Testicular and epididymal dysfunctions: searching a new index for the differential diagnosis / Disfunciones testiculares y epididimarias: búsqueda de un nuevo índice para el diagnóstico diferencial

Objective: This proof-of-principle aims to develop an index to aid the differential diagnosis of disorders affecting testicular and/or epididymis. A total of 202 subject data were evaluated in two groups: fertile men with children naturally conceived within 1 year of unprotected intercourse (n = 36) and infertile men (n = 166) who had attempted a pregnancy more than 1 year with unprotected intercourse. Materials and methods: Semen parameters (sperm count, vitality, motility, morphology, and hypoosmotic swelling test [HOST]) were evaluated. The index was calculated by dividing the percentage HOST by the percentage of sperm progressive motility in the fertile group (n = 36). Results: A normal range from 1.23 to 1.53 was determined. Using this index, the outcomes of semen analysis from infertile men were grouped in three study groups: below 1.23 (n = 24), normal (n = 44), and higher than 1.53 (n = 98). These parameters were significantly decreased in semen with normal range (p < 0.01) and in indexes higher than 1.53 (p < 0.0001). Receiver operating characteristic curves compared progressive motility and morphology in infertile men with indexes higher than 1.53 shows that semen samples with normal sperm progressive motility and morphology did not suggest dysfunctions in testis and epididymis. Semen samples with asthenozoospermia suggested epididymal dysfunction (area under the curve [AUC] 0.889, confidence interval [CI] 0.783-1), whereas semen samples with teratoasthenozoospermia suggested dysfunction in both testicles and epididymis (AUC 0.891, CI 0.77-1). Conclusions: The current index proof-of-principle of the success of such a strategy provides valuable information about whether a disorder individually affects testicular and/or epididymal function.

Objetivo: Esta prueba de principio tiene como objetivo desarrollar un índice que ayude al diagnóstico diferencial de los trastornos testiculares y/o epidídimales. Métodos: Se evaluaron 202 individuos divididos en dos grupos: hombres fértiles con hijos concebidos de forma natural en el plazo no mayor a un año (n = 36) y hombres infértiles (n = 166), los cuales habían intentado un embarazo por más de un año. Se evaluaron los parámetros seminales (concentración, viabilidad, movilidad, morfología y prueba de hinchazón hipoosmótica [HOST]). El índice se calculó dividiendo el porcentaje de HOST por el porcentaje de movilidad espermática progresiva en el grupo fértil (n = 36). Resultados: Se determinó un rango normal de 1,23 a 1,53. Utilizando este índice, los resultados del análisis del semen de los hombres infértiles se agruparon en tres grupos de estudio: por debajo de 1,23 (n = 24), normal (n = 44) y superior a 1,53 (n = 98). En contraste, estos parámetros disminuyeron significativamente en el semen de rango normal (p < 0,01) y en los índices superiores a 1,53 (p < 0,0001). Las curvas ROC comparadas con la movilidad espermática progresiva y la morfología en los hombres infértiles con índices superiores a 1,53 muestran que las muestras de semen con movilidad progresiva y morfología normales no sugieren disfunciones en los testículos y epidídimos. Las muestras de semen con astenozoospermia sugerirían una disfunción del epidídimo (AUC 0,889, IC 0,783-1), mientras que las muestra de semen que presentaban teratoastenozoospermia sugerirían una disfunción tanto en los testículos como en el epidídimo (AUC 0,891, IC 0,77-1).

