Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis / 中国医学科学杂志(英文版)

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.

Effect of ketotifen fumarate on experimental autoimmune orchitis and torsion of the spermatic cord / 亚洲男科学杂志(英文版)

The aim of this work was to study effects of ketotifen fumarate (KF) on prevention of tissue damage in testes of rats with experimental autoimmune orchitis (EAO) and on the contralateral testis in a model of prolonged testicular cord torsion (TCT). Rats with EAO or TCT were injected intraperitoneally once daily with KF or saline solution (vehicle group). Incidence and severity of testicular damage were evaluated by histopathology using an EAO score or a Johnsen score. Mast cells (MC) were identified by histochemistry and quantified. In EAO model, KF significantly reduced severity of histopathological testicular damage compared to rats in the vehicle group. KF also reduced the number of testicular MC compared to vehicle group. Similarly, in TCT model, multifocal damage of the contralateral testis was observed 30 days after testicular torsion characterized by sloughing of the germinal epithelium, seminiferous tubule atrophy, and interstitial edema. Focal signs of inflammation and fibrosis of seminiferous tubular walls were also observed. In contrast, sections of contralateral testis of rats injected with KF and killed 30 days after surgery showed normal histological features. A significant decrease in the number of MC was observed in rats treated with KF compared to untreated animals. In conclusion, we demonstrated that treatment with KF reduced testicular inflammatory process and MC infiltrates in both EAO and TCT models. The results suggest a promising treatment for infertile male patients with testicular pathologies associated with inflammation and germ cell loss.

Comprehensive transcriptome analysis based on RNA sequencing identifies critical genes for lipopolysaccharide-induced epididymitis in a rat model / 亚洲男科学杂志(英文版)

Epididymitis is a commonly diagnosed disease associated with male infertility. However, little is known about the molecules that are involved in its development. This study was to identify critical genes associated with lipopolysaccharide-induced epididymitis and analyze the molecular mechanism of epididymitis through RNA sequencing. Experimental epididymitis models were generated by administering male Sprague-Dawley rats' lipopolysaccharide. A total of 1378 differentially expressed genes, including 531 upregulated and 847 downregulated genes, were identified in the epididymitis model rats compared with those in sham-operated rats by RNA sequencing. Functional enrichment analyses suggested that the upregulated genes were markedly enriched in inflammation-related biological processes, as well as in the tumor necrosis factor (TNF) signaling pathway, cytokine-cytokine receptor interactions, complement and coagulation cascades, and in the chemokine signaling pathway. Four downregulated genes (collagen type XXVIII alpha 1 chain [Col28α1], cyclin-dependent kinase-like 1 [Cdkl1], phosphoserine phosphatase [Psph], and fatty acid desaturase 2 [Fads2]) and ten upregulated genes (CCAAT/enhancer-binding protein beta [Cebpβ], C-X-C motif chemokine receptor 2 [Cxcr2], interleukin 11 [Il11], C-C motif chemokine ligand 20 [Ccl20], nuclear factor-kappa-B inhibitor alpha [Nfkbiα], claudin 4 [Cldn4], matrix metallopeptidase 9 [Mmp9], heat shock 70 kDa protein 8 [Hspa8], intercellular cell adhesion molecule-1 [Icam1], and Jun) were successfully confirmed by real-time polymerase chain reaction. Western blot demonstrated that CDKL1 was decreased, while MMP9 and NFKBIA were increased in the experimental model group compared with those in the sham-operated group. Our study sheds new light on the understanding of the early response of the epididymis during bacterial epididymitis.

Delayed recovery of a patient with obstructive azoospermia and a history of acute epididymitis / 대한생식의학회지

Obstructive azoospermia caused by acute epididymitis is usually permanent, and microsurgical vasoepididymostomy is the only reconstructive treatment option. There have been no reports of delayed recovery of sperm count after over 1 year in a patient with obstructive azoospermia related to history of acute epididymitis. We present a young male patient who had azoospermia and a history of acute epididymitis who experienced delayed recovery, with complete restoration of sperm production and the ability to conceive naturally.

