ABSTRACT
BACKGROUND: Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. METHODS: Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. RESULTS: Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). CONCLUSIONS: We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients' sexual function and fertility during follow up after treatment completed.
Subject(s)
Epididymitis , Orchitis , Tuberculosis, Male Genital , Adult , Aged , Epididymitis/drug therapy , Follow-Up Studies , Humans , Male , Middle Aged , Orchitis/drug therapy , Retrospective Studies , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgerySubject(s)
Epididymitis/complications , Penis/pathology , Phlebitis/diagnosis , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Male Genital/complications , Aged, 80 and over , Epididymitis/microbiology , Epididymitis/surgery , Humans , Male , Mycobacterium tuberculosis/isolation & purification , Orchiectomy , Penis/microbiology , Phlebitis/microbiology , Phlebitis/pathology , Tuberculosis, Cutaneous/microbiology , Tuberculosis, Cutaneous/pathology , Tuberculosis, Male Genital/microbiology , Tuberculosis, Male Genital/surgeryABSTRACT
Tuberculosis (TB) is a global disease and if not adequately treated can lead to morbidity and mortality. Though genitourinary TB is common and only next to pulmonary TB, cutaneous 'ulcerative' tuberculosis of the scrotum is not reported so far in the literature. We present a 32-year-old man with a non-healing scrotal ulcer and underwent excision. Histopathology was consistent with TB. Antitubercular therapy was given and at the end of a year's follow-up, there has been no recurrence. TB of the scrotum should be considered in the differential diagnosis of scrotal ulcers. Proper diagnosis and adequate treatment will offer a cure to such patients.
Subject(s)
Scrotum , Tuberculosis, Male Genital/diagnosis , Adult , Antitubercular Agents/therapeutic use , Humans , Male , Skin Ulcer/etiology , Skin Ulcer/pathology , Skin Ulcer/surgery , Tuberculosis, Male Genital/complications , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgeryABSTRACT
Tuberculosis (TB) is a great mimic of many diseases and may present a dilemma in diagnosis. Sebaceous cyst is the commonest swelling that occurs in the scrotal skin. We present a 23-year-old patient who presented with a painful hard scrotal skin nodule, clinically diagnosed to be an infected calcified sebaceous cyst, excised and reported to be due to TB. Nodular scrotal skin TB is extremely rare but should nonetheless be considered as a differential diagnosis in regions where it is prevalent. Thus, excision of any suspicious nodule is indicated.
Subject(s)
Epidermal Cyst/diagnosis , Scrotum , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Male Genital/diagnosis , Diagnosis, Differential , Epidermal Cyst/surgery , Humans , Male , Tuberculosis, Cutaneous/surgery , Tuberculosis, Male Genital/surgery , Young AdultABSTRACT
Pulmonary localization is the most common site of tuberculosis (TB)and the most contagious form. Extrapulmonary tuberculosis with the rarest and most unexpected localizations represents a significant proportion of all cases of tuberculosis and remains an important public health problem. We report three unusual TB locations: skin, ear and testis occurred in three immunocompetent patients. In the case of skin and testicular lesions, diagnosis was based on pathological confirmation of granulomas with caseous necrosis. In the third case the diagnosis was made possible by identification of positive Acid-Fast Bacilli smear and positive culture from othic drainage fluid. The outcome at all three patients was good with antituberculous treatment. These unusual localization of tuberculosis also highlight the possibility of extrapulmonary tuberculosis as a differential diagnosis in many common diseases.
Subject(s)
Ear, Middle , Mastoiditis/microbiology , Mycobacterium tuberculosis/isolation & purification , Otitis Media, Suppurative/microbiology , Testicular Diseases/microbiology , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/microbiology , Tuberculosis, Male Genital/microbiology , Adult , Antitubercular Agents/therapeutic use , Biopsy , Diagnosis, Differential , Female , Hand/microbiology , Hand/pathology , Humans , Male , Mastoiditis/drug therapy , Middle Aged , Orchiectomy , Otitis Media, Suppurative/drug therapy , Rare Diseases , Risk Factors , Suppuration/microbiology , Testicular Diseases/diagnosis , Testicular Diseases/drug therapy , Testicular Diseases/surgery , Treatment Outcome , Tuberculosis, Cutaneous/drug therapy , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgeryABSTRACT
Genitourinary tract is the second most common site where extrapulmonary tuberculosis (TB) occurs. Genitourinary TB is notable for a latent clinical course and difficult diagnosis. The paper presents clinical observations of two patients treated in a urology department of a general public hospital. One of them was diagnosed with tuberculosis of the prostate, MTB+. In the other, TB of the prostate was suspected based on pathologic assessment of the surgical specimen after surgery for prostate cancer.
