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Salama N, Hatem A, Sirelkhatim Hassan O. Acute Epididymo-Orchitis Complicated With Abscesses in Testis and Seminal Vesicles: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476221146900. [PMID: 36643286 PMCID: PMC9837258 DOI: 10.1177/11795476221146900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Nader Salama
- Department of Urology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Alaa Hatem
- Department of Urology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Omer Sirelkhatim Hassan
- Department of Urology, Bahari Faculty of Medicine, Khartoum Bahari, Sudan,Omer Sirelkhatim Hassan, Department of Urology, Faculty of Medicine, University of Bahari, Khartoum Bahari Elkadaro, Khartoum 11111, Sudan.
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Li Y, Zeng Q, Deng H, Xiang T, Qi W, Wu D. Ameliorating effect of gold nanoparticles decorated on biodegradable apple pectin modified magnetic nanoparticles on epididymo-orchitis inducing alterations in sperm quality and spermatogenic cells apoptosis. INORG CHEM COMMUN 2022. [DOI: 10.1016/j.inoche.2022.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Meng L, Wang R, Zhang Z, Wang J, Yang J, Zhao G, Zhao X, Zhang Q, XU J, Liu C. A case report of staged testicular infarction. Radiol Case Rep 2022; 17:3595-3600. [PMID: 35923338 PMCID: PMC9340090 DOI: 10.1016/j.radcr.2022.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Segmental testicular infarction is a rare clinical condition most often seen as acute unilateral scrotal pain. Segmental testicular infarction should be suspected in patients with scrotal pain; when an ultrasound shows hypoechoic or mixed echogenic lesions within the testicular parenchyma; contrast-enhanced ultrasound shows a little or no contrast filling, along with negative multiple tumor markers. This report presents a 60-year-old male who presented with sudden onset of left testicular pain with no apparent cause. Emergency Doppler ultrasound, contrast-enhanced ultrasound, and laboratory tests showed findings characteristic of Segmental testicular infarction. The patient the final diagnosis was based on a combination of clinical findings (regression or cessation of symptoms, no tumor marker abnormalities, no palpable testicular mass) and ultrasound evidence of improvement (size reduction or shape change from oval to wedge) during a follow-up period of at least 3 months.
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Affiliation(s)
- Lei Meng
- School of Medical Imaging, Weifang Medical University
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Ruixian Wang
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
- School of Radiology, Shandong First Medical University, Tai'an, Shandong 271016, China
| | - Zhiyang Zhang
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
- School of Radiology, Shandong First Medical University, Tai'an, Shandong 271016, China
| | - Junfang Wang
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Jihua Yang
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Guofeng Zhao
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Xuan Zhao
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Qian Zhang
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Jianglei XU
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
| | - Cun Liu
- Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University
- Corresponding author at: Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Lixia District, Jinan, Shandong, China
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Zhou JH, Zhu XL, Li MY, Luo YW, Yang ZM, Wang L, Tong T, Qin SL, Liu BL, Chen BH, Hu W. Local adrenomedullin gene delivery inhibits Leydig cell dysfunction by rescuing steroidogenic enzymes in vivo. Andrologia 2022; 54:e14545. [PMID: 35942817 DOI: 10.1111/and.14545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Adrenomedullin (ADM) has beneficial effects on Leydig cells under pathological conditions, including lipopolysaccharide (LPS)-induced orchitis. Our previous studies demonstrated that ADM exerts a restorative effect on steroidogenesis in LPS-treated primary rat Leydig cells by attenuating oxidative stress, inflammation and apoptosis. In this study, we aim to investigate whether ADM inhibits Leydig cell dysfunction by rescuing steroidogenic enzymes in vivo. Rats were administered with LPS and injected with Ad-ADM, an adeno-associated virus vector that expressed ADM. Then, rat testes were collected for 3β-hydroxysteroid dehydrogenase (3β-HSD) immunofluorescence staining. Steroidogenic enzymes or steroidogenic regulatory factors or protein, including steroidogenic factor-1 (SF-1), liver receptor homologue-1 (LRH1), Nur77, steroidogenic acute regulatory protein (StAR), cytochrome P450 cholesterol side chain cleavage enzyme (P450scc), 3β-HSD, cytochrome P450 17α-hydroxylase/17, 20 lyase (CYP17) and 17β-hydroxysteroid dehydrogenase (17β-HSD), were detected via gene expression profiling and western blot analysis. Plasma testosterone concentrations were measured. Results showed that ADM may inhibit Leydig cell dysfunction by rescuing steroidogenic enzymes and steroidogenic regulatory factors in vivo. The reduction in the number of Leydig cells after LPS exposure was reversed by ADM. ADM rescued the gene or protein levels of SF-1, LRH1, Nur77, StAR, P450scc, 3β-HSD, CYP17 and 17β-HSD and plasma testosterone concentrations. To summarize ADM could rescue some important steroidogenic enzymes, steroidogenic regulatory factors and testosterone production in Leydig cells in vivo.
