Testicular exosomes disturb the immunosuppressive phenotype of testicular macrophages mediated by miR-155-5p in uropathogenic Escherichia coli-induced orchitis / 亚洲男科学杂志(英文版)

Male reproductive infections are known to shape the immunological homeostasis of the testes, leading to male infertility. However, the specific pathogenesis of these changes remains poorly understood. Exosomes released in the inflammatory microenvironment are important in communication between the local microenvironment and recipient cells. Here, we aim to identify the immunomodulatory properties of inflammatory testes-derived exosomes (IT-exos) and explore their underlying mechanisms in orchitis. IT-exos were isolated using a uropathogenic Escherichia coli (UPEC)-induced orchitis model and confirmed that IT-exos promoted proinflammatory M1 activation with increasing expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) in vitro. We further used small RNA sequencing to identify the differential miRNA profiles in exosomes and primary testicular macrophages (TMs) from normal and UPEC-infected testes, respectively, and identified that miR-155-5p was highly enriched in IT-exos and TMs from inflammatory testes. Further study of bone marrow derived macrophages (BMDMs) transfected with miR-155-5p mimic showed that macrophages polarized to proinflammatory phenotype. In addition, the mice that were administrated IT-exos showed remarkable activation of TM1-like macrophages; however, IT-exos with silencing miR-155-5p showed a decrease in proinflammatory responses. Overall, we demonstrate that miR-155-5p delivered by IT-exos plays an important role in the activation of TM1 in UPEC-induced orchitis. Our study provides a new perspective on the immunological mechanisms underlying inflammation-related male infertility.

Overview of human and animal brucellosis in Nigeria and its economic impacts on production

Brucellosis is a wide spread zoonotic bacterial disease of humans and animals. In humans the disease is recognized commonly as undulant fever, characterized by headache malaise, and arthritis. Brucellosis can occur in any age group, but mainly found in young men between the ages of 20 and 40 years because of occupational hazards. Domestic animals (cattle, sheep and goat, pigs, dogs etc) are highly susceptible to brucellosis. Generally, brucellosis manifest in female animals as abortion, retained placenta, stillbirth and death of young ones soon after birth. In males, the main features are vesiculitis, orchitis, and epididymitis, which may render infected male infertile for life. The endemicity of brucellosis has remained a threat in low- income countries of sub-Saharan Africa and South Asia and has multiple economic implications across agriculture and public health sectors, and broader implications on economic and social development sectors. Google and Google Scholar were used to retrieve articles used for this review, which included published research articles and local, national and international reports on brucellosis. In this review, we summarised human and animal brucellosis, prevalence of infections in Nigeria, and economic impacts on production. It is believed that this review will guide researchers on the state of brucellosis in developing countries where the disease is still endemic, using Nigeria as a case study.

Vasitis: a clinical confusion diagnosis with inguinal hernia

Abstract Vasitis or inflammation of the vas deferens is a rarely described condition categorized as either generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Vasitis nodosa, the commonly described inflammation of the vas deferens, is benign and usually associated with a history of vasectomy. Clinically, patients present with a nodular mass and are often asymptomatic and require no specific treatment.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis

ABSTRACT Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 - 28.822, p=0.017). Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.

Micro-dissection testicular sperm extraction for patients with non-obstructive azoospermia: A report of 196 cases / 中华男科学杂志

Objective@#To investigate the effect of micro-dissection testicular sperm extraction (microTESE) for patients with non-obstructive azoospermia (NOA) and the indications of the strategy.@*METHODS@#This retrospective study included 196 cases of NOA undergoing microTESE in our center from September 2014 to March 2017. We recorded the sperm retrieval rate (SRR) and analyzed its correlation with the patients' age, testis volume, level of blood follicle-stimulating hormone (FSH), and etiological factors.@*RESULTS@#Testicular sperm were successfully retrieved from 87 (44.4%) of the patients. No significant correlation was found between the SRR and the patients' age, testis volume, or blood FSH level (P >0.05). As regards etiological factors, the SRR was 100% (29/29) in the patients with orchitis, 66.7% (16/24) in those surgically treated for cryptorchidism, 55.6% (10/18) in those with other secondary testis lesions, 60.0% (3/5) in those with AZFc deletion, 40.9% (9/22) in those with severe idiopathic testicular atrophy, 21.4% (12/56) in those with idiopathic NOA, 20.5% (8/39) in those with Klinefelter's syndrome, and 0% (0/3) in those with other abnormal karyotypes.@*CONCLUSIONS@#MicroTESE is an effective strategy for sperm retrieval in NOA patients, and the SRR is correlated with etiological factors but not with the FSH level or testis volume of the patients.