Subject(s)
Prostatic Diseases/diagnosis , Tuberculosis, Male Genital/diagnosis , AIDS-Related Opportunistic Infections , Adult , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prostatic Diseases/diagnostic imaging , Prostatic Diseases/pathology , Prostatic Diseases/surgery , Tuberculosis, Male Genital/diagnostic imaging , Tuberculosis, Male Genital/pathology , Tuberculosis, Male Genital/surgery , UltrasonographyABSTRACT
OBJECTIVE: To study the causes of orchiectomy in different age groups. METHODS: We retrospectively reviewed the clinical data about 291 cases of orchiectomy performed between March 1993 and October 2014 and analyzed the causes of surgery and their distribution in different age groups. RESULTS: The main causes of orchiectomy were testicular torsion (45.8%), cryptorchidism (32.5%) and testicular tumor (16.9%) in the patients aged 0-25 years, testicular tumor (42.4%), cryptorchidism (25.9%) and tuberculosis (10.6%) in those aged 26-50 years. Prostate cancer was the leading cause in those aged 51-75 years (77.6%) or older (84.0%)), and testicular tumor was another cause in the 51-75 years old men (10.2%). Prostate cancer, testicular tumor, cryptorchidism, and testicular torsion were the first four causes of orchiectomy between 1993 and 2009. From 2010 to 2014, however, testicular tumor rose to the top while prostate cancer dropped to the fourth place. CONCLUSION: The causes of orchiectomy vary in different age groups. The proportion of castration for prostate cancer patients significantly reduced in the past five years, which might be attributed to the improvement of comprehensive health care service.
Subject(s)
Cryptorchidism/surgery , Orchiectomy , Prostatic Neoplasms/surgery , Spermatic Cord Torsion/surgery , Testicular Neoplasms/surgery , Adolescent , Adult , Age Factors , Aged , Causality , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Male , Middle Aged , Orchiectomy/statistics & numerical data , Retrospective Studies , Tuberculosis, Male Genital/surgery , Young AdultABSTRACT
We present an unusual case of tuberculous epididymitis in a 33-year-old African patient, who was referred to our Department of Urology with a right intrascrotal mass. There was no evidence of fever, hematuria, dysuria or symptoms from the lower urinary tract. The patient did not demonstrate any laboratory signs of inflammation (white blood cells, C reactive protein). Scrotal sonography revealed a solid heterogeneous, hypoecoic lesion between the epididymal head and the upper testis pole, with disruption of the architecture of the testicular parenchyma. Strong ultrasound suspicion of tuberculous etiology was confirmed by epididymectomy and partial orchiectomy. The patient started an antitubercular treatment. Although rare, epididymal TB may be the only clinically evident location of infection. Clinical suspicion and prompt diagnosis are important because earlier treatment can prevent complications and lead to clinical improvement.
Subject(s)
Antitubercular Agents/therapeutic use , Epididymitis/diagnosis , Epididymitis/microbiology , Orchiectomy , Tuberculosis, Male Genital/diagnosis , Adult , Diagnosis, Differential , Early Diagnosis , Epididymitis/drug therapy , Epididymitis/surgery , Humans , Male , Orchiectomy/methods , Time Factors , Treatment Outcome , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgerySubject(s)
Cysts/diagnosis , Cysts/surgery , Epididymitis/surgery , Scrotum/surgery , Spermatocele/surgery , Testicular Diseases/surgery , Testicular Hydrocele/surgery , Torsion Abnormality/surgery , Vasectomy/methods , Adult , Biopsy , Chronic Disease , Epididymitis/diagnosis , Humans , Male , Patient Education as Topic , Postoperative Complications/etiology , Scrotum/diagnostic imaging , Spermatocele/diagnosis , Spermatozoa/pathology , Testicular Diseases/diagnosis , Testicular Hydrocele/diagnosis , Testis/pathology , Torsion Abnormality/diagnosis , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/surgery , UltrasonographyABSTRACT
Genitourinary tuberculosis was diagnosed in 543 patients in Spanish hospital from 1978 through 2003. Of the 371 male 34 (9.2%) had orchiepididymitis. Mean age was 52.7 years and the presenting symptom was scrotal swelling and/or pain. Over 50% of cases involved the right ovotestis. Associated renal tuberculosis and active disease in extraurological organs presented in 64% and 19.2% of cases, respectively. Diagnosis was established by culture of Mycobacterium tuberculosis recovery from urine and/or purulent scrotal exudate. Genomic amplification techniques aided the diagnosis in 8 patients. Treatment was rifampin, isoniazide, and pyrazinamide or ethambutol. Eight patients required combined medical and surgical treatment.
