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Demirci A, Hızlı F, Başar H. Turkish validation of the chronic orchialgia symptom index and its association with the visual analog scale. Urologia 2024:3915603241246669. [PMID: 38600722 DOI: 10.1177/03915603241246669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To conduct a translation and validation study of the Chronic Orchialgia Symptom Index (COSI), which has 12 questions in three domains pain (P), sexual symptoms (SS), and quality of life (QoL), in the Turkish language. MATERIAL AND METHODS The study included a total of 175 patients diagnosed with chronic scrotal content pain (CSCP) between January 2023 and January 2024. In addition to demographic data, the scores obtained on the COSI questionnaire and Visual Analog Scale (VAS) were recorded. Internal consistency was assessed using Cronbach alpha coefficients. Reliability was evaluated using the test-retest correlation method. RESULTS The mean age of the patients was 37.2 ± 14.1 years and the median (IQR) duration of pain was 5.5 (9) months. The median total COSI score was determined as 13 (13) and the median subscores were 7 (7) for P, 1 (2) for SS, and 5 (6) for QoL. The test-retest correlation coefficient for each item was determined to be higher than r = 0.80 (p < 0.001). The Cronbach alpha values for the subscores were 0.80 for P, 0.71 for SS, and 0.80 for QoL. There was determined to be a statistically significant positive correlation between the VAS score and the COSI P, SS, QoL, and total scores (r: 0.63, p < 0.001; r = 0.32, p < 0.001; r = 0.56, p < 0.001; r = 0.59, p < 0.001, respectively). The optimal cutoff point of the COSI total score was determined to be 16.5 points (AUC:0.77, p < 0.001) for the determination of patients experiencing severe pain (⩾ 7.5) according to the VAS score. CONCLUSION The Turkish version of the COSI questionnaire is a valid, reliable, and repeatable questionnaire that can be used to evaluate the effects of symptom severity in patients with CSCP.
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Affiliation(s)
- Aykut Demirci
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Hızlı
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halil Başar
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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2
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Khastgir J. Advances in the antibiotic management of epididymitis. Expert Opin Pharmacother 2022; 23:1103-1113. [PMID: 35380486 DOI: 10.1080/14656566.2022.2062228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acute epididymitis is commonly encountered and typically presents acutely within a wide clinical spectrum. Most cases of acute epididymitis are caused by bacterial infection, most often by sexually transmitted organisms and urinary pathogens. Current treatment regimens remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm. AREAS COVERED The choice of the initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric or other. Adherence of clinical practice remains short of available guidance, which may be improved by thorough clinical and microbiologic assessment, supported by a knowledge of the commonly associated pathogenic organisms, and the appropriate choice of tests required for their identification. Use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms. The authors discuss these points in and provide their expert perspectives on its treatment and future developments. EXPERT OPINION Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis. Much of the presently available guidance is derived from previous guidance recommendations, knowledge of antimicrobial activities of specific agents, and treatment outcomes in uncomplicated infections. Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable.
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Affiliation(s)
- Jay Khastgir
- Princess of Wales Hospital, Cwm Taff Bro Morgannwg NHS University Health Board & Swansea University School of Medicine, Swansea
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3
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Goedde MA, Nguyen KD, Choi KB. Robotic microsurgical spermatic cord denervation for chronic orchialgia: a case series. J Osteopath Med 2021; 121:29-34. [PMID: 33512396 DOI: 10.1515/jom-2020-0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Chronic orchialgia is a frustrating urologic condition that is commonly refractory to conservative modes of therapy. Microscopic spermatic cord denervation is a proven solution for patients who do not achieve relief from nonsurgical treatments. However, current widely used techniques require additional training in microsurgery. Objective To describe an adaptation and improvement of spermatic cord microdenervation technique that leveraged the robotic surgical training common for new urologists and is also accessible for urologists not specifically trained in microsurgery. Methods Robotic-assisted microdenervation of the spermatic cord was performed in three patients using a fluorescence vascular imaging tool to improve visualization of vascular structures (Firefly™; Innovative Surgical, Sunnyvale, CA, USA), along with a tissue matrix allograft to allow for better healing (AminoFix™; MiMedx®, Marietta, GA, USA). Results All three patients (100%) experienced postoperative resolution of their chronic orchialgia, and none reported any new pain. Conclusion Utilization of robotic-assisted surgery offers more urologists the ability to use familiar techniques to treat chronic orchialgia when conservative measures are unsuccessful.