Tuberculosis miliar y orquiepididimitis tuberculosa en un paciente inmunocompetente / Miliary Tuberculosis and Tuberculosis Orchidepidimitis in an Immunocompetent Patient

La tuberculosis genitourinaria es la segunda forma de presentación más común de tuberculosis extrapulmonar luego del compromiso ganglionar, la epididimitis tuberculosa afecta preferentemente a pacientes con edades comprendidas entre los 30 y 50 años, y al menos un 70% tienen historia previa de tuberculosis pulmonar, la infección tuberculosa del escroto es rara y ocurre en aproximadamente el 7% de los pacientes con tuberculosis por extensión directa desde el epidídimo, planteando problemas de diagnóstico diferencial con procesos más agresivos como las neoplasias testiculares. Reportamos el caso de un hombre de 23 años con masa testicular que emulaba ser de origen neoplásico, llevado a orquidectomía unilateral. La patología describe necrosis y granulomas de caseificación conclusivo para orquiepididimitis tuberculosa, paciente inmunocompetente sin antecedente previo de tuberculosis.

Genitourinary tuberculosis is the second most common form of extrapulmonary tuberculosis after lymph node involvement; tuberculous epididymitis preferentially affects patients between the ages of 30 and 50 years, and at least 70% have a previous history of pulmonary tuberculosis, tuberculous infection scrotum is rare and occurs in approximately 7% of patients with tuberculosis by direct extension from the epididymis, posing problems of differential diagnosis with more aggressive processes such as testicular tumors. We report the case of a 23-year-old man with a testicular mass that emulated being of neoplastic origin, taken to unilateral orchidectomy. The pathology describes necrosis and caseification granulomas, conclusive for tuberculous orchiepididymitis, an immunocompetent patient with no previous history of tuberculosis

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.

Chronic epididymitis and Grade III varicocele and their associations with semen characteristics in men consulting for couple infertility / 亚洲男科学杂志(英文版)

Chronic epididymitis and varicocele are frequently observed genital disorders in men consulting for couple infertility, but their impact on semen characteristics at the time of infertility consultation is still a matter of debate. We investigated 652 male partners of couples who had their first infertility consultation between 1999 and 2015 in Argentina. Men with chronic epididymitis (n = 253), Grade III varicocele (n = 106), and both conditions (n = 125) were compared with a control group (n = 168) composed of men without these disorders or any other recognized causes of male infertility. We showed that men who presented isolated chronic epididymitis were more likely to have high percentages of low sperm motility and abnormal sperm morphology as well as a high number of white blood cells. Men with isolated Grade III varicocele had low sperm production and motility and an increased percentage of abnormal sperm morphology. Finally, men who simultaneously presented chronic epididymitis with Grade III varicocele had a low sperm motility and increased percentage of abnormal sperm morphology as well as a high number of white blood cells. Physical examination of the genital organs may identify common disorders, potentially involved as causal factors of patient's infertility. These disorders are associated with specific seminal profiles that should help in identifying the best treatment from the available therapeutic options, effectiveness, safety, and allowing as much as possible natural conception.

Mycoplasma genitalium and male urogenital diseases: An update / 中华男科学杂志

Mycoplasma genitalium (MG) was first isolated by Tully from the urinary tract of the male patient with non-gonococcal urethritis (NGU) in 1981. MG is extremely difficult to be cultured and was rarely studied until the development and application of molecular biology technology. The research on MG in China is still in the primary stage. However, relevant studies abroad have found that it is an important pathogen causing human genitourinary tract infection and spreading worldwide. Male MG infection is reportedly related to NGU, prostatitis, epididymitis, balanoposthitis, male HIV infection, and male infertility. This review outlines the advances in the studies of MG in male urogenital diseases.

Achados microbiológicos, moleculares e histopatológicos em pequenos ruminantes experimentalmente infectados com Actinobacillus seminis / Microbiological, molecular and histopathological findings in small ruminants experimentally infected with Actinobacillus seminis