The value of ultrasound in the treatment of chronic epididymitis / 中国医师进修杂志

Objective To observe the changes of ultrasound image before and after treatment and in order to provide the reference for clinical diagnosis.Methods Seventy-eight chronic epididymitis patients who treated with traditional Chinese medicine and western medicine from January 2007 to February 2009were enrolled in this study.They were given oral sparfloxacin tablets as 3 tablets once a day,at the same time,Danhong Tongjing decoction were given 1 dose/d,boiling water decoction,to take medicine morning and evening.Clinical effectiveness was observed after treated for 30 d.The epididymal size,internal echo intensity,resistance index(RI) of blood flow,maximum and minimum blood flow (Vmax,and Vmin),the ratio of systolic blood pressure and diastolic blood pressure (S/D) and blood flow changes of color Doppler flow imaging (CDFI) were detected before treatment,treatment for 15 d,and after treatment.Results Fifty patients were cured,20 patients were better and 8 patients had no effectiveness.In cured and better patients,the epididymal size,Vmax and Vmin,RI and S/D at treatment for 15 d and after treatment were significantly improved compared with before treatment [the epididymal size:the thickness of tail:(1.14 ± 0.19),(0.75 ±0.13) cm vs.(1.68 ± 0.25) cm; the thickness of body:(0.54 ± 0.17),(0.46 ± 0.11) cm vs.(0.63 ± 0.12)cm; the thickness of head:(1.12 ±0.16),(0.80 ±0.15) cm vs.(1.53 ±0.27) cm;Vmax:(0.22 ±0.12),(0.19 ± 0.10) m/s vs.(0.28 ± 0.13) m/s;Vmin:(0.14 ± 0.05),(0.07 ± 0.02) m/s vs.(0.19 ± 0.08) m/s;RI:0.64 ±0.13,0.52 ±0.10 vs.0.89 ±0.17;S/D:3.64 ±1.40,2.78 ±1.26 vs.4.35 ±1.62] (P ＜0.05).Conclusions Color Doppler ultrasound can accurately detect the significant changes before and after treatment in patients with chronic epididymitis,such as epididymal size,internal echo intensity,RI,Vmax,Vmin,S/D and grade of blood flow,which can provide information for prognosis,and guide the clinical treatment.It has important application value in the diagnosis and treatment of chronic epididymitis.

Comparative Study on the Clinical Characteristics of Tuberculous Epididymitis and Nonspecific Chronic Epididymitis / 대한비뇨기과학회지

Differential diagnosis between tuberculous epididymitis and nonspecific chronic epididymitis is one of the most difficult problem in the field of urology. The definitive diagnosis of tuberculous epididymitis is often made by pathological examination of the epididymectomy or orchiectomy specimen. However, the preferred approach to treatment of tuberculous epididymitis is primarily antituberculous chemotherapy and we believe that as a primary measure, surgical procedure is avoidable with careful clinical work-up. A clinical comparative investigation was undertaken on 20 cases of tuberculous epididymitis and 13 cases of nonspecific chronic epididymitis, diagnosed by histopathologic examination during recent 6 year period. Tuberculous epididymitis occurred most frequently in men aged 21-30 years (80%), whereas nonspecific chronic epididymitis occurred frequently in men aged above 31 years (69.2%). Tuberculous epididymitis and nonspecific chronic epididymitis Were present clinically as painless scrotal mass in 70%, 53.8%, painful scrotal mass in 30%, 46.2%, and voiding symptoms in 15%, 7.7% respectively. Scrotal swelling were present in 30% of tuberculous epididymitis, but only in 7.7% of nonspecific epididymitis. Irregularity of mass were noted in 65% of tuberculous epididymitis, and in 23.1% of nonspecific epididymitis. Scrotal fistula were present only in 5% of tuberculous epididymitis. Of the patients with tuberculous epididymitis, 20% had a history of tuberculosis, and 46.1% of the patients with nonspecific chronic epididymitis had a history of acute epididymitis. In tuberculous epididymitis, clinical findings of concurrent infection with tuberculosis were found in kidney, prostate, vas, lung, and testis in order of frequency. Past history of tuberculosis or acute epididymitis and clinical findings of concurrent tuberculous lesions were helpful for clinical diagnosis, in 70% of the patients with tuberculous epididymitis and 46.2 % of the patients with nonspecific chronic epididymitis.

The clinical usefulness of fine needle aspiration for differential diagnosis of chronic epididymitis / 대한비뇨기과학회지

Tuberculous epididymitis mimics nonspecific chronic epididymitis in every way and the diagnosis is rather difficult in case of no systemic involvement. We performed fine needle aspiration on 4 cases or chronic epididymitis with unknown etiology and examined cytologically and microbiologically. Out or 4 cases 3 were proven tuberculosis and the other one was turned out nonspecific chronic inflammation. We concluded that the fine needle aspiration of the epididymis is a simple and convenient diagnostic procedure when the diagnosis is doubtful.

Value of Excretory Urography in Chronic Epididymitis - Analysis of 60 Cases - / 대한비뇨기과학회지

To evaluate the cost-effectiveness of excretory urography, results were reviewed in 60 patients with chronic epididymitis. In 37 patients(of total 60 cases) who have neither scrotal fistula nor hematuria (microscopic or gross) nor positive urine AFB staining, there was no tuberculous finding in excretory urography. And findings consistent with renal tuberculosis were found in 11 cases (73% ) of 15 patients with scrotal fistula, in 9 cases (75%) of 12 patients with hematuria and in 4 cases (80%) of 5 patients with positive urine AFB staining. Therefore, routine use excretory urography in chronic epididymitis is revealing neither scrotal fistula nor hematuria nor positive AFB in urine is not always necessary for detection of renal tuberculosis in terms of cost effectiveness.