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Abstract Background Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis. Case presentation We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient’s condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis. Conclusions To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.

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

Background: Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis. Case presentation: We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient's condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis. Conclusions: To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (MTB) and now represents a significant global health concern, with an estimated 10 million people infected with TB in 2022, equivalent to 133 incident cases per 100,000 population. Indonesia faces a substantial burden. The World Health Organization (WHO) estimates 969,000 TB cases, with 717,941 confirmed cases reported. Extrapulmonary TB, contributing to 15% of TB cases, affects various areas such as bones, pleura, lymph nodes, genitourinary system, peritoneum, and meninges. Tuberculous epididymo-orchitis, a rare type of extrapulmonary TB, is characterized by MTB infection in the epididymis or testis. Case: A 31-year-old male was presented to the Emergency Department of Budi Rahayu General Hospital, Pekalongan, with a fever, bitter taste, body aches, and cough. Initially hospitalized for five days and discharged upon improvement of symptoms, the patient returned with fatigue, cough, and black stools. After being admitted under internist and pulmonary specialist care due to a suspected left lung TB apical lesion, biomolecular testing (GeneXpert) was performed. Consultation with a urologist revealed scrotal pain, prompting further tests including urine acid-fast bacilli (AFB) examination, testicular ultrasound, and aspiration culture. The patient was diagnosed with TB epididymo-orchitis and treated with a Category 1 TB regimen. Conclusion: TB epididymo-orchitis is a rare case requiring thorough diagnostic evaluation encompassing anamnesis, physical examination, and diagnostic procedures. Early detection and appropriate management are vital in combating this challenging disease.

Epididymo-orchitis (EO) is a common genitourinary clinical syndrome in men, and delayed investigation and improper management can lead to complications. This study aimed to analyze clinical and laboratory findings and treatment outcomes in EO patients. We conducted a retrospective record-based study at King Abdullah Hospital in southern Saudi Arabia from 2018 to 2022, reviewing data from 63 EO patients who had a median age of 34 years (range: 16–82 years). The results showed that the most common complaints were scrotal pain and swelling (54%), followed by testicular pain (44.4%). Scrotal ultrasonography showed increased vascularity in both testes and epididymis in 49 patients (77.8%), while 14 patients (22.2%) had epididymal involvement alone. Reactive hydrocele was observed in 15 patients (23.8%), abscesses in seven (11.1%), and hypoechoic lesions in three (3.8%). Anti-Brucella antibody titers (≥1:80) were detected in 22 cases, and 14.3% had positive urine cultures. Of the patients, 87.3% responded well to the initial treatment course, while four (6.3%) were cured after a second course of treatment. EO complications occurred in three cases (4.8%), and one patient (1.6%) succumbed to septicemia. Of the 15 patients treated with ceftriaxone and ciprofloxacin, one required orchiectomy due to non-response. Relapse occurred in one of the 10 patients treated with triple therapy (doxycycline, rifampicin and gentamicin). Among the nine patients treated with ceftriaxone and co-trimoxazole, one did not respond, developed a testicular abscess, and underwent incision and drainage. In conclusion, our study highlights that most cases of EO can be effectively resolved with appropriate antibiotic therapy, particularly combinations containing cefuroxime and/or ciprofloxacin. Clinicians in Brucella-endemic regions should consider the possibility of brucellosis as an underlying cause of EO.

Introduction. Infectious complications (ICs) after transurethral resection of the prostate (TURP) are significant and potentially life-threatening conditions with an incidence 0.5% – 20.0%. Most publications provide data regarding early infectious complications. At the same time, there are currently no studies aimed at a comprehensive assessment of long-term infectious complications after TURP. The problem of prevention and treatment of ICs is also accompanied by insufficient understanding of the role of undiagnosed inflammation in prostate tissues and the lack of representative laboratory markers.Objective. To assess the prostate-specific antigen density (PSAd) as a predictor of long-term infectious complications after transurethral resection of the prostate and to determine the optimal cut-off value.Materials & methods. This single-center study included 162 patients who underwent mono- and bipolar TURP between 2016 – 2023. Inclusion criteria for the study: prostate volume 30–80 cm3, no history of urinary tract infections (UTIs) at the time of hospitalization and antibiotic treatment at least one month before surgery, possible presence of latent UTIs before surgery, no prostate cancer. Exclusion criteria were failure to meet inclusion criteria. Infectious complications assessed included upper and lower UTIs, as well as epididymitis, orchitis and prostatitis, confirmed by clinical and laboratory data. Prostate-specific antigen (PSA) assessment was performed < 2 days before surgery.Results. The median PSAd value was 0.04 [0.03; 0.08] ng/ml2, the variable was significantly different in non-infection and infection groups (0.04 and 0.08 ng/ml2, respectively, p = 0.009). The area under the curve (AUC) was 0.67 (95% CI [0.546 – 0.791]). The optimal cut-off value of the PSAd in prediction of long-term ICs was > 0.07 ng/ml2, sensitivity / specificity: 58.3% and 76.1%, respectively. The analysis showed more than 4 times higher odds of developing an infectious complication in PSAd > 0.07 ng/ml2 patients: OR 4.3 (95% CI [1.7 – 10.5], p = 0.001).Conclusion. This study demonstrates data that defines a new clinical non-oncological significance of PSAd as a predictor of the development of long-term infectious complications after TURP.