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Affiliation(s)
- Michael A Goedde
- Department of Urology , University of Louisville School of Medicine , 501 E. Broadway, Suite 270 , 40202-2040 Louisville , KY , USA
| | - Kristy D Nguyen
- Department of Urology , University of Louisville School of Medicine , 501 E. Broadway, Suite 270 , 40202-2040 Louisville , KY , USA
| | - Kellen B Choi
- Department of Urology , University of Louisville School of Medicine , 501 E. Broadway, Suite 270 , 40202-2040 Louisville , KY , USA
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Campbell K, Lipshultz L. Current trends and therapies in orchialgia management. Ther Adv Urol 2021; 13:17562872211026433. [PMID: 34221127 PMCID: PMC8221700 DOI: 10.1177/17562872211026433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
The management of pain is a complex condition that will be encountered by most practicing clinicians. In the genitourinary community, testicular pain may be classified as acute or chronic. Initial evaluation of chronic groin and scrotal content pain (CGSCP) begins with a detailed history and physical examination to elucidate the presenting pathology. Multiple therapy algorithms have been proposed with no definitive consensus; however, most begin with conservative intervention and medical management prior to advancing to more invasive procedures. Surgical approaches may range from reconstruction, as in vasovasostomy for post-vasectomy pain syndrome, to excision of the offending agent, as in epididymectomy. This review seeks to focus on chronic pain in the genitourinary community and review techniques of pain management in the current intervention for orchialgia, as well as identify future methods of treatment.
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Affiliation(s)
- Kevin Campbell
- Baylor College of Medicine, Suite 1700, 6624 Fannin, Houston, TX 77030, USA
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5
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Jing Z, Liying G, Zhenqing W, Hui Z, Shuai L, Dingqi S, Qiang F, Keqin Z. Efficacy and Safety of Ningmitai Capsules in Patients with Chronic Epididymitis: A Prospective, Parallel Randomized Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:9752592. [PMID: 33854561 PMCID: PMC8021469 DOI: 10.1155/2021/9752592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of Ningmitai (NMT) capsules in patients with chronic epididymitis. METHODS This prospective randomized controlled trial included 112 patients diagnosed with chronic epididymitis. The patients were randomized (1 : 1 : 1) to receive levofloxacin (LVX), NMT, or NMT combined with LVX for 4 weeks. The patients were followed up at 2 and 4 weeks after initiation of treatment and were evaluated in terms of Chronic Epididymitis Symptom Index (CESI) scores, epididymal nodules, and safety parameters. The primary endpoints were the CESI scores at the end of 2 and 4 weeks of treatment. The secondary endpoints included the mean epididymal nodule diameter and the clinical efficacy rate. Safety was evaluated by hepatorenal function tests and adverse event reports during the trial. RESULTS After 2 weeks of treatment, the CESI score of the NMT group was significantly lower than that of the LVX group (P < 0.05). In addition, the clinical efficacy rate of the NMT group was significantly higher than that of the LVX group (55% vs. 8.33%, P < 0.0001), indicating that NMT has a rapid effect on chronic epididymitis. After 4 weeks of treatment, there was no significant difference in CESI scores or clinical efficacy rates between the two monotherapy regimens (P > 0.05); however, the mean diameter of epididymal nodules was significantly smaller in the NMT group than in the LVX group (P < 0.0001). Moreover, after 4 weeks of treatment, the patients in the LVX + NMT group, which had a clinical efficacy rate of 97.22%, had lower CESI scores (both P < 0.01) and a smaller epididymal nodule diameter (vs. LVX, P < 0.0001; vs. NMT, P < 0.05) than those in the other two groups. No adverse events or abnormal hepatorenal function were found during the study. CONCLUSION NMT significantly improved CESI scores and epididymal nodule diameter in patients with chronic epididymitis. The combination of NMT and LVX provides a much better effect than monotherapy, and this treatment regimen was well tolerated.
