AMIODARONE INDUCED EPIDIDYMITIS IN CHILDREN

The role of ultrasound in detecting renal tract abnormalities following a single episode of epididymitis

AIM

The aim of the study was to establish the utility of ultrasound scan in detecting renal tract abnormalities following a single episode of epididymitis.

METHODS

A single-centre retrospective review of all boys diagnosed with epididymitis between October 2012 and 2017 including review of follow up imaging and clinical course was completed. Primary outcome was new diagnosis of renal tract abnormality by ultrasound.

MAIN RESULTS

Eighty-four boys with a first diagnosis of epididymitis were identified. Sixty-four cases (76%) were diagnosed at scrotal exploration, the remaining twenty clinically. Median age was 7.30 years (range 0.08-15.83 years), and five had a positive urine culture at presentation. Forty-eight boys (57%) had a follow-up ultrasound scan (at median 4.57 weeks [range 1-31 weeks]). Only two renal tract abnormalities were identified by ultrasound scan, both in boys aged < 6 months, and neither was clinically relevant. Recurrent epididymitis occurred in 4 cases at median 26 days after initial presentation, of whom 3 had been followed up by ultrasound after initial presentation, all of which were normal. Further investigation revealed posterior urethral valves in 1 boy (age 6.5 months at initial presentation).

CONCLUSION

Following a single episode of epididymitis, ultrasound was not helpful at detecting clinically relevant renal tract abnormalities, and furthermore did not identify the only patient with a clinically relevant abnormality. Based on these data, we propose follow-up imaging only in boys ≤ 6 months of age with a positive urine culture or a recurrent episode with consideration given to micturating cystogram even if ultrasound normal.

LEVEL OF EVIDENCE

IV.

Scrotal pain: evaluation and management

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.

Amiodarone induced epididymitis: a case report

Introduction:

Amiodarone is an effective drug for life-threatening arrhythmias like recurrent ventricular fibrillation and atrial fibrillation. Amiodarone creates rarely genitourinary side effects are seen. These are epididymitis, testicular dysfunction and impotance. Amiodarone aggregates and triggers inflammation in the head of the epididym.

Case report:

We present the case of a patient who developed epididymitis after 17 months of amiodarone therapy, using a low dose (100 mg per day). Although cessation of medication or dose lowering was not performed, remission of the patient only by analgesics is a distinct case reported in urological literature.

Conclusions:

This case stresses the importance of considering an adverse effect of amiodarone treatment as a cause when making a differential diagnosis of epididymitis.

The aetiology and current management of prepubertal epididymitis

INTRODUCTION

The aim of this study was to review the published evidence on the pathogenesis and management of acute epididymitis (AE) in prepubertal boys after the authors encountered an unexpectedly large number of such cases in their institution.

METHODS

Using MEDLINE(®), a literature search was performed for articles in English with the words "pre-pubertal" OR "boys" OR "p(a)ediatric" OR "children" AND "epididymitis" OR "epididymo-orchitis".

RESULTS

The literature suggests that it is rare to find a bacterial infection or anatomical anomaly as a cause for AE in this population. A postviral infectious phenomenon is the most likely explanation. The management should be supportive and antibiotics reserved for those with pyuria or positive cultures. Urodynamic studies and renal tract ultrasonography have been advocated for those with recurrent epididymitis.

CONCLUSIONS

AE in prepubertal boys is more common than believed previously. A careful history for recent viral illnesses should be included. Antibiotics, urinary tract imaging and functional studies should be used in selected cases.

Ectopic ureter, renal dysplasia, and recurrent epididymitis in an infant: case report and review of the literature

KEY CLINICAL MESSAGE

The most common etiologies of acute scrotum in boys <1 year of age are torsion of the testis or an appendix, urogenital anomalies, and epididymitis. We report an infant with recurrent epididymitis associated with single-system ectopic ureter opening into the seminal vesicle and dysplastic right kidney. Treatment included nephroureterectomy.

Acute epididymitis in children: the role of the urine test

PURPOSE

Acute epididymitis is considered to have an important role in children with scrotal pain. Recent reports have shown that urinalysis is not helpful for the diagnosis and treatment of acute epididymitis owing to negative microbiological findings. Therefore, we analyzed clinical and laboratory characteristics to examine the diagnostic yield of urinalysis in children.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 139 patients who were diagnosed with acute epididymitis from 2005 to 2011. Diagnosis was based on symptoms, physical findings, and color Doppler ultrasonography (DUS). To investigate the characteristics of epididymitis in children, the patients were divided into 3 groups: group A (aged less than 18 years, 76 patients), group B (18 to 35 years old, 19 patients), and group C (older than 35 years, 44 patients).

RESULTS

There were statistically significant differences in age, symptom duration, hospital stays, and lesion location in each group. White blood cell count and serum C-reactive protein levels, pyuria, and positive urine culture results were statistically higher in the older age group. The most common cause of acute epididymitis in children was idiopathic (96.1%).

CONCLUSIONS

In our group of children with epididymitis, 73 cases out of 76 (96.1%) resulted in negative pyuria in urinalysis. In addition, the most common cause of epididymitis was idiopathic. Because most urinalyses do not show pyuria, we believe that routine antibiotics may be not required in pediatric patients with epididymitis. If urinalysis shows pyuria with or without positive urine culture, antibiotics should be considered.

Acute epididymitis in Greek children: a 3-year retrospective study

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

Acute epididymitis in boys: evidence of a post-infectious etiology

PURPOSE

We studied the etiology and management of pediatric epididymitis.

MATERIAL AND METHODS

We performed 1-year prospective study in children with epididymitis. All patients underwent an immediate sonographic study of the scrotum. Microbiological studies included throat and urine cultures as well as viral cultures of nasopharyngeal and stool specimens. Serological tests for group A streptococcus and Mycoplasma pneumoniae as well as for enteroviruses, adenoviruses, influenza and parainfluenza viruses in the appropriate seasons were performed in patients and controls.

RESULTS

A total of 44 patients 2 to 14 years old (mean age 9.8 +/- 3.2) were studied. Hospital admissions peaked during the summer and winter. The incidence of epididymitis was around 1.2/1,000 boys yearly. One patient had familial Mediterranean fever and another had Henoch-Schonlein purpura. Microbiological studies of the urine, throat, nasopharynx and stool yielded bacterial/viral growth in 9 patients (20.4%). Serological studies revealed significantly elevated titers to certain pathogens in patients with epididymitis compared with controls, including M. pneumoniae (53% vs 20%), enteroviruses (62.5% vs 10%) and adenoviruses (20% vs 0%). Most patients were treated with analgesics and 3 patients received antibiotics intravenously. Systemic and local signs and symptoms resolved gradually in 1 to 7 days.

CONCLUSIONS

Our results suggest that epididymitis in boys is not rare and it is mostly an inflammatory phenomenon (presumably post-infectious) with a benign course. The treatment of these patients is basically with analgesics with a little role for antibiotics.