1/33. Clinics in diagnostic imaging (33). Missed testicular torsion.A 13-year-old boy presented with a painful scrotal swelling. On examination, the left testis was enlarged and tender. Ultrasound scan showed diffuse hypoechogenicity, with absent intra-testicular but increased peri-testicular blood flow. The diagnosis of missed testicular torsion was confirmed at surgery. The role of imaging in differentiating among other causes of painful scrotal swelling, such as infection, trauma and tumour, are discussed.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
2/33. Epididymo-orchitis following intravesical bacillus Calmette-Guerin therapy.OBJECTIVE: To describe a case of epididymo-orchitis that developed four years after treatment with intravesical bacillus Calmette-Guerin (BCG) and to review the incidence of this adverse effect. DATA SOURCES: Information about the patient was obtained from the medical chart. A medline search of English-language literature (from January 1976 to April 1999) was conducted. STUDY SELECTION: All case reports of BCG-related epididymo-orchitis were evaluated. review articles describing complications of BCG therapy for bladder cancer and the prevention and treatment of these complications were reviewed. DATA EXTRACTION: Studies were evaluated for reports of BCG-related epididymo-orchitis and its treatment. DATA SYNTHESIS: Our case report is compared with others reported in the literature. The incidence of BCG-associated epididymoorchitis is rare. CONCLUSIONS: Epididymo-orchitis should be considered as a late complication of BCG therapy for bladder cancer. Proper patient selection may help decrease the risk of complications from BCG therapy.- - - - - - - - - - ranking = 0.001487049299302keywords = cancer (Clic here for more details about this article) |
3/33. Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient.STUDY DESIGN: A case report of xanthogranulomatous funiculitis and epididymo-orchitis. Xanthogranulomatous inflammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a striking cellular infiltrate of lipid-laden macrophages. CASE REPORT: A 21-year male sustained complete tetraplegia at C-6 level, after a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of the scrotum following removal of a blocked catheter. He was prescribed antibacterial therapy. Four weeks later, physical examination revealed a hard and irregular swelling encompassing the testis, epididymis and spermatic cord. The clinical diagnosis was epididymo-orchitis progressing to pyocele. Through a scrotal incision, the swollen testis, epididymis and diseased segment of the spermatic cord were removed en masse. Histopathology showed extensive areas of necrosis, with xanthogranulomatous inflammation in the spermatic cord and to a lesser extent in the testis/epididymis. CONCLUSION: Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasation of urine together with chronic, low-grade, suppurative infection possibly led to development of xanthogranulomatous inflammation in the testis and the epididymis. Since tissue destruction is a feature of xanthogranulomatous inflammation, the definite and curative treatment is either complete (or, where applicable, partial) excision of the affected organ in most of the cases.- - - - - - - - - - ranking = 4keywords = testis (Clic here for more details about this article) |
4/33. Acute epididymo-orchitis with abscess formation due to pseudomonas aeruginosa: report of 3 cases.We report 3 patients with acute epididymo-orchitis with abscess formation due to pseudomonas aeruginosa, which is relatively unusual and difficult to treat. All patients presented with swollen testicles, pain and high fever. First, they were treated empirically with several antibiotics. After several weeks of antibiotics therapy, the swelling of scrotum still persisted. In one patient, dark yellow pus drained from a fistula of the scrotum. Finally, an orchiectomy was performed on all patients. During the operation, an abscess was found in each testis. Each culture of the pus yielded P. aeruginosa, which is susceptible to many antibiotics.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
5/33. Preoperative diagnosis of bilateral tuberculous epididymo-orchitis following intravesical bacillus Calmette-Guerin therapy for superficial bladder carcinoma.We report a case of bilateral tuberculous epididymo-orchitis following intravesical bacillus Calmette-Guerin (BCG) therapy for superficial bladder carcinoma in which the diagnosis was made by ultrasonography prior to surgery. The US findings include heterogeneous enlargement of the epididymis and testis, associated with scrotal-skin thickening and scrotal sinus track. patients with bladder carcinoma treated with intravesical BCG therapy, the presence of scrotal swelling with scrotal-skin thickening and epididymal involvement suggests tuberculous epididymo-orchitis rather than testicular tumour. It is important to be aware of this rare complication and to be familiar with the ultrasonographic features so that appropriate treatment can be given.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