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Affiliation(s)
- Zhang Jing
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Guan Liying
- Physical Examination Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Wang Zhenqing
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Zhang Hui
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Liu Shuai
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Sun Dingqi
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Fu Qiang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
| | - Zhang Keqin
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
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6
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Mohseni-Rad H, Razzaghdoust A, Mishan MA, Gholamrezaie HR, Hosseinkhani A. Terazosin or baclofen in young men with chronic orchialgia: A cohort study of 499 patients. Urologia 2019; 87:35-40. [PMID: 31476980 DOI: 10.1177/0391560319873531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We aimed to investigate the comparative efficacy of terazosin and baclofen in young men with chronic orchialgia using National Institutes of Health Chronic Prostatitis Symptom Index measurement. PATIENTS AND METHODS Of 499 young men with chronic orchialgia, 255 received a daily 2 mg terazosin at bedtime and 244 received 10 mg baclofen during a period of 3 months. A daily 10-min hot-tub hip-bath rest was administered for all patients. Moreover, all patients with grade 3 and 18 patients with grade 2 varicocele underwent varicocelectomy. The National Institutes of Health Chronic Prostatitis Symptom Index score was assessed at baseline and 3 months later. RESULTS Both terazosin and baclofen groups experienced a significant reduction in mean National Institutes of Health Chronic Prostatitis Symptom Index score (24.78 and 24.81 at baseline to 19.68 and 19.60 after the treatment for terazosin and baclofen groups, respectively). However, there was no significant difference between the groups with regard to post-treatment National Institutes of Health Chronic Prostatitis Symptom Index score after adjustment for the pre-treatment score (p = 0.987). A total of 85 patients (33.4%) in terazosin group and 74 patients (30.3%) in baclofen group underwent varicocelectomy. Addition of the varicocelectomy to the treatment as a multimodal approach had no further improvement in the National Institutes of Health Chronic Prostatitis Symptom Index score. CONCLUSION Although a significant reduction was observed in mean National Institutes of Health Chronic Prostatitis Symptom Index score for both terazosin and baclofen groups, there was no significant difference between the treatments. Moreover, addition of varicocelectomy to terazosin or baclofen could not significantly decrease National Institutes of Health Chronic Prostatitis Symptom Index score; thus, varicocelectomy may not be appropriate for men who have some success with medical management. Further randomized studies are warranted.
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Affiliation(s)
- Hamed Mohseni-Rad
- Department of Urology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Abolfazl Razzaghdoust
- Urology and Nephrology Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amir Mishan
- Ocular Tissue Engineering Research Center, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Gholamrezaie
- Department of Urology, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Ali Hosseinkhani
- Department of Urology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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7
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Avellar MCW, Ribeiro CM, Dias-da-Silva MR, Silva EJR. In search of new paradigms for epididymal health and disease: innate immunity, inflammatory mediators, and steroid hormones. Andrology 2019; 7:690-702. [PMID: 31207127 DOI: 10.1111/andr.12654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
The primary job of the epididymis is to mature and protect the luminally transiting spermatozoa. Mounting evidence is showing that innate immune components [including Toll-like receptors (TLRs) and antimicrobial proteins, among which are β-defensins] and inflammatory mediators, under the primary influence of androgens, participate in the cellular and molecular processes that define this tissue. Here, we present an overview of the contributions of these signaling pathway components during epididymal homeostasis and discuss the hypotheses as to their involvement in epididymitis, the most common urological inflammatory condition in men, frequently impairing their fertility. Drawing primarily from rodent models, we also focus on how the distribution and functional expression of innate immune components are differentially regulated in the prenatal developing epididymis, providing new insights into the disruption of these signaling pathways throughout the lifespan. Male infertility is caused by a variety of conditions, such as congenital malformations, genetic and endocrine disorders, exposure to environmental toxicants, and inflammatory/infectious conditions. More than one-third of infertile men with an idiopathic condition cannot currently be adequately diagnosed. Thinking about the innate immunity and inflammation context of the epididymis may provide new insights and directions as to how these systems contribute to male fertility, as well as also uncover urological and andrological outcomes that may aid clinicians in diagnosing and preventing epididymal pathologies.
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Affiliation(s)
- M C W Avellar
- Department of Pharmacology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - C M Ribeiro
- Department of Pharmacology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - M R Dias-da-Silva
- Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - E J R Silva
- Department of Pharmacology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista 'Júlio de Mesquita Filho', Botucatu, SP, Brazil
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8
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Lei Y, Yang J, Li Y, Yu X, Deng S, Xue C, Zheng W, Shang J, Xue Y. Traditional Chinese medicine on treating epididymitis: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e15975. [PMID: 31192937 PMCID: PMC6587607 DOI: 10.1097/md.0000000000015975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epididymitis is a common disease in nonspecific infections of the male reproductive system according to the clinical incidence of acute epididymitis and chronic epididymitis. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of epididymitis. In this systematic review, we aim to evaluate the effectiveness and safety of traditional Chinese medicine (TCM) for epididymitis. METHODS We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet, Nature, Science online, China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of TCM for treating epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.Registration number: PROSPERO CRD42019130569.