Acute epididymo-orchitis (AEO) is becoming an increasingly common differential diagnosis in children with acute scrotal pain. It has been noted in adult men that SARS-CoV-2 has a propensity for involving the testis and epididymis, affecting sperm and testosterone production. Our literature search revealed only one case report of COVID-19 presenting with epididymo-orchitis in a child. We present three more children who presented with AEO, all recovering from PCR-confirmed SARS-CoV-2 infection. This article reviews the post-inflammatory aetiology of paediatric epididymo-orchitis, and the propensity SARS-CoV-2 has for the testis. Two pre-pubertal ten-year-old patients presented to the emergency department with a 48-h history of gradual onset unilateral scrotal pain and increasing erythema of the ipsilateral scrotal skin. One fifteen-year-old boy was referred for ongoing symptoms four days following a diagnosis of AEO made by his General Practitioner. On further questioning, all three had PCR-confirmed COVID infection two weeks prior to the onset of their scrotal symptoms and had just ended their isolation period. A literature search was then performed using the keywords SARS-CoV-2, testes and paediatric acute epididymo-orchitis. The SARS-Cov-2 virus has a propensity for affecting the testis and epididymis. This puts patients at increased risk of acute epididymo-orchitis during COVID infections. The inflammation induced by the virus appears to affect the cells responsible for testosterone production and sperm quality. However, there is no evidence that viral transmission can happen via semen. SARS-Cov-2 infection can lead to acute epididymo-orchitis. Knowledge of this is clinically significant, firstly to avoid unnecessary surgical intervention due to a mistaken diagnosis of testicular torsion and secondly, due to the potential of the virus to affect sperm quality and testosterone production. [ABSTRACT FROM AUTHOR]

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]

We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal swelling. Doppler ultrasound revealed normal testicles but an enlarged, echogenic left epididymis with pyocele. Despite initial therapy with amoxicillin and cefotaxime, a repeated ultrasound indicated compromised testicular vascularity, necessitating emergency surgical exploration. This revealed purulent discharge and inflammation, with Escherichia coli as a causative agent. Post-surgery, the patient showed significant improvement and was discharged in good condition after a ten-day of hospitalization. The study emphasizes the significance of including EO in the possible diagnoses for neonatal scrotal swelling.

Urothelial carcinoma of the bladder remains a challenging disease to treat. Intravesical instillation of BCG has demonstrated tremendous efficacy in preventing recurrence. BCG related necrotizing granulomatous epididymo-orchitis is rare and has not been previously linked to brachytherapy for adenocarcinoma of the prostate. We hypothesize that prior brachytherapy has a deleterious effect on the verumontanum that can result in retrograde transmission of BCG particles leading to granulomatous epididymo-orchitis. This is the first case report of necrotizing granulomatous epididymo-orchitis related to BCG in a patient status post brachytherapy for adenocarcinoma of the prostate.

This report documents the first case of Raoultella planticola epididymo-orchitis following campylobacter gastroenteritis in a 76-year-old male. Highlighting R. planticola's expanded pathogenic potential beyond common urinary tract infections, this case emphasizes its clinical significance in atypical genitourinary presentations, particularly in individuals with pre-existing conditions like diabetes mellitus and renal failure. Despite intrinsic ampicillin resistance, targeted ciprofloxacin treatment proved effective. This case underscores the necessity for broad diagnostic considerations and tailored antibiotic therapy in managing complex infections, advocating for increased awareness of emerging resistant uropathogens in clinical practice.

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

Background: Epididymitis is a common cause of scrotal pain in adults, with coliform bacteria being the most common isolated organisms in patients older than 35. Case presentation: A 51-year-old healthy patient presented with scrotal pain and swelling, and was found to have epididymo-orchitis and bacteraemia caused by Haemophilus influenzae, which has not previously been reported as a cause of epididymo-orchitis and bacteraemia in immunocompetent patients. Discussion: Diagnostic studies can help confirm the diagnosis and detect the causative pathogen. In all suspected cases, a urinalysis, urine culture and a urine or urethral swab for nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae and Chlamydia trachomatis should be performed. Colour Doppler ultrasonography often shows an enlarged thickened epididymis with increased Doppler wave pulsation in epididymitis. H. influenzae are pleomorphic gram-negative rods that commonly colonise the human respiratory tract and are associated with a number of clinical conditions. H. influenzae has been reported as a cause of epididymo-orchitis in prepubertal boys, and in few cases were associated with positive blood cultures. In adults, H. influenzae has been isolated before from urine samples or urethral swabs in patients with epididymitis or epididymo-orchitis. Conclusion: This case highlights the possibility of H. influenzae causing epididymo-orchitis and bacteraemia in immunocompetent patients. Healthcare providers should consider H. influenzae in the differential diagnosis of epididymitis and epididymo-orchitis in both immunocompetent and immunocompromised patients.