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Affiliation(s)
- Jian-Hua Zhou
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xia-Lian Zhu
- Department of Nuclear Medicine, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Ming-Yong Li
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - You-Wen Luo
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhi-Min Yang
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Li Wang
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Tao Tong
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Song-Lin Qin
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Bo-Long Liu
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Bing-Hai Chen
- Department of Urology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Wei Hu
- Department of Andrology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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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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Kbirou A, Alafifi M, Sayah M, Dakir M, Debbagh A, Aboutaieb R. Acute orchiepididymitis: Epidemiological and clinical aspects: An analysis of 152 cases. Ann Med Surg (Lond) 2022; 75:103335. [PMID: 35198183 PMCID: PMC8850673 DOI: 10.1016/j.amsu.2022.103335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Orchiepididymitis is an inflammation of the testis and epididymis. Epididymitis, orchitis, and true orchiepididymitis are all examples of orchiepididymites. They are the most frequent cause of adult acute scrotal pain. Objectives to investigate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of acute orchiepididymitis in the urology department of University Hospital Center. Materials and methods This is a three-year retrospective, descriptive study of 152 patients who consulted the urology department at the university hospital center for treatment of orchiepididymitis (2017–2019). Results In our study, 152 patients were included. The average age was 49,5 years (17–82 years). The average of consultation delay was 7 days. Prostatic pathology was found to be the main medical antecedent in 18.5% of patients, and transurethral resection of the prostate was found to be the main surgical antecedent in 8.5% of cases. Clinical examination revealed that the predominant clinical symptom was painful inflammatory bursa in 94% of cases, followed by lower urinary tract disorders in 57.5% of cases, and fever in 10% of cases. A germ was isolated in 26 cases after a systematic cytobacteriological examination of the urine (CBEU) (17%). All patients received medical treatment, and 21% of them were received urgical treatment. In 84.5% of cases, the outcome was favorable. Conclusion Acute orchiépididymitis is a common cause for a consultation to the emergency room. Diagnosis is based on clinical examination and ultrasound. Because of the frequency of complications and sequelae that might influence fertility in the long term, it is a diagnostic and therapeutic emergence Orchiepididymitis is an inflammation of the testis and epididymis, most often of infectious origin. Acute orchiépididymitis is a frequent reason for consultation in the emergency room. Diagnosis is based on clinical examination and scrotal ultrasound. The early and appropriate antibiotic treatment avoided serious complications
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Hassell J, Kitteringham L, Hall NJ. The role of ultrasound in detecting renal tract abnormalities following a single episode of epididymitis. J Pediatr Surg 2022; 57:275-277. [PMID: 34823844 DOI: 10.1016/j.jpedsurg.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Jack Hassell
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Lara Kitteringham
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