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Affiliation(s)
- Yi Lei
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jie Yang
- Beijing Fengtai Maternal & Child Health Hospital
| | - Yongqiang Li
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Xudong Yu
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Sheng Deng
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Chaohui Xue
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Wei Zheng
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
| | - Jianwei Shang
- Department of Andrology, Dongzhimen Hospital, Dongcheng District, Beijing, China
| | - Yahui Xue
- Department of Andrology, The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi
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9
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Xin S, Hao Y, Zhi-Peng M, Nanhe L, Bin C. Chronic epididymitis and leptin and their associations with semen characteristics in men with infertility. Am J Reprod Immunol 2019; 82:e13126. [PMID: 31006165 DOI: 10.1111/aji.13126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/22/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022] Open
Abstract
PROBLEM The aim of this study was to ascertain the associations between serum leptin levels and chronic epididymitis and semen parameters in patients with infertility. METHOD OF STUDY A total of 846 patients who were diagnosed as primary infertility were enrolled and divided into four groups. The general information, blood lipids, reproductive hormones, and semen parameters were collected. Receiver operating characteristic (ROC) curves of leptin were plotted for diagnosis of the poor sperm quality. We used Student's t test and the chi-squared test to analyze their relationships and used logistic regression analysis to evaluate potential confounding factors. RESULTS Receiver operating characteristic curve revealed that leptin had better sensitivity and specificity at the concentration of 6.02 (0.565 and 0.917). Isolated epididymitis or elevated leptin had no effect on sperm concentration and sperm membrane function, but the combination of these conditions would reduce the concentration and normal morphology rate both (P = 0.002, P = 0.005). Epididymitis or elevated leptin can affect the motility of sperms, the former presented more significance (P = 0.000), and the co-existence would further reduce the sperm motility (P = 0.001). CONCLUSION Low sperm motility and sperm normal morphology were found to be associated with chronic epididymitis and high leptin. Simultaneously suffering from chronic epididymitis and high leptin could produce a more serious effect on sperm quality.
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Affiliation(s)
- Song Xin
- Department of Urology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Hao
- Department of Urology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ma Zhi-Peng
- Department of Urology, Weifang Yi Du Center Hospital, Weifang, China
| | - Lin Nanhe
- Department of Urology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chen Bin
- Department of Urology, Shanghai Institute of Andrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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10
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Wang J, Han L, Bao B, Yu X, Zhang K, Dai H, Li X, Wang B, Li H. The safety and efficacy of acupuncture for epididymitis protocol for a systematic review. Medicine (Baltimore) 2019; 98:e13934. [PMID: 30608423 PMCID: PMC6344197 DOI: 10.1097/md.0000000000013934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epididymitis is a common disease in non-specific infections of the male reproductive system. According to the clinical incidence of acute epididymitis and chronic epididymitis, which is more common in chronic epididymitis. There are many clinical trials confirmed that acupuncture treatment can relieve pain and improve symptoms of epididymitis to some extent. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture for epididymitis. METHODS AND ANALYSIS We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis. ETHICS AND DISSEMINATION This systematic review will evaluate the efficacy and safety of acupuncture for epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial. REGISTRATION NUMBER PROSPERO CRD42018111348.
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Affiliation(s)
- Jisheng Wang
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Liang Han
- Department of Andrology, Fangshan Hospital, Beijing University of Chinese Medicine, Fangshan District
| | - Binghao Bao
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Xudong Yu
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Kaige Zhang
- Graduate School of Beijing University of Chinese Medicine
- Department of Encephalopathy, Dongzhimen Hospital, Beijing, China
| | - Hengheng Dai
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Xiao Li
- Graduate School of Beijing University of Chinese Medicine
- Department of Andrology, Dongzhimen Hospital
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital
| | - Haisong Li
- Department of Andrology, Dongzhimen Hospital
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11
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Fijak M, Pilatz A, Hedger MP, Nicolas N, Bhushan S, Michel V, Tung KSK, Schuppe HC, Meinhardt A. Infectious, inflammatory and 'autoimmune' male factor infertility: how do rodent models inform clinical practice? Hum Reprod Update 2018; 24:416-441. [PMID: 29648649 PMCID: PMC6016649 DOI: 10.1093/humupd/dmy009] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/02/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans. OBJECTIVE AND RATIONALE This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions. SEARCH METHODS An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: 'infection' and/or 'inflammation' and 'testis' and/or 'epididymis', 'infection' and/or 'inflammation' and 'male genital tract', 'male infertility', 'orchitis', 'epididymitis', 'experimental autoimmune' and 'orchitis' or 'epididymitis' or 'epididymo-orchitis', antisperm antibodies', 'vasectomy'. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team. OUTCOMES There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection have been instructive in a better understanding of the mechanisms of disease initiation and progression. In this regard, rodent models of acute bacterial epididymitis best reflect the clinical situation in terms of mimicking the infection pathway, pathogens selected and the damage, such as fibrotic transformation, observed. Similarly, animal models of acute testicular and epididymal inflammation using lipopolysaccharides show impairment of reproduction, endocrine function and histological tissue architecture, also seen in men. Autoimmune responses can be studied in models of experimental autoimmune orchitis (EAO) and vasectomy. In particular, the early stages of EAO development showing inflammatory responses in the form of peritubular lymphocytic infiltrates, thickening of the lamina propria of affected tubules, production of autoantibodies against testicular antigens or secretion of pro-inflammatory mediators, replicate observations in testicular sperm extraction samples of patients with 'mixed atrophy' of spermatogenesis. Vasectomy, in the form of sperm antibodies and chronic inflammation, can also be studied in animal models, providing valuable insights into the human response. WIDER IMPLICATIONS This is the first comprehensive review of rodent models of both infectious and autoimmune disease of testis/epididymis, and their clinical implications, i.e. their importance in understanding male infertility related to infectious and non-infectious/autoimmune disease of the reproductive organs.
