophilus influenzae can occasionally present with urethral discharge and symptoms of orchiepididymitis similar to those of a sexually transmitted disease. It is crucial for physicians to remember that this pathogen also causes genitourinary tract infections, given that most strains are resistant to Azithromycin. Consequently, they should adapt antibiotic therapy and investigations accordingly in these cases.

We report a case of primary hypogonadism induced by amiodarone and review the relevant literature. Amiodarone has a well-established and extensive profile of side effects including thyroid toxicity, corneal deposits and skin discoloration. In rare cases, epididymitis or orchitis may occur. This inflammation can lead to testicular atrophy, inducing primary hypogonadism. We present the case of a 57-year-old patient, treated with amiodarone for several years, initially presenting with testicular pain followed by gynaecomastia, and finally loss of libido indicative of hypergonadotropic hypogonadism. Imaging confirmed bilateral testicular atrophy. Amiodarone was discontinued, and androgen replacement therapy was initiated. This case, combined with data from the literature, highlights the importance of careful monitoring of patients on amiodarone to identify symptoms or clinical signs suggesting testicular dysfunction, to diagnose and treat consequent hypogonadism.

Objective: There are insufficient data in the literature concerning whether cellular changes in tissue are reflected in blood circulation in granulomatous infections, such as zoonotic brucellosis. In this study, we compared laboratory parameters between patients with brucella (BEO) and non-brucella epididymo-orchitis (NBEO). Materials and Methods: This retrospective study included 84 patients with BEO and 92 with NBEO who presented to six medical centers between 2017 and 2021. Results: The median age of the patients was 41 (interquartile range: 27-61) years. In the multivariate analysis, the presence of abdominal pain (p=0.003), the percentage of lymphocytes (p=0.012) and the percentage of monocytes (p=0.029) were significantly higher in the BEO group than in the NBEO group. In addition, the percentage of neutrophils (p=0.001) was significantly lower in the BEO group than in the NBEO group. In the receiver operating characteristic analysis, the percentage of lymphocytes had an area under the curve (AUC) value of 0.808 at a cut-off point of >22.1%, the percentage of monocytes had an AUC value of 0.745 at a cut-off point of >7.7%, and the percentage of neutrophils had an AUC value of 0.746 at a cut-off point of <66.8%. Conclusion: To the best of our knowledge, there is no other study comparing the percentages of lymphocytes, monocytes, and neutrophils between patients with BEO and NBEO. The percentages of mononuclear leukocytes (monocytes and lymphocytes) and neutrophils may be useful for the prediagnosis of BEO in endemic areas. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature on the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy; however, the literature on its efficacy is also scarce, with success rates varying from 10-90%. Our goal was to better describe the etiology and natural history of isolated epididymal pain and to describe the rates of success associated with epididymectomy. METHODS: A retrospective, case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed, and response rates, as well as response rates to surgical therapy were collected. RESULTS: From April 2022 to April 2023, a total of 275 patients with chronic orchialgia were identified; among them, 74 patients presented with chronic isolated epididymal pain. On average, 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response. CONCLUSIONS: Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy. [ABSTRACT FROM AUTHOR]

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Testicular compartment syndrome (TCS) impedes the microcirculation in the testicle, resulting from increased venous resistance or an extraluminal compression that might lead to a cascade of hypoxia, ischemia, and gangrene. We report a case of fulminant necrotizing orchitis occurring in a 45-year-old immunocompetent patient in the form of TCS. The patient underwent imaging, which suggested extensive localized right testicular abscess formation, for which the patient underwent guided drainage from the abscess. Subsequently, the patient was started on culture-sensitive intravenous antibiotics. Due to the failure of conservative treatment and symptomatic deterioration, we planned scrotal exploration. Intraoperatively, we found that the testicular tissue was necrotic and completely replaced by frank pus, with an already ruptured tunica, due to higher compartmental pressure. The patient underwent a right orchidectomy. The postoperative course in the hospital was uneventful. We report that this case as TCS is rare, and all surgeons should be aware of such possibility of occurrence.

Calciphylaxis is a rare and serious complication of chronic renal failure characterized by vascular calcium overload. It has a high mortality rate. Penile calciphylaxis is an extremely rare condition of penile necrosis due to calciphylaxis of the penile arterioles. Presented here is a severe case of systemic calciphylaxis initially presented as penile necrosis treated with sodium thiosulfate and amputation.