6/33. cysts of the ejaculatory system--a treatable cause of recurrent epididymo-orchitis in children.PURPOSE: The commonest causes of acutely painful scrotum are torsion (of appendix of the testis or the testis itself) and epididymo-orchitis. Exploration is the only way to prove the diagnosis and multiple such procedures are performed in patients with recurrent epididymo-orchitis. The purpose of our study was to investigate the cause of recurrent epididymo-orchitis in pre-pubertal children. Four children, aged three years or less, were investigated for recurrent left epididymo-orchitis. All four had cystic dilatation of the ejaculatory duct in the region of the prostatic utriculus, associated in two children with ectopic opening of the vas in the bladder. Initial ultrasound appeared to be normal in all four patients, a retrospective review of the sonographic films, however, revealed a retrovesical cyst in three of them. The diagnosis was established by a combination of urethroscopy with retrograde contrast study via the utriculus and open vasography. All four cases were treated operatively by a transtrigonal approach. The cyst was excised in each case. In one, a vasovasostomy was performed between the left and the normal right vas; in the other three the left vas was anastomosed to the blind end of the contralateral seminal vesicle. All four are symptom-free at one year follow-up. cysts of the ejaculatory duct are a treatable cause of recurrent epididymo-orchitis. Pre-pubertal children with recurrent epididymo-orchitis and no obvious underlying cause should have a thorough sonographic examination of the retrovesical region for cystic lesions.- - - - - - - - - - ranking = 2keywords = testis (Clic here for more details about this article) |
7/33. Testicular torsion versus epididymitis: a diagnostic challenge.Unlike the patient who presents with a potentially acute abdomen, the child or adolescent with a potentially acute scrotum cannot simply be observed. If testicular torsion is present, the testicle must be detorted and orchiopexy performed as soon as possible for fertility to be maintained. Torsion of the appendix testis, however, can usually be managed without surgery. Since the presentations of epididymitis and testicular torsion overlap, it is sometimes difficult to rapidly make the correct diagnosis. Early genitourinary consultation is appropriate in this setting. Any patient in whom testicular torsion is strongly considered should undergo immediate exploratory surgery without diagnostic studies. If the findings overlap, immediate testicular radionuclide scanning should be arranged; alternatively, with experience, Doppler sonography can be carried out. If these radiographic studies cannot be arranged and interpreted within one to two hours, scrotal exploration should be performed. Any patient with an acute scrotal complaint and a negative scan should receive daily follow-up until the symptoms subside. Although our adolescent patient did well, his acute presentation and findings should have warranted immediate exploration. It is only through this aggressive approach that we can continue to increase testicular salvage rates.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
8/33. Xanthogranulomatous orchitis.Xanthogranulomatous inflammation is an uncommon process that is usually associated with severe renal infection. We report a case of a 64-year-old man with xanthogranulomatous inflammation in the testis who presented with contralateral epididymoorchitis and a painless testicular mass. Only two prior cases of xanthogranulomatous orchitis have been reported. This case highlights the need for a broad differential diagnosis when approaching testicular masses, particularly in the setting of coincident infection.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
9/33. Metastatic appendiceal adenocarcinoma presenting late as epididymo-orchitis: a case report and review of literature.BACKGROUND: Whereas testicular metastases are in themselves a rare entity, testicular secondaries from an appendiceal carcinoma have not yet been described. The case also illustrates the diagnostic dilemma of a tumour presenting as epididymo-orchitis. CASE PRESENTATION: The authors present a case of an appendiceal carcinoma that, two years after radical therapy, manifested as a secondary in the testis. It was misdiagnosed as an epididymo-orchitis and was only revealed through histology. CONCLUSIONS: Practitioners need to remember that long-standing testicular inflammation may result form secondary tumours. Even "exotic" primary tumours in the medical history of the patient must give rise to an increased suspicion threshold.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
10/33. Tuberculous orchiepididymitis diagnosed by nucleic acid amplification test: a case report.Symptoms of tuberculous orchiepididymitis in a 39-year-old male started with swelling of left scrotum, followed by fistula formation with suppurative discharge. There was no any improvement produced by antibiotics. Surgical extirpation of inflammatory destroyed testicle and epidydimis was performed. Presence of tubercle bacilli was not shown by bacteriological analysis of testicle tissue. Tuberculous etiology was suggested after histopathological examination of testis and epididymis. Exudate from surgical wound was examined on presence of mycobacterium tuberculosis dna. Etiology of orchiepididymitis was proved by positive assay and inflammatory process was completely cured by antituberculotics therapy. By this report it was clearly shown that sometimes only molecular methods could confirm etiology of inflammatory process.- - - - - - - - - - ranking = 1keywords = testis (Clic here for more details about this article) |
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