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Affiliation(s)
- Monika Fijak
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Germany
| | - Mark P Hedger
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
| | - Nour Nicolas
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Vera Michel
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
| | - Kenneth S K Tung
- Departments of Pathology and Microbiology, Beirne Carter Center for Immunology Research, University of Virginia, 345 Crispell Drive, Charlottesville, VA, USA
| | - Hans-Christian Schuppe
- Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Germany
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Unit of Reproductive Biology, Aulweg 123, Giessen, Germany
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain. RECENT FINDINGS Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood. It is also important to recognize the psychosocial impact of CSP and consider formal referral for psychological evaluation and treatment if the patient endorses significant psychiatric responses to pain. It is important to also recognize the neuropathic component of pain that may arise in patients with CSP. Neuropathic medications show promise as a narcotic-sparing pharmacological intervention. There are promising surgical options for CSP including microsurgical denervation of the spermatic cord. This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain.
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Affiliation(s)
- Christopher Wu
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada
| | - Keith Jarvi
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada.
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Characteristics and Etiologies of Chronic Scrotal Pain: A Common but Poorly Understood Condition. Pain Res Manag 2017; 2017:3829168. [PMID: 28352209 PMCID: PMC5352901 DOI: 10.1155/2017/3829168] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 11/18/2022]
Abstract
Chronic scrotal pain (CSP) is a common and debilitating condition, but the underlying characteristics and etiology of CSP are poorly understood. The objective of this study is to identify the characteristic and etiologies of CSP. Men presenting for management of CSP completed a standardized questionnaire and underwent a complete physical examination. From Feb 2014 to Sep 2015, a total of 131 men (mean age 43) with CSP were studied. The CSP was of long duration (mean of 4.7 ± 5.95 years) and dramatically affected men's lives, with adverse effects on normal activities (71.%), ability to work (51.90%), and sexual functioning (61.8%). 50.4% felt depressed on most days, and 67.17% felt either unhappy or terrible with their present condition. Physical examination revealed that the epididymis was the most common tender area found in 70/131 men (53.43%), though a musculoskeletal source for the pain was found in 9.9%. Neuropathic changes were found in 30%. For close to half of the men (43.5%) we were unable to identify any potential cause for the CSP. This study characterizes the dramatic impact that CSP has on the lives of men, while providing an understanding of the common etiologies.
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Aljumaily A, Wu C, Al-Khazraji H, Gordon A, Lau S, Jarvi KA. Quality of life in men with chronic scrotal pain. Can J Pain 2017; 1:106-111. [PMID: 35005346 PMCID: PMC8730560 DOI: 10.1080/24740527.2017.1328592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Chronic scrotal pain (CSP) is a common and often debilitating condition found in up to 4.75% of men. There is little written on the impact of CSP on men’s lives. Aim: The aim of this study was to understand the impact of CSP on men’s lives. Methods: Patients with CSP were prospectively asked to complete a comprehensive questionnaire, including questions on quality of life (QoL), activities, and mood. Results: The mean age of the 131 patients was 43 years. Pain was intermittent, with severe pain episodes (mean pain scores 7.2 ± 2 out of 10) affecting men on average 40% ± 30% of the time. Overall, 88/131 (67.17%) of patients responded that they felt “unhappy” or “terrible” with their present situation. More than 40% of patients complained of depressive symptoms more than half the days of the month. Normal activities were adversely affected, with 68/131 (51.90%) reporting limited ability to work, 93/131 (70.99%) patients reporting decreased physical activity, and 81/131(61.83%) reporting decreased sexual activity. Comparing men with pain levels ≥ 7/10 vs. those with pain levels < 7/10, 47% (41/88) vs. 8.1% (3/37) reported that they felt “terrible,” 40% (35/88) vs. 13% (5/38) had depressive feelings more than half the time, and 35% (28/80) vs. 16% (6/38) felt little pleasure doing things (P < 0.01 for all). Conclusion: Our study suggests that QoL, mood, and the ability to perform normal activities are profoundly disturbed in CSP patients and that the pain severity is directly related to QoL.