Introduction: The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. Methodology: Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of = 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. Results: A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. Conclusions: Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement. [ABSTRACT FROM AUTHOR]

A previously healthy man in Austria had tularemia epididymo-orchitis develop, leading to unilateral orchiectomy. Francisella tularensis subspecies holartica was detected by 16S rRNA gene sequencing analysis of inflamed granulomatous testicular tissue. Clinicians should suspect F. tularensis as a rare etiologic microorganism in epididymo-orchitis patients with relevant risk factors.

Tuberculous peritonitis, though rare, is a serious condition and its diagnosis is challenging due to nonspecific clinical symptoms and imaging findings. Likewise, tuberculous epididymo-orchitis is a clinical dilemma, as it often mimics testicular tumors. We report a case of a 62-year-old patient diagnosed to have TB peritonitis, following tuberculous epididymo-orchitis with review of the imaging features of both entities. A high index of suspicion and careful clinical assessment will help in early diagnosis and treatment of TB peritonitis, preventing potential complications. Moreover, testicular tuberculosis should be considered in the differential diagnosis of scrotal mass.

Brucellosis is an endemic zoonotic disease caused by intracellular gram-negative coccobacilli called Brucella. This infectious disease may implicate many farm animals and is transmissible to exposed humans. Brucellosis is potentially life-threatening and may lead to granulomatous multi-organ involvement with tendency to chronicity and recurrence. The treatment of brucellosis requires combined and protracted antimicrobial therapies to eliminate the disease and to avoid its relapse. Genitourinary brucellosis is common among infected humans in endemic areas and is considered the second-most affected focal site, which commonly manifests as epididymo-orchitis. Testicular abscess, however, is an extremely rare complication of brucellosis. To the best of our knowledge, in the literature, there are to date only 16 previously published case reports, including 22 patients of brucellar testicular abscesses, emphasizing the extreme rarity of this condition. Most of these cases harbored small abscesses, which were treated conservatively using antibiotics therapy only, or with added drainage of the abscesses. Larger abscesses were reported to necessitate orchiectomy. In some cases, the abscesses were mimicking tumors, and surgeries for orchiectomy were done accordingly. A summary of the previously reported cases in the literature is presented. Here, we present the 17th case report of a 34-year-old man with a right-side huge multilocular brucellar testicular abscess apparently replacing the entire testicle, who was successfully treated with organ-sparing management by incision-drainage of the large abscess with antibiotics, to eventually preserve his testis. In conclusion, brucellosis should be considered among the differential diagnoses of any testicular swelling, especially in endemic areas. Drainage of brucellar testicular abscess with appropriate medical treatment is feasible and may preserve the testicle, even with large abscess apparently replacing the entire testicle. [ABSTRACT FROM AUTHOR]

Aim: To investigate the value of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in differentiating acute scrotal conditions. Methods: A total of 60 patients, including 30 epididymo-orchitis and 30 testicular torsions, diagnosed and treated in our clinic between January 1, 2010 and December 2022, were included in the study. The patients were divided into two groups; group 1 (testicular torsion = TT) and Group 2 (epididymo-orchitis = EO). The age, diagnosis, and hemogram parameters of the patients were evaluated. Results: Both Group 1 and Group 2 consisted of 30 patients each. The mean ages of group 1 and 2 were 13.7, and 11.2 years, respectively (p>0.05). When compared to the group 2, NLR was higher in the group 2 (p<0.05). There was no statistically significant difference between the groups in terms of PLR value (p >0.05). ROC analysis was performed for NLR. According to the ROC analysis; at a cut-off value of 2.92, the sensitivity was 51% and the specificity was 87%, AUC (0.79; CI: 0.694 - 0.896). Conclusion: TT and EO can be diagnosed using inflammatory markers such as NLR. However, additional prospective studies are needed. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL) has rarely been reported in patients with chronic granulomatous disease (CGD), despite the fact that they seem more susceptible to intracellular infection. We describe a rare presentation of VL and epididymo‐orchitis in a patient with CGD, which has not been seen previously in the literature following inflammatory syndrome. [ABSTRACT FROM AUTHOR]

Brucellosis is an endemic zoonotic disease caused by intracellular gram-negative coccobacilli called Brucella. This infectious disease may implicate many farm animals and is transmissible to exposed humans. Brucellosis is potentially life-threatening and may lead to granulomatous multi-organ involvement with tendency to chronicity and recurrence. The treatment of brucellosis requires combined and protracted antimicrobial therapies to eliminate the disease and to avoid its relapse. Genitourinary brucellosis is common among infected humans in endemic areas and is considered the second-most affected focal site, which commonly manifests as epididymo-orchitis. Testicular abscess, however, is an extremely rare complication of brucellosis. To the best of our knowledge, in the literature, there are to date only 16 previously published case reports, including 22 patients of brucellar testicular abscesses, emphasizing the extreme rarity of this condition. Most of these cases harbored small abscesses, which were treated conservatively using antibiotics therapy only, or with added drainage of the abscesses. Larger abscesses were reported to necessitate orchiectomy. In some cases, the abscesses were mimicking tumors, and surgeries for orchiectomy were done accordingly. A summary of the previously reported cases in the literature is presented. Here, we present the 17th case report of a 34-year-old man with a right-side huge multilocular brucellar testicular abscess apparently replacing the entire testicle, who was successfully treated with organ-sparing management by incision-drainage of the large abscess with antibiotics, to eventually preserve his testis. In conclusion, brucellosis should be considered among the differential diagnoses of any testicular swelling, especially in endemic areas. Drainage of brucellar testicular abscess with appropriate medical treatment is feasible and may preserve the testicle, even with large abscess apparently replacing the entire testicle.