Development and trial of vaccines against Brucella

The search for ideal brucellosis vaccines remains active today. Currently, no licensed human or canine anti-brucellosis vaccines are available. In bovines, the most successful vaccine (S19) is only used in calves, as adult vaccination results in orchitis in male, prolonged infection, and possible abortion complications in pregnant female cattle. Another widely deployed vaccine (RB51) has a low protective efficacy. An ideal vaccine should exhibit a safe profile as well as enhance protective efficacy. However, currently available vaccines exhibit one or more major drawbacks. Smooth live attenuated vaccines suffer shortcomings such as residual virulence and serodiagnostic interference. Inactivated vaccines, in general, confer relatively low levels of protection. Recent developments to improve brucellosis vaccines include generation of knockout mutants by targeting genes involved in metabolism, virulence, and the lipopolysaccharide synthesis pathway, as well as generation of DNA vaccines, mucosal vaccines, and live vectored vaccines, have all produced varying degrees of success. Herein, we briefly review the bacteriology, pathogenesis, immunological implications, candidate vaccines, vaccinations, and models related to Brucella.

Ultrasonography of the scrotum in adults

Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities. A 12-17 MHz high frequency linear array transducer provides excellent anatomic detail of the testicles and surrounding structures. In addition, vascular perfusion can be easily assessed using color and spectral Doppler analysis. In most cases of scrotal disease, the combination of clinical history, physical examination, and information obtained with ultrasonography is sufficient for diagnostic decision-making. This review covers the normal scrotal anatomy as well as various testicular and scrotal lesions.

Brucella orchitis: A retrospective study of 69 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the epidemiological characteristics, clinical manifestations, diagnosis, and treatment of Brucella orchitis, so as to provide reliable evidence for the prevention and treatment of the disease.</p><p><b>METHODS</b>We conducted retrospective statistical analyses on the medical records of 48 outpatients and 21 inpatients with Brucella orchitis.</p><p><b>RESULTS</b>Brucella orchitis was diagnosed in 6.67% of the male patients with brucellosis (69/1 034). The disease exhibited typical epidemiological features, with a higher incidence rate among those in frequent contact with sheep and elderly people, in the period from April to July, and in the areas with sheep husbandry. All the Brucella orchitis patients had such local symptoms as testicular pain and swelling, more frequently involving both testes, and other most common symptoms included fever, chills, sweating, and painful joints. Based on IIEF-5, 45 of the patients suffered from severe erectile dysfunction, with their reproductive function temporarily affected in the course of the disease. Misdiagnosis easily occurred in the early stage of the disease. Therapeutic options mainly included doxycycline hydrochloride and rifampicin, administered orally or intravenously, which could effect a cure, though relapse might occur in some cases.</p><p><b>CONCLUSION</b>Bru- cella orchitis has distinct epidemiological characteristics, with clinical manifestations of testicular pain and swelling. Though a transient disease, it affects the reproductive function of the patient before cured. It can be treated by combined oral and intravenous medication, with painkillers or ice bags for testicular pain and swelling.</p>

Periorquitis meconial: A propósito de un caso / Meconium periorchitis: A case report

La periorquitis meconial es infrecuente. En el feto, está abierto el conducto peritoneo vaginal y, ante una perforación intestinal por cualquier causa (atresia intestinal, vólvulo, entre otras), se produce una peritonitis meconial. El contenido intestinal puede pasar hacia la cavidad vaginal escrotal. La peritonitis meconial puede resolverse espontáneamente y sin consecuencias. Restos calcificados de este evento pueden quedar en la cavidad peritoneal y/o en el escroto. En el recién nacido, se observará un hidrocele y una masa palpable intraescrotal, ecográficamente heterogénea y con calcificaciones. La periorquitis meconial o vaginalitis meconial se resuelve espontáneamente. Su desconocimiento podría llevar a cirugías innecesarias en el neonato. Se presenta el caso de un paciente de 33 días de vida con una masa escrotal, en quien se realizó una cirugía exploratoria. El diagnóstico anatomopatológico fue de periorquitis meconial.