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Affiliation(s)
- Aosama Aljumaily
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Murray Koffler Urologic Wellness Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christopher Wu
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Hind Al-Khazraji
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allan Gordon
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Keith A. Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Murray Koffler Urologic Wellness Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial. J Urol 2015; 194:1323-7. [PMID: 26004866 DOI: 10.1016/j.juro.2015.05.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE We prospectively evaluated the results of microsurgical spermatic cord denervation in a series of patients with chronic scrotal content pain in a multicenter study, including 1 center in Germany and 3 centers in Chile. MATERIALS AND METHODS A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis. RESULTS No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery. CONCLUSIONS After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.
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Orchialgia and the chronic pelvic pain syndrome. World J Urol 2013; 31:773-8. [PMID: 23645410 DOI: 10.1007/s00345-013-1092-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/22/2013] [Indexed: 01/15/2023] Open
Abstract
This review paper highlights the important health issue of orchialgia and the chronic pelvic pain syndrome. There are a number of specific and non-specific etiologies and different treatment options based on the sub-categorization of orchialgia. The focus of this article is on the specific etiologies of chronic orchialgia as well as non-specific scrotal pain, and the diagnostic evaluation and optimal management of these men. The clinician must be cautious about assuming that orchialgia is constitutive in the chronic pelvic pain syndrome, and must be diligent in ruling out specific etiologies for scrotal pain prior to managing orchialgia as a non-specific chronic pain syndrome.
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Teichman JM. New Treatments for Painful Urological Conditions. J Urol 2013; 189:415-6. [DOI: 10.1016/j.juro.2012.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Joel M.H. Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Chung JH, Moon HS, Choi HY, Jeong TY, Ha US, Han JH, Cho JM, Kim TH, Lee SW. Inhibition of adhesion and fibrosis improves the outcome of epididymectomy as a treatment for chronic epididymitis: a multicenter, randomized controlled, single-blind study. J Urol 2012; 189:1730-4. [PMID: 23219538 DOI: 10.1016/j.juro.2012.11.168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE We measured the effectiveness of inhibition of adhesion and fibrosis on patient outcomes after epididymectomy as a treatment for chronic epididymitis. MATERIALS AND METHODS An initial cohort of 152 patients was treated conservatively for chronic epididymitis. Of these patients 43 did not respond to conservative treatment and following informed consent they were enrolled in the clinical trial. The patients were randomized into 2 groups so that 22 underwent epididymectomy with concurrent administration of the inhibitors of adhesion and fibrosis hyaluronic acid and carboxymethylcellulose (group 1), and 21 underwent epididymectomy only (group 2). Visual analog pain scores and patient satisfaction scores were obtained at postoperative weeks 4, 12 and 24. RESULTS There were no postoperative complications such as wound infection or hematoma in either group. One patient was lost to followup from group 1 and 2 were lost from group 2. At postoperative week 24, 12 patients (57.1%) from group 1 and 3 (15.8%) from group 2 were pain-free, 6 (28.6%) from group 1 and 6 (31.6%) from group 2 exhibited limited pain relief, 2 (9.5%) from group 1 and 7 (36.8%) from group 2 exhibited no pain relief, and 1 (4.8%) from group 1 and 3 (15.8%) from group 2 exhibited recurrence of pain after initial resolution at earlier followup intervals (p = 0.028). CONCLUSIONS Inhibition of adhesion and fibrosis after epididymectomy as a treatment for chronic epididymitis improves pain relief and patient satisfaction.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Strebel RT, Schmidt C, Beatrice J, Sulser T. Chronic scrotal pain syndrome (CSPS): the widespread use of antibiotics is not justified. Andrology 2012; 1:155-9. [DOI: 10.1111/j.2047-2927.2012.00017.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 03/24/2012] [Accepted: 07/06/2012] [Indexed: 11/29/2022]
Affiliation(s)
- R. T. Strebel
- Department of Urology; Kantonsspital Graubünden; Chur; Switzerland
| | - C. Schmidt
- Department of Urology; GZO Wetzikon; Wetzikon; Switzerland
| | - J. Beatrice
- Department of Urology; Spital Uster; Uster; Switzerland
| | - T. Sulser
- Department of Urology; University Hospital Zurich; Zurich; Switzerland
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Horovitz D, Tjong V, Domes T, Lo K, Grober ED, Jarvi K. Vasectomy Reversal Provides Long-Term Pain Relief for Men With the Post-Vasectomy Pain Syndrome. J Urol 2012; 187:613-7. [DOI: 10.1016/j.juro.2011.10.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Indexed: 11/27/2022]