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.

Background: Scrotal pain is a common urological condition. Common causes of scrotal pain are Hydrocele, testicular torsion, epididymitis, epididymo-orchitis and occasionally due to post vasectomy pain, varicocele, testicular trauma etc. Ultrasound is an ideal imaging modality for the evaluation of scrotum in all age group patients. Scrotal ultrasound can differentiate between solid and cystic masses and localize the mass as either testicular or Para testicular. Objectives: The aim of study is to evaluate causes of scrotal pain on ultrasound and to determine the common causes of scrotal pain. Methodology: Patients presented with scrotal pain who were referred to radiology department of our hospital were included in the study. All patients were subjected to ultrasound of scrotum with color Doppler study when needed. Descriptive variables were studied and analyzed. Results: In the present study out of 160 cases, maximum i.e. 33 (20.62%) patients were ranged in age from 61-70 years. It was observed that majority of cases had hydrocele (35.62%) followed by Non specificorchalgia (26.25%), inflammatory lesion (20%) and others like varicocele (8.1%), torsion infarct (3.4%) Spermatocele (5%), undescended testis (8%). Among 42 cases of inflammatory scrotal pathology, acute epididymo orchitis was present among 12 (28.57%) cases followed by acute epididymitis. Conclusion: Our research led us to the conclusion that hydrocele was the most frequent cause of scrotal pain. For assessing patients with scrotal pathological disorders, Ultrasonography is an excellent, safe, and reliable tool. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Testicular necrosis is a rare and severe complication of immunoglobulin A (IgA) vasculitis (IgAV). Herein, We report a case of a 10-year-old boy who was admitted to the hospital due to skin purpura and intermittent abdominal pain for 10 days and bilateral testicular pain for 2 days. Scrotal ultrasonography indicated right testicle ischemia, right epididymo-orchitis, and bilateral hydrocele of the testis. Scrotal surgical exploration revealed significant swelling and darkening of the right testicle. Conservative treatment led to improvement in his condition, and he was discharged. During 3 months of follow-up, there was no recurrence of skin purpura or pain, and the urine tests were normal. Color ultrasound indicated only partial blood flow signal to the right testicle tissue, which was slightly smaller than the left testicle. This case highlights the need for continuous attention from clinicians to the signs and symptoms of the reproductive system during the diagnosis and treatment of IgAV. Continuous monitoring with ultrasound can aid in early detection, diagnosis, and treatment of reproductive system lesions of IgA vasculitis.

Abstract Visceral leishmaniasis (VL) has rarely been reported in patients with chronic granulomatous disease (CGD), despite the fact that they seem more susceptible to intracellular infection. We describe a rare presentation of VL and epididymo‐orchitis in a patient with CGD, which has not been seen previously in the literature following inflammatory syndrome.

Epididymo-orchitis is a common intra-scrotal inflammation among males that causes swelling of the epididymis and testis. In the era of modern antibiotics, complications associated with this condition are now rare. Herein, we report a 28-year-old man with acute epididymo-orchitis complicated by the formation of several abscesses involving the left testis and seminal vesicles. The literature review showed this patient as the first case with such extensive complications following epididymo-orchitis. Initial antimicrobial therapy was unable to resolve the condition. The management necessitated surgical intervention, which included MRI-guided aspiration of the seminal vesicle abscesses and testicular sparing drainage of the testicular abscess. [ABSTRACT FROM AUTHOR]

Introduction:  To investigate the current experience of the ARM-Net Consortium in the management of epididymo-orchitis (EO) in patients with anorectal malformations (ARMs), and to identify specific risk factors and the need for urological care involvement.Materials and Methods:  We retrospectively collected data of EO in patients with ARM between 2015 and 2019. Data on urological aspects, ARM type, surgical approach, associated anomalies, diagnosis, and treatment of EO were collected and analyzed.Results:  Twenty-nine patients were reported by 12 centers. Twenty-six patients with EO (90%) had ARM with a rectourinary fistula. Median age at first EO was 2 years (range: 15 days-27 years). Twenty patients (69%) experienced multiple EO, and 60% of recurrences were ipsilateral. Associated urological anomalies included vesicoureteral reflux (48%), urethral anomalies (41%), neurogenic bladder (41%), and ectopic vas (10%). A positive urine culture during EO was present in 69%. EO was treated with antibiotics (90%), limiting surgical exploration to 14%. Prevention of recurrences included surgery (bulking agents 15%, vasectomy 15%, and orchiectomy 5%) and antibiotic prophylaxis (20%).Conclusion:  Urologists may encounter patients with EO in ARM patients, frequently with positive urine culture. An appropriate urologic work-up for most ARM patients is necessary to identify and treat underlying risk factors. A practical scheme for the work-up is suggested for a close collaboration between pediatric surgeons and urologists. [ABSTRACT FROM AUTHOR]