Introduction. Urethroplasty is a urological operation that is widely used in the management of urethral stricture (US). However, postoperative complications are relatively common in this procedure. In their structure, infection takes the leading position in most cases. Nevertheless, to date the problems of prevention and treatment of infectious complications, be it urinary tract infection (UTI) or wound infection, remain poorly studied.Objective. To generalise and critically analyse the worldwide literature data on infectious complications in urethroplasty, as well as to study the expediency and validity of infectious conditions treatment before urethroplasty, the efficacy of the protective effect of antibiotic prophylaxis in the aspect of postoperative complications.Materials & methods. The study was conducted accordance with the recommendations on preferred reporting elements for systematic reviews and meta-analyses. The search was conducted in the PubMed database from 1992 to 2022 by keywords, considering the inclusion and exclusion criteria which led to the selection of twenty papers for further study. Results. We have observed the influence of UTI on postoperative complications or recurrence. The presence of infectious postoperative complications, in turn, also has a significant impact on US recurrence. Some authors have drawn attention to the influence of surgical aspects, bed-days and aetiology of US on the incidence of surgical site infection. The studies to date provide little insight into the appropriateness of preurethroplasty infection treatment and antibiotic prophylaxis in the context of their impact on complications and US recurrence which leave these issues open to debate.Conclusion. Infectious complications are the most frequent hospital-acquired sequela after surgery; consequently, more efforts should be made to eliminate them in patients receiving urethroplasty. The systematic review revealed insufficient study of the issues of complications and US recurrence prevention in urethroplasty, no consensus on the optimal antibiotic prophylaxis regimes and the appropriateness of preoperative UTI treatment.

Abstract Background We present a case report of an immunocompetent host with presumed sexually transmitted cytomegalovirus proctitis and epididymitis, where there currently is a sparsity of published data. Case presentation A 21-year-old previously healthy Caucasian individual was admitted for severe rectal and testicular pain in the setting of proctitis and epididymitis. Serology and rectal pathology confirmed acute primary cytomegalovirus infection. Conclusions This report details his diagnostic workup and highlights cytomegalovirus as a rare cause of sexually transmitted disease among immunocompetent persons.

Zinner syndrome is a rare congenital anomaly characterized by a triad of renal dysgenesis/agenesis, cysts in the ipsilateral seminal vesicle, and ejaculatory duct obstruction. Though often diagnosed in infancy, the diagnoses can be incidentally found in adults who present with nonspecific genitourinary symptoms including dysuria, ejaculatory dysfunction, or genital pain. We present an unusual case of a 29-year-old male patient who presented to the emergency department with recurrent testicular pain and hematospermia and was found to have an atrophic right kidney with an ectopic ureter implanting into a cystic seminal vesicle. These findings were consistent with a rare subvariant of Zinner syndrome only previously described four times in the literature. We performed a robotic-assisted laparoscopic ectopic nephroureterectomy with sparing of his seminal vesicle. To our knowledge, this is the first report to describe the safe and effective use of robotic surgery in this setting to remove affected anatomy while preserving the patient's seminal vesicle. [ABSTRACT FROM AUTHOR]

Two male Japanese Black calves developed an enlarged scrotum and testis. Orchiectomy was performed and pus was collected during surgery. After removal of the testis, bacteriological and histopathological examinations were conducted to investigate the cause and confirm the diagnosis. Based on the results obtained, both cases were diagnosed with epididymitis caused by an infection with Pasteurella multocida. This is the first study to show that P. multocida causes epididymitis in male calves. Further studies are required to clarify the details underlying the infection of calves with P. multocida. [ABSTRACT FROM AUTHOR]

Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management. [ABSTRACT FROM AUTHOR]

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Introduction: The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated. Case: We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging–Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew Mycobacterium tuberculosis complex strain BCG. As prostate specific antigen (PSA) rose, prostate’s biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy. Discussion: BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.