O objetivo deste trabalho foi avaliar a patogenicidade, em ovinos, de uma cepa de Actinobacillus seminis isolada de caprino no Brasil. Foram utilizadas amostras de sêmen, punção e fragmentos de epidídimo, ducto deferente, testículos e glândulas seminíferas de dois caprinos (animais 1 e 2) e dois ovinos (animais 3 e 4), e foram realizados exame histopatológico, cultivo microbiológico e diagnóstico molecular. O inóculo foi preparado com solução salina na diluição de 10-2 correspondendo ao padrão 1,0 da escala de McFarland, com colônias previamente cultivadas de A. seminis e administrado no volume de 2 mL pelas vias intra-prepucial (animais 1 e 3) e na cauda do epidídimo (animais 2 e 4). Na avaliação clínica observou-se aumento unilateral de consistência firme após 30 dias no epidídimo e testículo do animal 4 que continuou até o dia da eutanásia, bem como o animal 1 apresentou discreto aumento unilateral dos testículos. As lesões macroscópicas e microscópicas observadas nos animais 3 e 4 foram compatíveis com aquelas causadas pela infecção por A. seminis. A. seminis foi isolado de material de punção e sêmen de um ovino (animal 4). Conclui-se que o modelo de infecção experimental utilizando caprinos e ovinos comprovou a patogenicidade da amostra de A. seminis, isolada de um caprino no semiárido brasileiro e reproduzida em um ovino, comprovando a predileção do agente pelo epidídimo, com quadro clinico, achados histopatológicos, isolamento bacteriano e diagnóstico molecular positivo.(AU)

The aim of this study was to evaluate, in sheep, the pathogenicity of an Actinobacillus seminis strain isolated from a goat in Brazil. Samples of semen, puncture and fragments of epididymis, deferent duct, testicles and seminal vesicles from two goats (animals 1 and 2) and two sheep (animals 3 and 4) were used, and histopathological, microbiological culture and molecular diagnoses were performed. The inoculum was prepared with saline solution at 10-2 dilution corresponding to 1.0 McFarland standard, with A. seminis colonies previously cultured and administered on 2mL volume by intra-preputial (animals 1 and 3) and epididymis tail (animals 2 and 4) routes. At clinical evaluation it were found unilateral swelling of firm consistency after 30 days in epididymis and testicle from animal 4 that continued until the day of euthanasia, as well as animal 1 shown discrete unilateral swelling of testicles. Gross and microscopic lesions in animals 3 and 4 were compatibles with that caused by A. seminis infection. A. seminis was isolated from material of puncture and semen of one sheep (animal 4). It is concluded that the experimental infection model using goats and sheep has proved the pathogenicity of the A. seminis strain isolated from a goat in the Brazilian semiarid and reproduced in a sheep, which confirm the prediletion of the agent for epididymis, with clinical signs, histopathological findings, bacterial isolation and positive molecular diagnosis.(AU)

Ningmitai Capsule for the treatment of andrological diseases: Advances in studies / 中华男科学杂志

Ningmitai Capsule is a classical patent medicine prepared from multiple effective ingredients of Chinese herbal medicine, with a wide range of biological activities and a significant efficacy in the treatment of urogenital diseases. Ningmitai Capsule has been widely applied in the management of urological and andrological diseases, with a particularly ideal effect on chronic prostatitis, since its first introduction nearly 20 years ago. With no obvious adverse effect on the male reproductive system, it has also been gaining a gradual application in the treatment of such diseases as urinary tract infections, diabetes, non-gonococcal urethritis, seminal vesiculitis, acute epididymitis, overactive bladder, hematuria, and semen non-liquefaction. However, the definite efficacy of Ningmitai Capsule needs to be further verified with more large-scale multi-centered randomized controlled trials, and its pharmacological mechanism remains to be further explored via more biomolecular experiments. The present article focuses on the recent advances in the application and studies of Ningmitai Capsule in the treatment of urological and andrological diseases.

Real-time transrectal ultrasonography in seminal vesiculoscopy / 中华男科学杂志

Objective@#To compare three different pathways for transurethral seminal vesiculoscopy (SVS) and investigate the reliability and efficiency of transrectal ultrasonography (TRUS)-guided SVS (TRUS-SVS).@*METHODS@#We retrospectively analyzed 90 cases of seminal vesiculoscopy conducted directly through the ejaculatory duct or prostatic utricle or under the guide of TRUS. We compared the success rate and complications among the three approaches.@*RESULTS@#Operations were successfully performed in 87 (96.67%) of the 90 cases, 30 through the ejaculatory duct, 37 via the prostatic utricle, and 20 under the guide of TRUS, the operation time ranging from 25 to 75 minutes. Sperm was detected from the seminal vesicle fluid in (92.06%) of the azoospermia patients (58/63) during the surgery and in 77.78% of them (49/63) in semen analysis at 1 week postoperatively. Fifteen hematospermia and 12 spermatocystitis patients were cured. Postoperative follow-up found 20 cases of water-like semen and 3 cases of orchiepididymitis, but no such complications as retrograde ejaculation, incontinence, or rectourethral fistula.@*CONCLUSIONS@#Transejaculatory duct and transprostatic utricle pathways are two common approaches to SVS, while TRUS-SVS may achieve a higher success rate and avoid injury of both the prostate and the rectum.