Pseudomonas otitidis is a rare and unique species among the Pseudomonas genus that has not been previously reported as a cause of male genitourinary tract infection. In this report, we describe a case of a 20-year-old immunocompetent male who presented with recurrent epididymo-orchitis, which was initially misidentified as Vibrio vulnificus and treated successfully. The causative agent could not be identified appropriately using the available routine methods, but a final identification was established using 16S rRNA targeted sequencing followed by whole-genome sequencing. [ABSTRACT FROM AUTHOR]

Introduction: Epididymo-orchitis (EO) is a disease of both the epididymis and ipsilateral testis. Brucellar epididymo-orchitis (BEO) is an uncommon localized infection of the testis and epididymis which occurs in about 2–14 % of all patients with brucellosis as a result of urine Brucella removal or due to blood-borne septic metastasis. Methods: Between January 2018 and June 2021, 50 patients with fever, chills, swelling, and pain of the testicle (testicles) were referred to our center. Two approaches were used for the treatment of brucellarepididymo-orchitis among these individuals. Intravenous Gentamicin and Doxycycline were used in seven cases, while Rifampicin was added to this combination for the remaining 43 patients. Intravenous Gentamicin was administered for 7 days and the other drugs were used for 45 days. All patients were followed up for six months by monitoring the symptoms and signs of the disease. Results: None of the patients had been diagnosed with brucellosis before referral to our clinic. 43 patients were successfully treated by. Intravenous Gentamicin, Doxycycline and Rifampicin, whereas seven patients were fully treated using. Intravenous Gentamicin and Doxycycline. The two therapeutic groups were hospitalized for 7.56 ± 3.45 (3–23) and 10.14 ± 1.77 (8–13) days, respectively. Treatment failure, drug side effects, and disease complications were not observed in any of the cases over a 6-month follow-up period. Conclusions: Physicians should be alert regarding Brucellarepididymo-orchitis (BEO) within the differential diagnosis of nonspecific epididymo-orchitis, especially in regions where the disease is endemic. Delay in diagnosis or inappropriate management of BEO may result in complications.

Tuberculous epididymo-orchitis is a rare complication of intravesical bacillus Calmette–Guérin (BCG) immunotherapy for bladder cancer. We report a patient with bladder cancer and a history of intravesical BCG immunotherapy who presented with right scrotal pain for 1 week. A heterogeneous, hypoechoic, and solid mass surrounded by increased blood flow in the right testis was seen on scrotal echogram. Urine ordinary and tuberculosis culture yielded negative results. After failure of antibiotic treatment and the inability to rule out tumor, the diagnosis was confirmed by radical orchiectomy. Acid-fast staining of pus in the tumor and tumor tissue was positive, and a pus culture was positive for Mycobacteria tuberculosis complex. Right radical orchiectomy was performed, and anti-tuberculosis treatment with rifampicin, isoniazid, ethambutol, and pyrazinamide was given. The patient is still currently under anti-tuberculosis treatment, and no significant adverse effects have been noted. BCG-related epididymo-orchitis should be suspected in patients with a history of intravesical BCG immunotherapy if the empiric antibiotic treatment typically used to treat common epididymo-orchitis fails. [ABSTRACT FROM AUTHOR]

This comprehensive study delved into the pivotal function of chemokine-like receptor 1 (CMKLR1) in lipopolysaccharide (LPS)-triggered epididymo-orchitis in mice. Upon LPS exposure, wild-type (WT) mice exhibited marked elevations in serum pro-inflammatory markers, including G-CSF, IL-6, and RANTES, along with heightened levels of TNF-α and IL-6 in testicular and epididymal tissues, which accompanied by pronounced structural damage within the testicular tissue and a concurrent decline in serum testosterone, estradiol (E2) levels, and testicular steroid synthetase expression. Remarkably, Cmklr1 gene ablation intensified the pro-inflammatory response in the serum (especially IFN-γ), testes, and epididymis of epididymo-orchitis models. Furthermore, Cmklr1 deficiency uniquely induced structural alterations within the epididymis, which is absent in the WT model. This genetic manipulation also exacerbated the decline in serum testosterone and E2 levels and testicular steroid synthase activity. While chemerin levels were significantly diminished in WT epididymo-orchitis models, Cmklr1 knockout had no discernible effect on chemerin expression in the model. In addition, a noteworthy observation was the elevation of the serum low density lipoprotein/high density lipoprotein (LDL/HDL) ratio in Cmklr1 -deficient mice. Collectively, these findings underscore that the lack of chemerin/CMKLR1 signaling axis could potentially worsen the symptoms during LPS-induced epididymo-orchitis, highlighting its potential as a therapeutic target in related pathologies.

