A rare case of isolated tubercular epididymitis

Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical signs of kidney. Here we present a middle-aged man who presented with swelling in the right scrotum since, 45 days. On clinical examination, mild tenderness was noted in the right scrotal region, a course of oral antibiotics was started but again patient presented with same complaints after 15 days. Fine needle aspiration cytology of testicular swelling was performed which was confirmatory of tuberculous epididymitis. The patient was advised anti-tuberculosis treatment, which he continued for a duration of 6 months. Following the anti-tubercular treatment, there was no evidence of recurrence.

Clinical Investigation of Epididymal Tuberculosis / 대한비뇨기과학회지

A clinical investigation was undertaken on 43 patients with epididymal tuberculosis who were seen in our department during the period from 1978 to 1982. Histopathologic examination was performed on 30 patients with obstructive azoospermia. The results obtained were as follows: 1. A total of 43 patients with epididymal tuberculosis corresponds to 38% of total male patients with genitourinary tuberculosis. 2. The highest occurrence was observed in the age groups of 20 to 39 (72%). 3. Of presenting symptoms, Swelling of epididymis was observed in 81%; scrotal fistula, 30%; and infertility, 12%. 4. The most common affected region of epididymis was diffuse invasion in 37%, followed by tail in 30%. 5. Lateralization showed 21% in the right, 30% in the left, and 49% in the both sides. 6. In urine examination, pyuria was observed in 42%, hematuria in 37%, and tubercle bacilli in 19%. 7. In semen analysis, azoospermia was observed in 64%, oligozoospermia in 32%, and normal spermiogram in 4%. 8. The active pulmonary tuberculosis was observed in 28%, renal tuberculosis in 42%, prostatic tuberculosis in 42%, tuberculosis of vas in 51%, and tuberculosis of testis in 14%. 9. The causes of obstructive azoospermia were chronic nonspecific inflammation (53%), fibrosis and obliteration (20%), tuberculous inflammation (10%), absence of vas (10%) and sperm granuloma (7%) in order of frequency.

Clinical Observation on Tuberculosis of the Epididymis / 대한비뇨기과학회지

Forty-three cases of tuberculosis of the epididymis seen during the period from January 1968 to August 1970 were studied clinically and the following results were obtained. 1). Incidence of tuberculosis of the epididymis is 7.7 % of Urological adimissonal patient. 2). Lateralization shows 20. 9% in the right, 16. 3% in the left and 62.8% in the both. 3). In 18.6%, tuberculous diseases were present in the past history the pleura and the lung were most frequently invaded. 4). Of presenting symptoms, painful epididymal swelling were observed in 53.5%, Unpainful epididymal swelling 27.9%, frequency of urination 20.9% and hematuria 11.6%. 5). Sperm analysis in 34 cases(bilat. 24 cases, unilat. 10 cases) disclosed azoospermia in 53.0% oligospermia in 23.5% and normospermia in 17.6%. 6). Observing the epididymal TB. associated with TB. involvement in other organ, the lung and pleura TB. inextrarenal organ show the highest percent (44.2%) and the prostatic TB. in the genitourinary tract (72.1%). 7). In 43 cases, the total or partial epididymectomy was done in 12 cases and the epididymcorchiectomy in 2 cases.

Studies on Tuberculosis of the Epididymis: 2. Influence of Chemotherapy on tuberculous lesions of the Epididymis / 대한비뇨기과학회지

Forty five cases of tuberculosis of the epididymis were classified according to grade of invasion and length of antituberculous chemotherapy and the histopathological response to chemotherapy was evaluated as follows: 1) Tuberculosis of the epididymis is graded according to the size and extent of invasion. Grade I (mild) A single nodule in size of small finger tip or smaller in the head, body or tail is palpable. Differentiation with nonspecific lesion is very difficult. Grade II (moderate): A single nodule in size of index finger tip or smaller ie palpable. No adhesion is noticeable. Grade III (advanced): One or two nodules in size of thumb or smaller are palpable. Adhesion is present or absent and the vas shows thickening. Grade IV (far advanced): Tow or more nodules in size of thumb or larger are palpable and scrotal fistula or abscess present. Adhesion is usually present and the beaded vas is palpable. 2) Histopathological response to chemotherapy are as follows: a) Caseation: the longer the duration of chemotherapy the less the caseation is present. b) Epitheloid cells show degeneration, atrophy and decrease. c) Giant cells show degeneration, atrophy, vacuolization and decrease. d) Perifocal reaction is reduced gradually upon chemotherapy. e) Fibrosis is very significant in the group of treatment and vacuolization readily occurred early in the chemotherapy with longer chemotherapy. Hyalinization of fibrous tissue is prominent f) Lymphocytic infiltration and vacuolization are observed both in treated and untreated groups, more significant in the first. g) Almost same grade of reticulosis is observed both in the treated and untreated groups. h) It was observable that among the testis, epididymis and the vas deferens, somewhat faster response to the chemotherapy vas obtained in the vas than in the epididymis and the testis showed the slowest response to the chemotherapy. i) Significant histopathological response is obtained in the group of two months or longer chemotherapy, j) From these observations, the author is of belief that extensive chemotherapy is only indicated for epididymal tuberculosis of grades I and II without surgery. However, the grades III and IV lesions require surgical intervention following a trial with chemotherapy for 2 months or longer.