Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Introduction Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. Materials and Methods We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters. Results Twenty-six patients were identified with documented episodes of epididymitis. Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. Conclusion Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration .

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...

Acute epididymo-orchitis - is empirical therapy for Chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20's. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 [43%] patients and in only 12 [14%] of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis

Emergencias urológicas / Urological emergencies

El pediatra que atiende niños en servicio de urgencia recibe pacientes politraumatizados, en los cuales es relevante descartar una lesión de riñon o de vías urinarias, las que pueden ser silenciosas en sus manifestaciones clínicas y en general requieren resolución quirúrgica de urgencia. A continuación se describen los problemas urológicos que constituyen una emergencia y la forma correcta de estudio y tratamiento

Acute scrotum in 7 cases of Schoenlein-Henoch syndrome

Schoenlein-Henoch syndrome (SHS), one of the manifestations of systemic vasculitis, usually involves the skin, gastrointestinal tract, joints and kidney. Since the involvement of male genitalia is very rare and there is little mention of it in textbooks, doctors have a tendency to neglect this finding in SHS. Unless there is a confirming diagnosis, it is easily mistaken for testicular torsion and the patients undergo unnecessary operations because they complain of unbearable scrotal pain. SHS is not uncommon in Korea, but hardly any cases of scrotal involvement are found. We have experienced 7 cases of acute scrotum associated with SHS admitted to Severance Hospital, Yonsei University College of Medicine during the last 20 years; 2 underwent operation and 5 received conservative treatment only.

Post-transplantation epididymitis associated with cytomegalovirus.

Cytomegalovirus (CMV) infection, though usually systemic, has been known to cause localised involvement of organs like lung, liver, testis and gastrointestinal tract. We report a case of cytomegaloviral infection involving the epididymis without systemic manifestations in an young male one month after renal transplantation. The diagnosis was made on histopathologic examination of the epididymo-orchidectomy specimen. Clinical improvement occurred after the emergency epididymo-orchidectomy. To the best of our knowledge, only three cases of CMV epididymitis have been described in the world literature--two in transplant patients and one in an AIDS patient.

A epididimite como complicaçäo das prostatectomias / Epididymitis as a complication of prostatectomy

O autor se propöe a verificar a incidência da epididimite como complicaçäo pós-operatória em 264 prostatectomias realizadas no Hospital Universitário da UFPB, no período de janeiro de 1980 a julho de 1989. Nesta casuística näo foi registrado nenhum caso de epididimite no pós-operatório das prostatectomias realizadas pelos processos atualmente existentes, o que demonstra o seu quase desaparecimento após cirurgias da próstata

Uretrite nao gonococica: atualizacao clinica e terapeutica / Nongonococcal urethritis: clinical and therapeutic updating

A uretrite nao gonococica pode ser produzida em 60 a 80% dos casos por Chlamydia trachomatis ou Ureaplasma urealyticum. Nos demais pacientes quase sempre nenhum micro-organismo e encontrado. A doenca produz secrecao uretral nao muito intensa e sintomas uretrais mais discretos mas o seu indice de recidiva pode ser tao alto quanto 30%. O tratamento recomendado e o uso de tetraciclina tendo como alternativa a eritromicina por 7 dias. As recorrencias causam as vezes grande sofrimento emocional e sao de dificill manejo clinico. A epididimite e talvez a sindrome de Reiter sao complicacoes desta doenca

Vasectomia em cirurgia prostática / Vasectomy in prostatic surgery

Faz-se um estudo comparativo entre cirurgias da próstata sem e com vasectomia e analisam concomitantemente as vasectomias prévias e posteriores à cirurgia. Conclue-se que existe vantagem em se optar pela vasectomia. Porém, em nossos casos submetidos à vasectomia prévia, constatou-se maior incidência de epididimite em relaçäo aos submetidos à vasectomia posterior