Background Acute scrotum is a medical emergency commonly encountered in clinical practice, particularly in pediatric and adolescent populations. It is characterized by sudden onset of scrotal pain and may involve swelling, redness, or tenderness. The most common etiologies include testicular torsion, epididymo-orchitis, trauma, and, less frequently, tumors. Early and accurate diagnosis is critical, especially in cases of testicular torsion, where timely surgical intervention is required to preserve testicular viability. Ultrasound (US), particularly high-resolution gray-scale imaging combined with color Doppler (CD), has emerged as the primary imaging modality for evaluating acute scrotal conditions due to its accessibility, non-invasiveness, and high diagnostic accuracy. Aims and objectives This study aims to assess the diagnostic accuracy of US in differentiating the causes of acute scrotum, specifically focusing on testicular torsion, epididymo-orchitis, and varicocele. We also evaluate its role in reducing unnecessary surgical explorations and improving clinical decision-making in urgent settings. Materials and methods This retrospective observational study was conducted in a tertiary care center in Puducherry, India. A total of 250 male patients, ranging in age from 10 to 70 years, presented with acute scrotal pain over the 12-month study period. Inclusion criteria included all patients with sudden scrotal pain, regardless of clinical suspicion of underlying pathology. US scans were performed using a 7.5- to 12-MHz linear transducer. Gray-scale imaging was used to evaluate the testes, epididymis, spermatic cord, scrotal wall, and inguinal region, while CD was used to assess vascular flow. Statistical analysis was conducted using SPSS Version 18 (IBM Corp., Armonk, NY). Diagnostic accuracy was calculated based on sensitivity, specificity, positive predictive value, and negative predictive value. Results The most common cause of acute scrotum was inflammatory pathology, including epididymo-orchitis, accounting for 56.4% of cases (141 patients). Varicocele was the second most common cause, diagnosed in 11.6% of patients (29 cases), while hernias and epididymal cysts were found in 8% and 7.6% of cases, respectively. Testicular torsion was diagnosed in 2% of cases (five patients). US demonstrated high diagnostic accuracy for inflammatory pathologies, with sensitivity and specificity reaching 97% and 96%, respectively. The sensitivity for testicular torsion was 62%, reflecting the challenges in diagnosing partial or intermittent torsion, while specificity was high at 99%. US's performance in identifying varicocele was excellent, with a sensitivity of 93% and specificity of 98%. Conclusion US, especially when combined with CD, is an indispensable tool in the emergency evaluation of acute scrotum. It provides high diagnostic accuracy for inflammatory pathologies and varicocele while serving as an effective screening modality for testicular torsion. This study reinforces the role of US in reducing unnecessary surgical explorations, guiding clinical management, and improving patient outcomes in urgent clinical settings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Human Ethics Committee of the Mahatma Gandhi Medical College and Research Institute issued approval N/A. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vijayakumar et al.)

Abstract Background Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. Methods Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. Results Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). Conclusions We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

Schistosomiasis is a trematodes infection that causes significant morbidity and mortality in the Middle East, particularly in Yemen. Despite its impact, testicular schistosomiasis is still viewed as an uncommon illness. We present a 15-year-old child with left testicular pain and fever for three days diagnosed as left epididymo-orchitis based on the clinical and ultrasonographical findings. The patient was treated empirically with intravenous antibiotics alongside supportive care without improvement after one week. Ultrasonography follow-up showed that the left testis was heterogeneously enlarged without intratesticular blood flow, suggesting left testicular torsion. Immediate scrotal exploration was performed, revealing a dark, congested, and 180° twisted left testicle. Thus, an orchiectomy was performed. The specimen's histology revealed calcified ova of Schistosoma haematobium. In conclusion, even though testicular schistosomiasis is rare, clinicians should provide a thorough clinical evaluation and histopathological analysis for resected specimen, particularly in high-risk patients.

Hand, foot, and mouth disease (HFMD) is a childhood febrile disease. Oral lesions and papulovesicular lesions on the hands and feet are the clinical signs of the disease. In our case, a 17-year-old boy presented to the emergency department, where he was diagnosed with HFMD. After 6 days, he felt intense pain in his right testicle, and therefore an ultrasound (US) examination was performed. US detected a hypoechoic mass-like area in the right testis. Viral etiology was suspected, and no therapy was prescribed. After a little more than 3 months, US examination showed a reduced lesion size. Viral epididymo-orchitis should be suspected in young men with a recent history of HFMD and testicular pain. [ABSTRACT FROM AUTHOR]