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Das S, Roychoudhury S, Roychoudhury S, Agarwal A, Henkel R. Role of Infection and Leukocytes in Male Infertility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:115-140. [DOI: 10.1007/978-3-030-89340-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ilangovan S, Ghazanfar N, Chitale S. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac060. [PMID: 35280055 PMCID: PMC8906843 DOI: 10.1093/jscr/rjac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sanjana Ilangovan
- Correspondence address. Barnet Hospital, Royal Free Hospital NHS Trust, London EN5 3DJ, United Kingdom. Tel +44(0)7923291014; E-mail:
| | - Noman Ghazanfar
- Urology Department, Whittington Hospital, London N19 5NF, United Kingdom
| | - Sudhanshu Chitale
- Urology Department, Whittington Hospital, London N19 5NF, United Kingdom
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Yasynetskyi M, Banyra O, Nikitin O, Ventskivska I, Kozlov V, Kvach M, Borzhievskyy A. Mixed Sexually Transmitted Infections in Infertile Couples: Empirical Treatment and Influence on Semen Quality. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2021; 16:227-236. [PMID: 34844551 DOI: 10.2174/2772434416666211129105145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/29/2021] [Accepted: 10/20/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) and Ureaplasma urealyticum (UU) are common sexually transmitted infections (STIs) that are diagnosed in infertile couples (cps). In cases with their simultaneous presence in a patient (mixed STI, MSTIs), treatment is complicated by the different sensitivity of microorganisms to antibacterial drugs. Moreover, in cases of complicated infections, the empirical treatment should be started before obtaining the results of drug susceptibilities. OBJECTIVE The objective of the current study is to find the effective and well-tolerated combination of drugs for the empirical antibacterial treatment of mixed STIs presented by TV, MG and UU in infertile couples. We also aimed to establish the influence of mixed STIs on semen quality. METHODS Our prospective study included 154 infertile couples (308 patients) with confirmed symptomatic MSTIs in one of the couples caused by the simultaneous presence of TV, MG and UU. All couples were randomized on three groups for empirical treatment: Group 1 (n=49 cps, 98 pts) who were treated by initial prescribing of anti-trichomoniasis drug Secnidazole, 2.0 g po followed by Azythromycin 500 mg on day 1 continuing by 250 mg on days 2-7; Group 2 (n=52 cps, 104 pts: Secnidazole, 2.0 g po followed by Josamycin 1000 mg bid for 12 days); Group 3 (n=53 cps, 106 pts: Secnidazole, 2.0 g po followed by Moxifloxacin 400 mg once daily for 12 days). The endpoints were clinical and microbiological cure rates as well as the frequency of side-effects in analyzed groups. We determined the basic parameters of the spermogram and Deoxyribonucleic acid (DNA) fragmentation levels in 59 patients with MSTIs before and at the 3rd, 6th and 9th month after pathogens eradication comparing them with results in 63 healthy sperm donors. RESULTS After the treatment, clinical cure rates in analyzed groups were 82.6% (Group 1) vs. 96.1% (Group 2) vs. 92.3% (Group 3). Microbiological cure rates (UU+MG) were 73.9% vs. 97.1% vs. 84.5% correspondingly (p<0.05). TV microbiological cure rates were 97.8% vs. 98.0% vs. 96.1% (p>0.05). Side-effects were registered in 28.6% vs. 12.5% vs. 18.9% cases correspondingly (p<0.05). In MSTIs patients, we registered the increasing DNA fragmentation rates, leucocytes count and decreasing semen volume, motility, vitality, sperm concentration, total spermatozoa number and number of spermatozoa with normal morphology. At the 6th month after complete pathogens eradication, these parameters approached normal values. CONCLUSION At the present time, the combination of Secnidazole+Josamycin can be considered the most effective and well-tolerated for the empirical treatment in patients with MSTIs presented by TV, MG and UU. Complete eradication of these MSTIs in males improves their semen parameters.