What Can We Do for Chronic Scrotal Content Pain?

Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.

Hemospermia due to Multiple Stones in the Enlarged Prostatic Utricle

Cystic enlargement of prostatic utricle, a vestigial remnant of mullerian duct, is a rare condition in males. The prostatic utricle distends with urine during voiding and then passively drains. Poor emptying leads to urine retention and stasis. Stone formation may result from obstruction. Patients present clinically with chronic urinary tract infection, hematuria, urethral discharge, epididymitis, and voiding dysfunction. We present a case of multiple stones in the enlarged prostatic utricle associated with hemospermia.

8.5/11.5F transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory hematospermia / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical application value of 8.5/11.5 F transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory hematospermia.</p><p><b>METHODS</b>We retrospectively analyzed 78 cases of refractory hematospermia diagnosed and treated by 8.5/11.5 F transurethral seminal vesiculoscopy from June 2012 to June 2014. The patients underwent serum PSA examination, transrectal ultrasonography, seminal vesicle ultrasonography, and pelvis CT or MRI before surgery, and all received transurethral seminal vesiculoscopy under the 8.5/11.5 F rigid ureteroscope.</p><p><b>RESULTS</b>Operations were all successfully accomplished, which revealed abnormal opening of the ejaculatory duct in 5 cases, mucosal inflammatory hyperemia in the prostatic utricle and seminal vesicle in 78, dark red mucilage substance in the seminal vesicle in 34, seminal vesicle stones in 19, small polyp in the seminal vesicle in 2, and ejaculatory duct or seminal vesicle cyst in 4. All the patients received symptomatic treatment during the surgery. After surgery, hematouria was found in 13 cases, which disappeared within 2 weeks, pelvic hematoma in 1 case, which was cured by conservative treatment within 3 months, and epididymitis in 2 cases, which was controlled by anti-infection treatment. Hematospermia recurred in 3 cases during the 1-year postoperative follow-up.</p><p><b>CONCLUSION</b>8.5/11.5 F transurethral seminal vesiculoscopy, with its advantages of easy operation, wide field of vision, large channel for operation, and few complications, deserves general clinical application in the diagnosis and treatment of refractory hematospermia.</p>

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.

Real-time PCR for detection of Brucella ovis and Histophilus somni in ovine urine and semen / PCR em tempo real para detecção de Brucella ovis e Histophilus somni em urina e sêmen ovino

A epididimite infecciosa ovina é uma das principais enfermidades reprodutivas de carneiros. O presente estudo teve por objetivo desenvolver protocolos de PCR em tempo real para B. ovis e H. somni e avaliar sua aplicabilidade em amostras de sêmen e urina de carneiros. Delinearam-se primers e sondas espécie-específicos para cada agente. As sondas foram delineadas com o sistema TaqMan incorporando um marcador FAM para B. ovis e Cy5 para H. somni na extremidade 5' e um quencher na extremidade 3'. A PCR em tempo real para B. ovis e H. somni foi altamente sensível, uma vez que a amplificação de DNA ocorreu com até 0,2ng de DNA/reação. A especificidade dos iniciadores e sondas foi avaliada com amostras de DNA de outros agentes causadores de epididimite ovina e nenhuma amplificação inespecífica foi observada. A aplicabilidade da técnica em amostras biológicas também foi confirmada, pois não houve perda de eficácia (P>0,05) quando comparada à PCR convencional com amostras de sêmen e urina de carneiros experimentalmente infectados.

Fosfomycin for urogenital tract infections: Advances in studies / 中华男科学杂志

Fosfomycin (FOM) is an antibiotic with a small relative molecular weight (138.1) and a long half-life, and has a unique chemical structure and antibacterial mechanisms. It exerts a bactericidal activity by inhibiting the early synthesis of bacterial cell walls. It is also a broad-spectrum antibiotic with a good drug tolerance and compliance and a low pressure to bacterial resistance, but no cross-resistance with other antibiotics. Recent studies show the effectiveness of FOM in the treatment of acute uncomplicated urinary tract infections and urogenital tract infections as well, such as prostatitis and epididymitis. This review focuses on the clinical application of FOM in the treatment of infectious diseases of the urogenital tract.

Scrotal pain: Evaluation and management

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.