The testicular consequences of acute epididymo-orchitis remain largely unelucidated in long-term damage, which might be a neglected factor for male infertility. In this study, the differential phenotype of testicular immune cell subpopulations in lipopolysaccharide (LPS)-induced mouse epididymo-orchitis were analyzed by flow cytometry on day 1, day 7, and day 28. The number of macrophages, neutrophils, and myeloid-derived suppressor cells (MDSCs) steadily decreased in the testes with inoculation. Total F4/80-CD11c+ dendritic cells (DCs) maintained a relatively stable level, whereas conventional type 1 dendritic cells (cDC1) increased gradually from day 1 to day 28. There was a lower number of CD4+ and CD8+ T cells at day 1 and day 7, and they had similar results with a ceiling level at day 28. The testes displayed a higher level of CD3+ T cells but a lower frequency of macrophages, cDC2, and neutrophils at 28 days post-inoculation compared with the epididymis. In summary, our data indicates acute epididymo-orchitis could lead to long-term damage in the testes, which is characterized by CD3+ T cell (including CD4+ and CD8+ T cells)-mediated immune responses. • Long-term damage testes of LPS-induced mouse epididymo-orchitis is found. • Macrophages, neutrophils, and MDSCs decrease gradually along with inoculation. • Conventional type 1 DCs increase gradually along with inoculation. • CD3+T cell-mediated immunity is dominant in testes in long-term consequence. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine discriminative role of haematological inflammatories between acute scrotal pathologies and malignancies. In addition, it was aimed to search for a predictive marker of testicular survival in the TT group. Medical data of 141 patients with acute scrotal pathology and 63 TTm patients who presented to our clinic between January 2015 and July 2019 were retrospectively reviewed and compared in terms of haematological values and demographic parameters following the inclusion of 92 healthy controls. In the TTm group, NLR was the discriminative parameter with a median of 2.42 (0.25–8.42), whereas discriminative median values of MCV for TT and CRP for EO were 83.65 (56.9–98.16) and 59.5 (2.9–337) respectively. NLR, PLR, MER and RDW values were statistically lower in the control group compared to the patients groups. In TT subgroup analysis, monocyte count, MER and CRP were found to be statistically higher in the orchiectomy group, while multivariate logistic regression analysis performed for testicular viability revealed monocyte count to be the only significant variable (Odds Ratio [95% Confidence Interval] = 0.046 (0.006–0.366), p<0.004). While our study demonstrated both diagnostic and discriminative values of haematological parameters, it also showed that monocyte count could predict testicular salvage in TT patients. However, further prospective studies are required. [ABSTRACT FROM AUTHOR]

The symptoms of epididymo-orchitis (EO) are usually mild, but serious complications such as abscess and testicular necrosis can occur. There are a few cases of testicular necrosis secondary to EO to our knowledge. We present a case of a 60-year-old diabetic male patient who presented with left scrotal pain and fever in the last week. The scrotal ultrasonography (US) revealed increased flow of the left testicle in favour of the left EO. After seven days of antibiotic therapy, the patient's condition worsened and developed into a scrotal abscess. The scrotal US showed scrotal abscess with the absence of left testicular arterial vascularity in favour of testicular necrosis. For that, a left orchiectomy was performed, and a histopathology report confirmed the diagnosis. In conclusion, testicular necrosis secondary to EO is a rare occurrence. When there is a suspicion of EO, medical therapy should be started as soon as possible to avoid significant complications. [ABSTRACT FROM AUTHOR]

Background: Anorectal malformation (ARM) is a congenital malformation that has an incidence of 1 in 5000. Krickenbeck classification separate different types of ARM according to the anatomy, with major clinical groups such as perineal fistula, rectourethral fistula (prostatic or bulbar), rectovesical, vestibular, cloaca, no fistula and anal stenosis. Recto-urethral fistula with a normal anus is a rare variant among all ARM with very few cases reported in previous literature. Case report: We hereby report a case with H type recto-urethral fistula with a rare clinical presentation of recurrent epididymo-orchitis, with our workup including micturating cystourethrogram (MCUG) and cystoscopy which revealed the fistula; subsequent surgical management using a modified anterior sagittal transrectal (ASTRA) approach and literature review on similar cases. Conclusion: Recto-urethral fistula with a normal anus is a rare condition and an ASTRA approach provides good early results. Furthermore, MCUG should be considered in boys with recurrent epididymitis to rule out urethral anomalies.

Background: Scrotal swellings represent a common condition in surgical practice although there is limited literature available that encompasses the multitude of scrotal pathologies in adults. Aims and Objectives: The study aimed to analyze the etiology, modes of presentation, management and complications of different types of scrotal swellings in adults. Material and methods: Over a period of two years 400 male patients with scrotal swellings of age 14 years and above were studied. All the patients were evaluated according to a preformed proforma including an elaborate history, a detailed clinical examination, routine investigations and specific investigations if any like scrotal ultrasonography, ultrasonography of abdomen, contrast enhanced computed tomography of abdomen and serum tumor markers. The post-operative course including all complications were documented. Results: Mean age was 40.47Ü0.67 years. Epididymo-orchitis was the most common cause. UTI was the commonest predisposing factor (n=152) and E.coli was the most common organism isolated. Out of eight cases of testicular tumors encountered in our study seven were malignant tumors amongst which one had a lymphoma testis. Two hundred and sixteen patients were operated. Jaboulay's procedure was the most common surgery done. Orchiectomy was done for all 12 cases of torsion testis, as all of them had gangrene of testis. All complications were recognised in the hospital and managed with good results except two patients who had recurrence of varicocele and had to be reoperated. Conclusions: A careful history taking and examination are usually enough to arrive at diagnosis in scrotal swellings, but ancillary investigations like grey scale ultrasound and colour doppler ultrasound are also needed to differentiate certain conditions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the value of direct and indirect markers showing inflammation in the diagnosis of Brucella epididymo-orchitis (BEO) and its differentiation from non-Brucella epididymo-orchitis. Material and Methods: A total of 152 patients that presented to our clinic with acute scrotal complaints and were diagnosed with epididymo-orchitis between January 2015 and January 2019 were retrospectively evaluated. Excluded from the study were 15 patients with a hematologic disease, coronary artery disease or malignant diagnosis, eight patients aged below 18 years, and 13 patients whose hemogram and C-reactive protein (CRP) values were not available in their medical records. The diagnosis of epididymo-orchitis was based on laboratory (leukocytosis, CRP elevation) and radiological findings. The diagnosis of BEO was defined as ≥1/160 titer value and/or positive blood culture in the standard tube agglutination (STA) test in addition to orchitis symptoms and signs. Results: The median WBC (p=0.033), neutrophil (p=0.013) and monocyte (p=0.006) counts and NL (p=0.014) and ML (p=0.002) ratios were statistically significantly lower in the BEO group. The ML ratio had the highest predictive value with an AUC of 0.725 (95% CI = 0.146-0.424; p=0.002), as well as high specificity (97.3%) and diagnostic accuracy (83.5%) in predicting a BEO diagnosis. No parameter was an independent factor in the differentiation of BEO and NBEO. Conclusions: Easy, fast and low-cost hemotological inflammatory markers provide diagnostic benefits complementing serological tests in distinguishing BEO from NBEO cases. In particular, MLR has a high diagnostic accuracy compared to other parameters