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Affiliation(s)
- Mykola Yasynetskyi
- Department of Urology, Bogomolets National Medical University, Kyiv,Ukraine
| | - Oleg Banyra
- Department of Urology, St. Paraskeva Medical Centre, Lviv,Ukraine
| | - Oleg Nikitin
- Department of Urology, Bogomolets National Medical University, Kyiv,Ukraine
| | - Iryna Ventskivska
- Department of Obstetrics and Gynecology No. 1, Bogomolets National Medical University, Kyiv,Ukraine
| | - Vadym Kozlov
- Department of Urology, Bogomolets National Medical University, Kyiv,Ukraine
| | - Mykola Kvach
- Department of Urology, Bogomolets National Medical University, Kyiv,Ukraine
| | - Andrii Borzhievskyy
- Department of Urology, Danylo Halytsky National Medical University, Lviv, Ukraine
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Ye L, Huang W, Liu S, Cai S, Hong L, Xiao W, Thiele K, Zeng Y, Song M, Diao L. Impacts of Immunometabolism on Male Reproduction. Front Immunol 2021; 12:658432. [PMID: 34367130 PMCID: PMC8334851 DOI: 10.3389/fimmu.2021.658432] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
The physiological process of male reproduction relies on the orchestration of neuroendocrine, immune, and energy metabolism. Spermatogenesis is controlled by the hypothalamic-pituitary-testicular (HPT) axis, which modulates the production of gonadal steroid hormones in the testes. The immune cells and cytokines in testes provide a protective microenvironment for the development and maturation of germ cells. The metabolic cellular responses and processes in testes provide energy production and biosynthetic precursors to regulate germ cell development and control testicular immunity and inflammation. The metabolism of immune cells is crucial for both inflammatory and anti-inflammatory responses, which supposes to affect the spermatogenesis in testes. In this review, the role of immunometabolism in male reproduction will be highlighted. Obesity, metabolic dysfunction, such as type 2 diabetes mellitus, are well documented to impact male fertility; thus, their impacts on the immune cells distributed in testes will also be discussed. Finally, the potential significance of the medicine targeting the specific metabolic intermediates or immune metabolism checkpoints to improve male reproduction will also be reassessed.
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Affiliation(s)
- Lijun Ye
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Wensi Huang
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Su Liu
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Songchen Cai
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Ling Hong
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Weiqiang Xiao
- Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Kristin Thiele
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yong Zeng
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Mingzhe Song
- Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lianghui Diao
- Shenzhen Key Laboratory for Reproductive Immunology of Peri-implantation, Clinical Research Center for Reproductive Medicine, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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Chirwa M, Davies O, Castelino S, Mpenge M, Nyatsanza F, Sethi G, Shabbir M, Rayment M. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS 2021; 32:884-895. [PMID: 34009058 DOI: 10.1177/09564624211003761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.
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Affiliation(s)
- Mimie Chirwa
- Genitourinary Medicine, 9762Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Olubanke Davies
- Genitourinary Medicine, Epsom & St Helier University Hospitals NHS Trust, London, UK
| | - Sheena Castelino
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Mbiye Mpenge
- Consultant Microbiologist, Weston Area Health NHS Trust, Weston-super-Mare, Somerset, UK
| | - Farai Nyatsanza
- Genitourinary Medicine, Cambridge Community Services NHS Trust, Cambridgeshire, UK
| | - Gulshan Sethi
- Genitourinary Medicine, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Majid Shabbir
- Urologist, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Michael Rayment
- Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Tan J, Tian M, Zhao F, Deng S, Jin P, Wang Y, Wen H, Qin X, Gong Y. An Investigation of the Male Genitourinary Abscess Originated from Urinary Tract in a Tertiary Hospital, Shanghai, China, from 2004 to 2019. Infect Drug Resist 2021; 14:1795-1803. [PMID: 34017185 PMCID: PMC8131006 DOI: 10.2147/idr.s298250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Male genitourinary abscess is one of the serious complications of urinary tract infections (UTIs). There were few researches on the clinical and pathogenic characteristics of male genitourinary abscess. Patients and Methods A retrospective observational study was conducted between January 2004 and April 2019. Male patients with genitourinary abscess originated from urinary tract, including sites of scrotum, testis, epididymis, spermatic cord, and prostate, were enrolled. Clinical and microbial records were collected and analyzed, and antimicrobial susceptibility testings were performed according to CLSI standard. Whole-genome sequencing was applied to detect the β-lactamase genes and virulence genes, as well as to determine the multilocus-sequence typing (MLST) of the collected Klebsiella pneumoniae (K. pneumoniae) isolates. Results A total of 22 male patients were included. The main clinical symptoms were fever (86.4%), scrotal swelling (68.2%), local skin warmth (59.1%) and ulceration (45.5%). Urinary irritation was often presented in prostate involved abscess. Ultrasound features had a 94.7% positive rate. Surgical treatment, including abscess drainage, was helpful to the prognosis. No matter where the specimens obtained from, including blood, urine or pus, multidrug-resistant K. pneumoniae was the dominant (11 cases, 50.0%) microorganism in positive cultures. Nine of eleven K. pneumoniae isolates had been preserved and recovered. As for MLST typing, all the nine available isolates of K. pneumoniae belonged to the ST11 type and characterized with blaKPC-2 carbapenemase gene. Virulence genes rmpA2, ybtS, kfuC, wzi, aerobactin genes (iucABCD and iutA) and type 3 fimbriae genes (mrkAD) were identified in all the K. pneumoniae isolates. Conclusion It seemed that more patients under 35 years old were vulnerable to genitourinary abscess. There was an increasing trend that multidrug-resistant K. pneumoniae isolates with multiple virulence genes were involved in male genitourinary abscess. Prompt and proper antibiotic use, combined with adequate drainage of the abscess, was important to prognosis.
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Affiliation(s)
- Jiaying Tan
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Mi Tian
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Feng Zhao
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Shuixiang Deng
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Peng Jin
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Yao Wang
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Huimei Wen
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Xiaohua Qin
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.,Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, 200040, People's Republic of China
| | - Ye Gong
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.,Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
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14
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Abolghasemi S, Alizadeh M, Hashemi A, Tehrani S. Etiology and Clinical Features of Epididymo-orchitis: A Single-center Study in Tehran, Iran. Infect Disord Drug Targets 2021; 21:142-145. [PMID: 32067623 DOI: 10.2174/1871526520666200218115400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022]
Abstract
CDATA[Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed at investigating the etiology, clinical sequelae and risk factors of patients with epididymo- orchitis in Tehran, Iran. METHODS Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. RESULTS Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). CONCLUSIONS The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. The use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.
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Affiliation(s)
- Sara Abolghasemi
- Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Alizadeh
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Departmenet of Microbiology, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Tehrani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Oh PJ, Bajic P, Lundy SD, Ziegelmann M, Levine LA. Chronic Scrotal Content Pain: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:12. [PMID: 33447905 DOI: 10.1007/s11934-020-01026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP. RECENT FINDINGS We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.
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Affiliation(s)
- Paul J Oh
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | - Petar Bajic
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA.
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Building Q10-1, Cleveland, OH, 44195, USA
| | | | - Laurence A Levine
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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16
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Sivaraj V, Ahamed A, Artykov R, Menon-Johansson A. Epididymitis and its aetiologies in a central London sexual health clinic. Int J STD AIDS 2020; 32:96-99. [PMID: 33292092 DOI: 10.1177/0956462420963879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.