Meconium periorchitis is uncommon. In the unborn child the peritoneum vaginal canal is open and, secondary to intestinal perforation due to any cause (intestinal atresia, volvulus, and others), meconium peritonitis occurs. The intestinal content reaches the scrotal vaginal cavity. Meconium peritonitis can heal spontaneously and without consequences. Calcified remnants of this event may remain in the peritoneal cavity and/or scrotum. In the newborn, a hydrocele and scrotal mass can be observed; the ultrasound will show a heterogeneous image with calcifications. Meconium periorchitis or meconium vaginalitis resolves spontaneously. The lack of awareness of this disease could lead to unnecessary surgery in the newborn. We present a 33 days old patient with a scrotal mass in whom surgery was performed with the pathological diagnosis of meconium periorchitis.

Varón marroquí con espondilodiscitis de larga evolución, orquitis y endocarditis / Moroccan man with longstanding spondylodiscitis, orchitis and endocarditis

La afectación osteoarticular es la complicación más frecuente de la brucelosis. La espondilodiscitis es una complicación grave, ya que suele estar asociada con la formación de abscesos. Se presenta el caso de un varón de 43 años de edad, natural de Marruecos, con síntomas, signos y hallazgos imagenológicos de espondilodiscitis de larga evolución, orquitis y endocarditis. Mediante la realización de pruebas de laboratorio complementarias se llega al diagnóstico de infección por Brucella spp. El presente caso busca concientizar a la comunidad médica sobre la importancia de considerar la infección por Brucella spp. como diagnóstico diferencial en pacientes con sospecha de espondilodiscitis infecciosa, especialmente en aquellos pacientes con antecedentes epidemiológicos, permitiendo así realizar un acertado y oportuno diagnóstico. Este caso resulta interesante porque nunca antes se había descrito la presencia simultánea de estas tres manifestaciones de la brucelosis en un paciente inmuno competente. (Acta Med Colomb 2015; 40: 166-168).

Osteoarticular involvement is the most common complication of brucellosis. Spondylodiscitis is a serious complication as it is often associated with abscess formation. The case of a 43 years old man born in Morocco with symptoms, signs and imaging findings of longstanding spondylodiscitis, orchitis and endocarditis is presented. Through the implementation of complementary laboratory tests, diagnosis infection by Brucella spp. was made.This case aims to raise awareness in the medical community about the importance of considering Brucella spp. as a differential diagnosis in patients with suspected infectious spondylodiscitis, especially in those patients with epidemiological background, allowing make a successful and timely diagnosis. This case is interesting because never before had been described the simultaneous presence of these three manifestations of brucellosis in an immunocompetent patient. (Acta Med Colomb 2015; 40: 166-168).

Evaluación ultrasonográfica del síndrome escrotal agudo / Ultrasound examination in acute scrotum syndrome

El síndrome escrotal agudo es una urgencia médica cuyos causales pueden ser de origen vascular o infeccioso, si bien se debe incluir en esta clasificación también el trauma escrotal. La característica común de los pacientes que cursan síndrome escrotal agudo es la notoria algesia escrotal, lo que impide la correcta palpación. Es por ello que el examen ecográfico, junto con el Doppler color, sumado a la sintomatología y los antecedentes del paciente, es de suma ayuda a la hora de determinar el diagnóstico de la entidad y establecer la terapéutica adecuada. Conocer los patrones ultrasonográficos y los diagnósticos diferenciales de cada entidad permite orientar al médico tratante y evita la pérdida de tiempo valioso en el rescate y tratamiento del testículo afectado...

Isolation of Actinobacillus seminis from a goat with clinical epididymo-orchitis in Brazil

The present study reports the first isolation of Actinobacillus seminis from a goat in Brazil. A four-year-old Moxotó breeding goat in a flock of 70 goats and 65 sheep reared together in the county of Patos, semiarid region of Northeastern Brazil, showed clinical signs of unilateral orchitis and epididymitis. Diagnosis of A. seminis infection was confirmed by association of clinical findings, bacterial isolation and 16S rRNA gene sequencing. This result suggests that A. seminis may be an additional cause of infertility in goats, and that sheep may be the source of infection because the mixed farming system allows the contact between sheep and goats in the semiarid region of Northeastern Brazil.

Orchiectomy performed in two patients with brucella orchitis mimicking testicular tumour / Orquiectomía realizada en dos pacientes con orquitis brucelosa semejante a un tumor testicular

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis ofbrucellosis was made.