Objective: To explore the value of complete blood count (CBC), including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte lymphocyte ratio (MLR) in diagnosis of testicular torsion (TT) and differential diagnosis from epididymo-orchitis. Methods: The study was conducted at the Antalya Training and Research Hospital Emergency Department in Turkey with acute scrotal pain patients from January 1st, 2016 to January 1st, 2018. The patients were categorized into 3 groups: the TT group who underwent an operation for TT (n=70), the epididymo-orchitis group who received epididymo-orchitis treatment (n=120), and the healthy control group (n=100). NLR, PLR, and MLR of the three groups were analysed and compared. The optimum cut-off values of NLR, MLR, and PLR were analyzed. Results: Mean NLR and MLR values were significantly higher in the epididymo-orchitis group and the TT group compared to the control group (P

Pseudomonas otitidis is a rare and unique species among the Pseudomonas genus that has not been previously reported as a cause of male genitourinary tract infection. In this report, we describe a case of a 20-year-old immunocompetent male who presented with recurrent epididymo-orchitis, which was initially misidentified as Vibrio vulnificus and treated successfully. The causative agent could not be identified appropriately using the available routine methods, but a final identification was established using 16S rRNA targeted sequencing followed by whole-genome sequencing.

Isolated tuberculous epididymo-orchitis (TBEO) is an exceptionally rare type of genitourinary tuberculosis (GUTB). It carries a very small percentage of incidence and most of the time are missed or picked up late due to its benign presentation. The clinical presentation can be varied and due to its nature of presentation, the diagnosis can be misleading and lead to a delay in treatment. We report a peculiar case of disseminated tuberculosis (TB) with tuberculous epididymo-orchitis in a middle-aged man who presented to us with a chronic right testicular swelling which initially worked-up for testicular malignancy. Patient underwent high ligation right orchidectomy and the histopathology examination (HPE) reported as necrotizing granulomatous inflammation of the right testis. Patient is treated with anti-tuberculous chemotherapy and a complete recovery is achieved after 6 months of treatment. Sufficient and detailed evaluation of testicular mass, particularly in the middle-aged population is important as the timing of diagnosis may yield a better prognosis. Tuberculous epididymo-orchitis has very similar clinical presentation with other testicular pathology. Due to lack of highly sensitive investigations preoperatively to diagnose it, no wonder it is considered as a "great mimicker". [ABSTRACT FROM AUTHOR]

Background: Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes.Methods: Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available.Results: Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%).Conclusions: We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients' sexual function and fertility during follow up after treatment completed. [ABSTRACT FROM AUTHOR]

Speedy diagnosis are mandatory in testicular torsion, nevertheless some cases of irreversible ischemia still occur. In this study we analysed the results of patients undergoing surgical exploration for acute scrotum. A multicentric retrospective clinical evaluation was carried out on patients who underwent urgent scrotal exploration at 12 different departments in North-Eastern Italy. Data included complete anagraphic information, clinical presentation, numeric pain rating scale, previous testicular surgery, Doppler serial ultrasonography (US) evaluation and concordance with surgical findings, testicular mobility, surgical treatment, staged or concurrent treatment of the contralateral gonad. Statistical analysis was conducted both for descriptive and inferential statistics with SPSS v26. Three hundred and sixty-eight cases were collected between January 2010 and June 2019. The time between symptom onset and ER access time was within 6 h in majority of patients. However, 17.4% of subject presented after more than 12 h. In patients undergoing US, this showed signs of ischemia in 237 patients (77.2%) and normal vascularisation in 70 (22.8%) of whom 26 had signs of testicular torsion at surgical exploration. Overall, the US data were concordant with the surgical findings in 254 cases (82.7%). A significant association was found between time-to-evaluation and time-to-treatment and the need for orchiectomy (p < 0.01). Testicular torsion management is still challenging in terms of time-saving decision making. Scrotal US is helpful, but even in the contemporary its sensitivity is low era in a non-neglectable number of cases, therefore surgical exploration is warranted in acute scrotum when torsion cannot be ruled out, even when US shows vascularisation. [ABSTRACT FROM AUTHOR]

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