Affiliation(s)
- David Horovitz
- Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Vehniah Tjong
- Faculty of Medicine, Institute of Medical Sciences, the University of Toronto, Toronto, Ontario, Canada
| | - Trustin Domes
- Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kirk Lo
- Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Institute of Medical Sciences, the University of Toronto, Toronto, Ontario, Canada
| | - Ethan D. Grober
- Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Urology, Women's College Hospital, Toronto, Ontario, Canada
| | - Keith Jarvi
- Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Institute of Medical Sciences, the University of Toronto, Toronto, Ontario, Canada
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Lee JY, Lee TY, Park HY, Choi HY, Yoo TK, Moon HS, Han JH, Park SY, Lee SW. Efficacy of Epididymectomy in Treatment of Chronic Epididymal Pain: A Comparison of Patients With and Without a History of Vasectomy. Urology 2011; 77:177-82. [DOI: 10.1016/j.urology.2010.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/25/2010] [Accepted: 05/05/2010] [Indexed: 11/17/2022]
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Bhushan S, Schuppe HC, Fijak M, Meinhardt A. Testicular infection: microorganisms, clinical implications and host-pathogen interaction. J Reprod Immunol 2010; 83:164-7. [PMID: 19836838 DOI: 10.1016/j.jri.2009.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 05/07/2009] [Accepted: 07/06/2009] [Indexed: 11/18/2022]
Abstract
The male reproductive tract harbours effective immune mechanisms to protect the host from invading microorganisms. As the frontline of defence, the innate immune system has evolved receptors that recognise molecular patterns of pathogens to sense infections. These Toll-like receptors discriminate between different pathogen-associated molecules and activate signalling cascades that lead to immune responses, but can also result in tissue destruction leading to fertility disturbances. The testis is unique as it produces a large number of immunogenic cells expressing neo-antigens with no apparent adverse consequences for the majority of men. On the other hand the male gonad appears to be particularly susceptible to tissue damage resulting from infection or inflammatory reactions, a challenge that provides an important task both to clinicians and basic scientists. This review is intended to provide an overview of pathogens relevant in male reproductive tract infection, with a special emphasis on the testis. It also highlights the recent work broadening our understanding of the mechanisms underpinning germ cell loss in the presence of bacteria.
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Affiliation(s)
- Sudhanshu Bhushan
- Department of Anatomy and Cell Biology, Justus-Liebig-University of Giessen, Giessen, Germany
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Patterns of single and multiple claims of epididymitis among young privately-insured males in the United States, 2001 to 2004. Sex Transm Dis 2009; 36:490-2. [PMID: 19455076 DOI: 10.1097/olq.0b013e3181a396d8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Hori S, Sengupta A, Shukla CJ, Ingall E, McLoughlin J. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol 2009; 182:1407-12. [PMID: 19683304 DOI: 10.1016/j.juro.2009.06.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the long-term outcomes of patients who underwent epididymectomy for the treatment of chronic epididymal pain. MATERIALS AND METHODS All 72 patients who underwent epididymectomy at our institution between 1994 and 2007 were invited to participate in the study. Patients were mailed questionnaires covering various aspects of the treatment. Questions regarding pain were rated on a scale between 0 and 10 (0--no pain, 10--severe pain). Patients who did not return the questionnaires were followed up by telephone and the medical case notes of all respondents were reviewed. Statistical analysis was performed using the Wilcoxon signed-rank and Fisher's exact tests with p <0.05 considered statistically significant. RESULTS A total of 53 patients participated (74% response rate) and mean followup was 7.4 years. Of these patients 45 (84.9%) underwent epididymectomy for post-vasectomy pain and the remainder (8 of 53, 15.1%) had the procedure for various nonvasectomy reasons. There were significant improvements in pain score in the post-vasectomy (mean 7.3 preoperative to 2.4 postoperative, p <0.001) and nonvasectomy (mean 7 preoperative to 2.8 postoperative, p = 0.002) groups. Of the patients in the post-vasectomy group 93.3% (42 of 45) had less or no pain postoperatively compared to 75% (6 of 8) in the nonvasectomy group. The satisfaction rate with epididymectomy was also higher in the post-vasectomy (42 of 45, 93.3%) compared to the nonvasectomy (5 of 8, 62.5%) group (p = 0.038). CONCLUSIONS With high patient satisfaction and a favorable long-term outcome epididymectomy appears to be an effective treatment option particularly for post-vasectomy chronic epididymal pain.
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Affiliation(s)
- Satoshi Hori
- Department of Urology, West Suffolk Hospital, Bury St. Edmunds, United Kingdom.