La brucelosis es una zoonosis causada por cocobacilos gram negativos, y es una enfermedad infecciosa endémica en Turquía. La infección generalmente se adquiere como resultado del contacto directo con animales infectados o por consumo de leche o queso recién producidos a partir de ellos. Existe un amplio espectro de signos y síntomas clínicos de la brucelosis. Muchos sistemas, incluyendo los sistemas musculoesquelético, cardiovascular, gastrointestinal y génitourinario, pueden estar implicados en la brucelosis. El sistema génitourinario se ve afectado en 2% a 20% de los casos con brucelosis. Las formas más comunes de brucelosis son la epidídimo-orquitis, el absceso testicular, y la atrofia. La prueba de aglutinación de suero para detectar la presencia de anticuerpos es una prueba confiable en pacientes con síntomas urogenitales. Se ha hallado que la terapia antibacteriana combinada y a largo plazo son eficaces en la brucelosis. Presentamos dos casos sometidos a orquiectomía debido a una masa testicular antes de que se realizara el diagnóstico de brucelosis.

Orquiepididimite em carneiro por Salmonella enterica sub-diarizonae: primeiro caso na América do Sul / Orchiepididymitis in ram by Salmonella enterica sub diarizonae: first case in South America

O objetivo deste artigo é relatar um caso de orquiepididimite associado com infecção por Salmonella enterica subespécie diarizonae em carneiro da raça Santa Inês de quatro anos de idade, vasectomizado. Ao exame clínico reprodutivo, o animal mostrou aumento severo do conteúdo escrotal, sendo o testículo direito maior do que o esquerdo e a cauda do epidídimo direita maior do que a esquerda. A consistência testicular, avaliada em escala de 1 a 5, foi 5 para o testículo direito e 2,5 para o esquerdo; o órgão apresentava-se muito sensível ao toque. Na ultrassonografia foram observadas estruturas anecoicas/hipoecoicas circulares na cauda do epidídimo, sugestivas de abscessos; alguns pontos hiperecogênicos no parênquima testicular, sugerindo lesões de calcificação; e todo o testículo direito rodeado por imagem hipoecoica, indicativa de edema. Uma das estruturas da cauda do epidídimo direita foi puncionada, encontrando-se exsudato purulento, o qual foi enviado para exame microbiológico, sendo isolada e identificada Salmonella enterica subespécie diarizonae. O carneiro foi submetido a orquiepididectomia, e o órgão foi caracterizado macroscopicamente por adesões fibrosas entre as camadas escrotais, coexistência de abscessos epididimários e degeneração testicular. A Salmonella enterica subespécie diarizonae deve ser considerada no diagnóstico diferencial de infecção genital em ovinos.

The objective of this manuscript was to report a case of orchiepididymitis associated with Salmonella enterica subespécie diarizonae infection in a vasectomized 4-year-old Santa Inês ram. In the clinical-reproductive examination, the animal showed a severe enlargement of the scrotal contents, being the right testicle larger than left, and the right epididymal cauda was higher than the left. The testicular consistency, evaluated in a scale from 1 to 5, was 5 to the right and 2.5 to the left, and the organ was very sensitive to the touch. In the ultrasound circular structures anechoic/hypoechoic in the epididymal cauda were observed, and in the parenchyma of testicles some points of hyperechogenic image, suggesting calcification lesions and the entire right testicle was surrounded by hypoechoic image, indicative of edema. One of those structures of the right epididymal cauda was aspirated and a purulent exsudate was found, which was sent to microbiological exam, was isolated and identified Salmonella enterica subespécie diarizonae. The ram was submitted to orchiepididectomy, and the organ was characterized macroscopically by fibrous adhesions between scrotum layers, coexistence of epididymal abscesses and testicular degeneration. The Salmonella enterica subspecie diarizonae must be taken into account in the differential diagnosis of ovine genital infections.

Chlamydia and Male Lower Urinary Tract Diseases

Of the chlamydia species that can cause infections in humans, C. trachomatis is responsible for lower urinary tract diseases in men and women. C. trachomatis infections are prevalent worldwide, but current research is focused on females, with the burden of disease and infertility sequelae considered to be a predominantly female problem. However, a role for this pathogen in the development of male urethritis, epididymitis, and orchitis is widely accepted. Also, it can cause complications such as chronic prostatitis and infertility. This review summarizes C. trachomatis infection in the male genitourinary tract, including urethritis, epididymitis, orchitis, and its complications, and addresses the microbiology, epidemiology, screening, clinical manifestations, diagnosis, and treatment.