Aim: To classify (etiologically) and to evaluate various scrotal pathologies using ultrasonography and describe the role of High resolution ultrasound and colour doppler in their diagnosis and differentiation. Methods: A prospective study was conducted in the Department of Radiology. The 100 patients with clinical features of scrotal diseases were include in this study. All the patients included in the study underwent scrotal ultrasonography using 7.0-12.0 MHZ high frequency linear array transducer coupled with Colour Doppler in Esaote My Lab 40 and Phillips affinti 70G equipments. Results: The patients most commonly involved were those belonging to the age group of 30 to 40 years (38%). The least number of patients belonged to the age group of 0-10 years (4%). On USG, the total number of lesions detected were 120. The most common cause of scrotal pathologies was hydrocele (n=31, 25.83%) followed by epididymal cyst (n= 20, 16.67%), epididymo-orchitis (n =16, 13.33%), epididymitis (n = 9; 7.5%), funiculitis (n=8, 6.67%), varicocele (n = 7, 5.83%), pyocele (n= 6, 5%), testicular torsion (n=5, 4.17%), testicular abscess (n = 5, 4.17%), inguino-scrotal hernia (n = 4, 3.33%), testicular microlithiasis (n= 3, 2.5%), testicular tumour (n=3, 2.5%) and tubercular epididymo-orchitis (n=3, 2.5%). The number of scrotal lesions seen on the left side were 45(37.5%), on the right side were 35 (29.17%) and in bilateral locations were 20(16.67%). Associated symptoms included swelling, pain, fever and infertility. Almost all the scrotal pathologies were associated with scrotal swelling (n=97, 97%) except in 3 cases. Epididymal cysts were seen in 20 patients, Acute epididymo-orchitis(n=16) was most commonly seen on the left side. Hydrocele (n=31) was the most common scrotal pathology detected in this study. Varicocele 7 patients was most commonly seen on the left side. Testicular torsion was detected in 5 (n = 5) patients. 3 (n=3, 60%) patients had right testicular torsion. Conclusion: High frequency ultrasonography with Color Doppler study serves as an excellent diagnostic imaging modality in the evaluation of scrotal diseases. It is the investigation of choice since it is highly sensitive, easy to perform, widely available, repeatable and involves no risk of ionizing radiation. Periodic follow-up USG scans are recommended for patients with inflammatory scrotal lesions to monitor response to treatment and to reveal the development of complications. [ABSTRACT FROM AUTHOR]

Background: We present a case report of an immunocompetent host with presumed sexually transmitted cytomegalovirus proctitis and epididymitis, where there currently is a sparsity of published data. Case presentation: A 21-year-old previously healthy Caucasian individual was admitted for severe rectal and testicular pain in the setting of proctitis and epididymitis. Serology and rectal pathology confirmed acute primary cytomegalovirus infection. Conclusions: This report details his diagnostic workup and highlights cytomegalovirus as a rare cause of sexually transmitted disease among immunocompetent persons. [ABSTRACT FROM AUTHOR]

Canine brucellosis or beagle fever is a zoonotic bacterial reproductive disease of dogs, caused by Brucella canis and occasionally by Brucella abortus, B. melitensis and B. suis. The actual seroprevalence of canine brucellosis in India is unknown and not yet studied in Kerala. A total of 131 animals presented to the outpatient unit of medicine, gynaecology and obstetrics of the two University Veterinary Hospitals at Mannuthy and Kokkala with clinical signs of epididymitis, orchitis, abortion, still birth, foetal resorption, foetal mummification, foetal maceration, neonatal death and infertility were randomly selected for the study. Paired sera samples were collected on the day of presentation and after three weeks of presentation for Rose Bengal Plate Test (RBPT). In this study, sera samples from forty-seven (35.88 per cent) infected dogs showed agglutination on RBPT using B. abortus S99 antigen. Out of forty-seven RBPT positive samples, 80.85 per cent (38/47) were female and 19.15 per cent (9/47) were male dogs. The high seroprevalence of canine brucellosis in this study is attributed to the endemicity of bovine brucellosis in the study area.

Abstract Background Epididymitis has several etiologies that can be related to infectious and non-infectious causes, autoimmune conditions, aseptic causes, and even certain pharmaceutical medications (amiodarone and chemotherapeutic agents). Some cases of epididymitis are complicated with pyocele formation that requires emergent surgical intervention to prevent testicular gangrene. This report describes the case of a 66-year-old male who developed severe bilateral epididymitis complicated by bilateral pyocele and ensuing sepsis. Astonishingly, the condition resolved completely without surgical intervention. Case presentation We are presenting a case of a non-sexually active male who developed bilateral severe epididymitis complicated by pyocele that led to the development of septic shock. Further history revealed that the patient was not sexually active with male or female partners and denied any form of trauma. Physical examination demonstrated scrotal swelling and erythema on inspection and severe tenderness on palpation. Digital rectal examination as well as abdominal examinations was unremarkable. Laboratory investigations disclosed severe leukocytosis with a neutrophil predominance (39,000 K/UL, normal range 4500–11,000 K/UL), as well as an elevation of systemic inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein. Urine culture was positive for Escherichia coli. Ultrasound revealed bilateral epididymitis and pyocele. This patient was managed with a course of meropenem, resolving the epididymitis and pyocele without the need of surgical intervention. Conclusions Surgical intervention is considered the standard of care and the approved management for pyocele to avoid further complications such as Fournier’s gangrene. However, this patient was treated solely with antibiotics, and his condition was stabilized without the need of surgical intervention that would result in additional cost and length of stay for the patient. This case raises further questions regarding the potentially better bioavailability of this antibiotic in the scrotum compared to elsewhere in the body and the potential for a non-surgical alternative approach in the management of patients with pyocele and requires further research.