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Affiliation(s)
| | - Azraan Ahamed
- Sexual Health Department, Guy's & St. Thomas NHS Foundation Trust, London, UK
| | - Ruslan Artykov
- Sexual Health Department, Guy's & St. Thomas NHS Foundation Trust, London, UK
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17
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Moubasher A, Waqar M, Raison N, Brunckhorst O, Ahmed K. A Review of the Management of Chronic Scrotal Pain. Cureus 2020; 12:e11979. [PMID: 33312831 PMCID: PMC7725413 DOI: 10.7759/cureus.11979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic scrotal pain (CSP) is a common and poorly understood medical condition that significantly affects individuals' quality of life. Many patients seek evaluation and management of their symptoms from multiple physicians. Our review aims to address diagnostic modalities, clinical evaluation, and surgical and non-surgical management. We conducted a computerised detailed search of the PubMed, Medline, Embase and Cochrane databases for reports pertaining to CSP using the Medical Subject Headings keywords 'chronic scrotal pain', 'testicular pain' and 'orchialgia', and we included in the review those that fulfilled the inclusion (adult male with CSP presenting with the criteria of CSP ) and exclusion (extra-scrotal pain) criteria. After the direct causes of CSP were identified by reviewing the clinical evaluations (history taking and examination are mandatory) and the diagnostic evaluations (urine analysis is crucial and ultrasound can be helpful), the most-used medical and non-surgical treatments for CSP were tricyclic antidepressants (success rate of up to 66.6%) and spermatic block (success rate of more than 90%), and the most-used surgical procedure was microsurgical denervation of the spermatic cord (success rate of up to 70%). The evidence currently available remains rare and of low quality, making it difficult to strongly recommend individual treatment options. However, multimodal treatment modalities using physical therapy and psychotherapy may help patients and provide useful tools for coping with this condition. There are also useful non-surgical and surgical options for CSP that depend on the patient's state, the severity of the complaint and what options have already been tried.
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Affiliation(s)
- Amr Moubasher
- Urology, King's College Hospital, London, GBR
- Dermatology and Andrology, Assiut University, Assiut, EGY
| | | | - Nicholas Raison
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Oliver Brunckhorst
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Kamran Ahmed
- Urology, King's College Hospital, London, GBR
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
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18
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Klein B, Bhushan S, Günther S, Middendorff R, Loveland KL, Hedger MP, Meinhardt A. Differential tissue-specific damage caused by bacterial epididymo-orchitis in the mouse. Mol Hum Reprod 2020; 26:215-227. [PMID: 32011693 PMCID: PMC7187874 DOI: 10.1093/molehr/gaaa011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/13/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
Ascending bacterial urinary tract infections can cause epididymo-orchitis. In the cauda epididymidis, this frequently leads to persistent tissue damage. Less coherent data is available concerning the functional consequences of epididymo-orchitis on testis and caput epididymidis. This in vivo study addresses the functional and spatial differences in responsiveness of murine epididymis and testis to infection with uropathogenic Escherichia coli (UPEC). Whole transcriptome analysis (WTA) was performed on testis, caput, corpus and cauda epididymidis of adult C57BL/6 J wildtype mice. Following UPEC-induced epididymo-orchitis in these mice, epididymal and testicular tissue damage was evaluated histologically and semi-quantitatively at 10 days and 31 days post-inoculation. Expression of inflammatory markers and candidate antimicrobial genes were analysed by RT-qPCR. WTA revealed distinct differences in gene signatures between caput and cauda epididymidis, particularly amonst immunity-related genes. Cellular and molecular signs of testicular inflammation and disruption of spermatogenesis were noticed at day 10, but recovery was observed by day 31. In contrast to the cauda, the caput epididymidis did not reveal any signs of gross morphological damage or presence of pro-inflammatory processes despite confirmed infection. In contrast to beta-defensins, known UPEC-associated antimicrobial peptides (AMP), like Lcn2, Camp and Lypd8, were inherently highly expressed or upregulated in the caput following infection, potentially allowing an early luminal protection from UPEC. At the time points investigated, the caput epididymidis was protected from any obvious infection/inflammation-derived tissue damage. Studies addressing earlier time-points will conclude whether in the caput epididymidis a pro-inflammatory response is indeed not essential for effective protection from UPEC.