Epididimite ovina por Actinobacillus seminis no Estado de Pernambuco / Sheep epididymitis by Actinobacillus seminis in the state of Pernambuco, Brazil

Relata-se a ocorrência de orquite e epididimite ovina associada ao isolamento de Actinobacillus seminis no Estado de Pernambuco. Clinicamente observou-se aumento de volume nos testículos e epidídimos, dor e aumento de temperatura local à palpação, e atrofia testicular bilateral. Após o abate observou-se a presença de conteúdo purulento no epidídimo. À microscopia dos testículos observou-se espessamento da túnica albugínea, necrose de coagulação e calcificação de túbulos seminíferos, infiltrado inflamatório com predominância de linfócitos entre túbulos seminíferos, além de mineralização incipiente de túbulos. No epidídimo observou-se intensa proliferação de tecido conjuntivo ao redor dos ductos epididimários. O diagnóstico de orquite e epididimite por Actinobacillus seminis foi confirmado pela associação dos achados clínico-patológicos, isolamento e identificação da bactéria.

This study reports the occurrence of sheep epididymitis and the isolation of Actinobacillus seminis in the state of Pernambuco, Brazil. An increase in volume of the testicles and epididymis, pain and increase in the local temperature at palpation, and bilateral testicular atrophy were clinically observed. After slaughter, the presence of purulent content in the epididymis was found. In microscopy of the testicles, coagulation necrosis and calcification of seminiferous tubules, thickening of the tunica albuginea, fibrosis, inflammatory infiltrate with predominance of lymphocytes between seminiferous tubules and incipient mineralization of tubules was observed. In the epididymis, intense proliferation of conjunctive tissue and fibrosis around the epididymal ducts was found. The diagnosis of epididymitis by Actinobacillus seminis was confirmed with association of the clinical findings, isolation and identification of the bacteria, as well as through histopathological exam.

Case for diagnosis / Caso para diagnóstico

Henoch-Schönlein Purpura (HSP) is the most common vasculitis in children. In the absence of significant renal disease it has an excellent prognosis. In the case described, HSP initially presented together with orchitis. This infrequent event required the exclusion of testicular torsion.

A Púrpura de Henoch-Schönlein é a vasculite mais comum na idade pediátrica, tendo um prognóstico excelente na ausência de doença renal significativa. No caso descrito, a apresentação inicial cursou com orquite, o que não é frequente, obrigando a exclusão de torção testicular.

Orquioepididimitis de repetición secundaria a reflujo uretrodeferente: presentación de un caso / Recurrent Orquioepididimitis secondary to uretro-deferent duct reflux: a case report

Revisar et reflujo uretrodeferente como causa de orquioepidimitis recurrente en pacientes con antecedentes manipulación instrumental en uretra prostática, y su manejo diagnóstico y terapéutico. Descripción del caso de un paciente con antecedentes de resección trasuretral prostática (RTU) y con orquioepidimitis de repetición, que muestra en uno de los episodios una colección escrotal cuyo contenido es puncionado y se obtiene orina, planteando así la posibilidad diagnóstica de reflujo uretrodeferente. Se obtiene el diagnóstico mediante cistouretrografia miccional seriada (CUMS), observando opacificación con el contraste yodado del conducto deferente hasta el epidídimo. El tratamiento fue quirúrgico, con ligadura del conducto deferente a nivel inguinal. No hubo recurrencias posteriores. Es importante sospechar esta patología en pacientes con antecedentes de RTU, pues su diagnóstico y el tratamiento es diferente del resto de orquioepididimitis...

To review the uretro-deferent duct reflux as a cause of recurrent orquiepidemitis in patients with a history of instrumental manipulation in the prostatic urethra, its diagnostic and therapeutic management. Method: Description of a patient with a history of transurethral resection of prostate (TURP) and repeat orquiepidimitis, presenting in one of the episodes a scrotal collection whose content is punctured and urine is obtained; thus raising the diagnosis of uretro-deferent duct reflux. Diagnosis is confirmed by voiding cystourethrogram (VCUG), observing iodinated contrast opacification of the deferent duct up to the epididymis. The treatment was surgical, with inguinal ligation of the vas deferens. There was no subsequent recurrence.lt is important of suspect this condition in patients with a history of TURP, because lts diagnosis and treatment is different from usual orquiepididimitis...