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Tracy CR, Steers WD, Costabile R. Diagnosis and Management of Epididymitis. Urol Clin North Am 2008; 35:101-8; vii. [DOI: 10.1016/j.ucl.2007.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Nikolaou M, Ikonomidis I, Lekakis I, Tsiodras S, Kremastinos D. Amiodarone-induced epididymitis: a case report and review of the literature. Int J Cardiol 2007; 121:e15-6. [PMID: 17692943 DOI: 10.1016/j.ijcard.2007.05.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 05/26/2007] [Indexed: 11/22/2022]
Abstract
Epididymitis, as an unusual side-effect of amiodarone use, in a patient with dilated cardiomyopathy is reported along with a pertinent literature review. The diagnosis was one of exclusion after the patient received several regimens of antimicrobials and was only established after a dose reduction of the amiodarone regimen. Cardiologists should be aware of this rare but existing side effect of amiodarone, in order promptly intervene with dose adjustment or discontinuation of amiodarone and to avoid prolonged use of unnecessary antimicrobial regimens.
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Vasić D, Milićević S, Pajović B, Petković M. Epididymitis: Diagnosis and treatment. SCRIPTA MEDICA 2007. [DOI: 10.5937/scrimed0702095x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pontari MA. Chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: Are they related? Curr Urol Rep 2006; 7:329-34. [PMID: 16930505 DOI: 10.1007/s11934-996-0013-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Interstitial cystitis and chronic prostatitis/chronic pelvic pain syndrome are clinical syndromes characterized by pelvic pain with or without voiding symptoms such as urgency and frequency. There are many similarities in their epidemiology, adverse effect on quality of life, etiology/pathophysiology, natural history, and response to similar treatments. However, overlapping clinical definitions and similar entrance criteria for large-scale cohort studies make comparisons problematic. Newer efforts to classify pelvic pain syndromes should help in our recognition that interstitial cystitis and chronic prostatitis/chronic pelvic pain syndrome likely are not organ-specific syndromes but urogenital manifestations of regional or systemic abnormalities.
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Affiliation(s)
- Michel A Pontari
- Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Strebel RT, Leippold T, Luginbuehl T, Muentener M, Praz V, Hauri D. Chronic scrotal pain syndrome: management among urologists in Switzerland. Eur Urol 2005; 47:812-6. [PMID: 15925078 DOI: 10.1016/j.eururo.2005.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2004] [Accepted: 01/04/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Management of patients presenting with chronic or recurrent pain located in the scrotum is often very challenging. Evidence-based literature and clinical practice guidelines for the management of chronic scrotal pain syndrome (CSPS) are not available. We assessed the current perception and management of chronic scrotal pain syndrome by urologists in Switzerland. METHODS In July 2004, all the members of the Swiss Society of Urology received a questionnaire focusing on diagnostic and treatment practices for the management of chronic scrotal pain syndrome. The questionnaire consisted of 6 topics concerning practice setting, incidence, aetiology, diagnostics, therapy and treatment success rate. RESULTS 103 questionnaires were completed (63%). All but 2 (2%) responding Swiss urologists see a mean of 6.5 new patients per month (range 1-30). 79% of Swiss urologists consider CSPS to be infectious or post-infectious in nature. Furthermore, a history of vasectomy, psychosomatic disorders, chronic prostatitis, neuromuscular disorders, a history of inguinal surgery, and idiopathic aetiology were mentioned in decreasing order. The most commonly used examinations are urinalysis in 96% and ultrasound in 93%. Additional assessments include blood sampling, duplex ultrasound, assessment for coexisting chronic prostatitis, and referral to an Orthopaedist, Rheumatologist or Psychiatrist. The predominant medication prescribed for CSPS is a non-steroidal anti-inflammatory agent given for a mean of 15.5 days. An antibiotic trial is prescribed by 82% for a mean of 20.5 days. 74% consider epididymectomy the treatment option of choice in recurrence. Inguinal orchiectomy is performed by 7%, microsurgical spermatic cord denervation is performed by 6% of surgeons. Mean estimated recurrence rate after conservative treatment is 48% and thus higher than after epididymectomy with 18%. CONCLUSIONS Chronic pain located in the scrotum is a common clinical condition in Switzerland. Most urologists consider an infection or post-infectious alterations as the predominant aetiology for CSPS. Consequently, an antibiotic trial in combination with an anti-inflammatory agent is prescribed as first-line therapy. Recurrence rates for conservative treatment are estimated high which is in contradiction to the presumed aetiology. Therefore, further evaluation of this poorly described disease complex is required.
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Affiliation(s)
- Raeto T Strebel
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091 Zurich, Switzerland.
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