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Affiliation(s)
- Britta Klein
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen 35385, Germany
| | - Sudhanshu Bhushan
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen 35385, Germany
| | - Stefan Günther
- ECCPS Bioinformatics and Deep Sequencing Platform, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Ralf Middendorff
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen 35385, Germany
| | - Kate L Loveland
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton 3168, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton 3168, Australia
| | - Mark P Hedger
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton 3168, Australia
- Department of Molecular and Translational Sciences, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton 3168, Australia
| | - Andreas Meinhardt
- Institute of Anatomy and Cell Biology, Justus-Liebig University of Giessen, Giessen 35385, Germany
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton 3168, Australia
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19
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20
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Banyra O, Nikitin O, Ventskivska I. Acute epididymo-orchitis: relevance of local classification and partner's follow-up. Cent European J Urol 2019; 72:324-329. [PMID: 31720038 PMCID: PMC6830488 DOI: 10.5173/ceju.2019.1973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/24/2019] [Accepted: 08/21/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Acute epididymo-orchitis (AEO) is a male urological emergency without an approved clinical classification. We aimed to determine the clinical value of proposed in 2012 local AEO classification system and summarize results of partner's follow-up. Material and methods A total of 293 patients with AEO were enrolled into our study. Based on the investigated AEO classification, they were divided into four groups: 118 patients (40.3%) with Stage I AEO; 97 patients (33.1%) with Stage II AEO; 42 patients (14.3%) with Stage IIIA AEO; 36 patients (12.3%) with Stage IIIB AEO. If after 72 hours of conservative treatment there was no clinical improvement, AEO patients underwent surgery. We analyzed the clinical value of the investigated classification system and results of partner's follow-up. Results Only 3 (2.5%) patients with Stage I AEO required surgery. In patients with Stage II AEO, conservative treatment was effective in 79 (81.4%) cases. A total of 27 (64.3%) patients with Stage IIIA and 36 (100%) patients with stage IIIB AEO underwent surgery. Sexually transmitted infections (STIs) were detected in 176 (60.1%) cases among 293 patients with AEO and bacterial infection in 117 (39.9%) cases. We registered a statistically lower incidence rate of trichomoniasis in AEO patients compared to their sole female partners (13.8% vs. 23.3%, p <0.05). Distribution of other STIs in AEO patients and their sole partners was similar. Conclusions The investigated classification system enables the determination of a treatment strategy in patients with AEO. Partner's follow-up allows for the clarification of the etiology of disease, complete evaluation of STIs and prevents reinfection in couples.
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Affiliation(s)
- Oleg Banyra
- St. Paraskeva Medical Centre, Lviv, Ukraine.,2 Lviv Municipal Polyclinic, Lviv, Ukraine
| | - Oleg Nikitin
- Department of Urology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Iryna Ventskivska
- Department of Gynecology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
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Treatment of Acute Epididymitis: A Systematic Review and Discussion of the Implications for Treatment Based on Etiology. Sex Transm Dis 2018; 45:e104-e108. [DOI: 10.1097/olq.0000000000000901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Yan Y, Chen S, Chen Z, Pei X, Zhou J, Xiao Y, Wang X. The applied value of medical history, physical examination, colour-Doppler ultrasonography and testis scintigraphy in the differential diagnosis of acute scrotum. Andrologia 2018; 50:e12973. [PMID: 29460432 DOI: 10.1111/and.12973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/28/2022] Open
Abstract
Acute scrotum, especially testicular torsion, is a common surgical emergency. A delay in diagnosis or management may lead to permanent testicular ischaemic damage. Thus, it is particularly important to differentiate testicular torsion from other acute scrotum conditions as soon as possible. Our study has retrospectively investigated 358 patients with acute scrotum admitted to our hospital from the year 2007 to 2016. We have collected a thorough history and clinical data and drew the conclusion by comparing clinical features of different acute scrotum cases, medical history, imaging and surgical findings. Therefore, we propose an innovative "Testicular Torsion (TT) Green Channel" concept. Through the combination of a comprehensive medical history, physical examination and auxiliary colour-Doppler ultrasonography, the diagnosis of testicular torsion is definite in most circumstances. Testis scintigraphy is a novel and complementary diagnostic modality that can reduce the negative exploration rate in ambiguous and certain cases. The TT Green Channel is a new concept in the management of testicular torsion.
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Affiliation(s)
- Y Yan
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - S Chen
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Z Chen
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - X Pei
- Department of Emergency, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - J Zhou
- Department of Urology, Jingzhou Central Hospital, The Second Clinical College, Yangtze University, Jingzhou, China
| | - Y Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Laboratory of Precision Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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