ABSTRACT We report a case of urethral obstruction due to seminal vesiculitis in a Dorper sheep, with symptoms of anuria, rectal prolapse, orchitis/epididymitis, and uroperitoneum and biochemical tests indicating severe azotemia. The animal died due to advanced azotemia, and necropsy revealed kidneys with cortical and medullary necrosis, pyelonephritis of renal calyces, hydronephrosis, ruptured and necrotic bladder, and vesicular, bulbourethral, and ampoule accessory sex glands. There was prostate hyperplasia that revealed a large amount of pus in the cross section, which was also observed bilaterally in the epididymis and right testis. Morphotintorial and biochemical analyses of bacteria obtained from microbiological culture revealed Corynebacterium sp. and Escherichia coli. Infection, hyperplasia, and abscessation of accessory sex glands caused urethral compression, resulting in an obstructive condition, similar to urolithiasis, in addition to bacteremia. Hyperplastic seminal vesiculitis, although rare, must be included among the differential diagnoses of obstructive processes in the urinary tract of sheep.

Introduction: Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery. Objective: The aim of our study is to identify early predictors of Brucella EO. Patients and Methods: We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for Brucella based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for Brucella orchitis. Results: A comparison between Brucella-positive and Brucella-negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the Brucella group, 72% of the patients had a history of animal contact compared to 33% in non-Brucella group (P = 0.006). When comparing CBC parameters in the two groups, Brucella group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus Brucella negative group 17.35 ± 5.28, 7.8 ± 10.53, and P values were 0.037 and 0.004, respectively. Brucella group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non-Brucella group 13.22 ± 8.05 and P < 0.01. Conclusion: Brucella orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for Brucella orchitis in endemic areas.

Purpose: Acute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups. Methods: A retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period. Results: 140 patients were identified, the age range was 0–89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0–15-year-olds), sexually active young men (Group 2a, 16–35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b. Conclusion: Overall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%). [ABSTRACT FROM AUTHOR]

Background: Torsion of the appendix testis (TAT) is considered the most common cause of acute scrotum in childhood. When clinical and ultrasound (US) findings agree with the diagnosis, after testicular torsion has been excluded, conservative therapy is attempted whereas scrotal exploration and removal of the hydatid are required when medical therapy has failed. We hypothesized there are US features that can predict the failure of conservative therapy. Methods: We conducted a retrospective analysis on pediatric patients treated for TAT. The age of patients, number of days spent with symptoms before the start of treatment, presence of epididymitis and/or hydrocele, and dimension of the twisted hydatid were analyzed. A search for a correlation between these variables and failure of conservative treatment was conducted. Results: Patients were divided into 2 groups based on the efficacy of conservative management: responders (group I) and non-responders subjected to surgical treatment (group II). No statistically significant differences were registered in regard to age (p = 0.25), average dimension of hydatid (p = 0.09), and time gap between symptoms and the start of therapy (p = 0.92) between the 2 groups. An associated epididymitis was described in 27.5% of patients in group I and 41.7% in group II (p = 0.03; OR 1.89), and associated hydrocele was described in 33.4% of patients in group I and 45.8% in group II (p = 0.03; OR 1.83). Considering the odds ratios, the probability of surgical intervention when presenting only epididymitis without hydrocele is estimated to be 15%, when presenting only hydrocele without epididymitis: 9%, with both epididymitis and hydrocele: 74%, and without epididymitis nor hydrocele: 2%. Conclusions: The presence of both epididymitis and hydrocele at first US evaluation is associated with a high probability of conservative treatment failure, thus predicting the need for surgical intervention. [ABSTRACT FROM AUTHOR]

Although various viruses are considered to be the clinical cause for acute orchitis, it is completely unclear to what extent and which viruses are etiologically involved in acute orchitis and what the clinic and course of these patients are like. Therefore, a prospective study was set up to decipher acute isolated orchitis. Between July 2007 and February 2023, a total of 26 patients with isolated orchitis were recruited and compared with 530 patients with acute epididymitis. We were able to show for isolated orchitis, that (1) orchitis is usually of viral origin (20/26, 77%) and enteroviruses with coxsackievirus B strains (16/26, 62%) are predominant, (2) virus isolates could be received from semen indicating the presence of replication‐competent virus particles, (3) a polymerase chain reaction (PCR) for enteroviruses should be conducted using semen provided at the onset of disease, because the virus is not detectable in serum/urine, (4) there is a circannual occurrence with the maximum in summer, (5) orchitis is associated with a characteristic inflammatory cytokine panel in the semen and systemic inflammation, (6) orchitis is usually rapidly self‐limiting, and (7) about 30% of patients (6/20) suffer ongoing oligozoospermia. These seven emerging aspects are likely to fundamentally change thinking and clinical practice regarding acute isolated orchitis. [ABSTRACT FROM AUTHOR]