Subject(s)
Epididymitis/epidemiology , Mycobacterium tuberculosis/isolation & purification , Orchitis/epidemiology , RNA, Ribosomal, 16S/genetics , Ribotyping , Tuberculosis, Male Genital/epidemiology , Adult , Aged , Aged, 80 and over , Antitubercular Agents/therapeutic use , Combined Modality Therapy , Comorbidity , Epididymitis/diagnosis , Epididymitis/drug therapy , Epididymitis/microbiology , Epididymitis/surgery , Ethambutol/therapeutic use , Exudates and Transudates/microbiology , HIV Infections/epidemiology , Humans , Isoniazid/therapeutic use , Male , Middle Aged , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/genetics , Orchitis/diagnosis , Orchitis/drug therapy , Orchitis/microbiology , Orchitis/surgery , Prostatitis/drug therapy , Prostatitis/epidemiology , Prostatitis/microbiology , Pyrazinamide/therapeutic use , Retrospective Studies , Rifampin/therapeutic use , Scrotum/microbiology , Spain/epidemiology , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/microbiology , Tuberculosis, Male Genital/surgery , Tuberculosis, Renal/epidemiology , Urine/microbiologyABSTRACT
Intravesical Bacillus Calmette-Guérin (BCG) is widely used as an adjuvant therapy in the treatment of superficial bladder cancer. BCG is administered as a live, attenuated form of Mycobacterium bovis, and acts as an immunomodulary agent to delay tumor progression. BCG is generally well tolerated, though localized and systemic infectious complications may occur. A literature search revealed that tuberculous epididymitis is a rarely reported complication of intravesical BCG therapy. We report the case of an 82-year-old male who developed tuberculous epididymitis while undergoing intravesical BCG treatment for transitional cell carcinoma of the bladder. Right orchiectomy was performed, followed by rifampin and isoniazid therapy once M. bovis was identified as the infectious agent. The patient responded well to these treatments, and made a full recovery. Tuberculous epididymitis is an uncommon complication resulting from intravesical BCG therapy, which is likely explained by retrograde migration from the prostatic urethra in this case.
Subject(s)
BCG Vaccine/adverse effects , Carcinoma, Transitional Cell/drug therapy , Epididymitis/microbiology , Tuberculosis, Male Genital/etiology , Urinary Bladder Neoplasms/drug therapy , Administration, Intravesical , Aged, 80 and over , BCG Vaccine/administration & dosage , BCG Vaccine/therapeutic use , Epididymitis/diagnostic imaging , Epididymitis/etiology , Epididymitis/surgery , Granuloma/pathology , Humans , Immunotherapy/adverse effects , Male , Orchiectomy , Tuberculosis, Male Genital/diagnostic imaging , Tuberculosis, Male Genital/surgery , Ultrasonography, DopplerABSTRACT
A 51-year-old man presented with painless left testicular swelling for 1 month, with fevers, chills, night sweats, weight loss, and increased difficulty voiding over 6 months. He underwent radical orchiectomy; surgical pathology revealed granulomas containing acid-fast bacilli in the testis and epididymis. Male genital tuberculosis was diagnosed using nucleic acid amplification on urine and confirmed by positive urine and sputum cultures for Mycobacterium tuberculosis. Genital disease is an unusual extrapulmonary manifestation of tuberculosis, often seen in middle-aged men with renal or pulmonary tuberculosis. Clinical findings are variable, but commonly include dysuria with sterile pyuria or a painless testicular mass. Initial diagnosis is often incidentally made on pathological specimens and confirmed with nucleic acid amplification and cultures. Treatment using a standard four-drug regimen is usually sufficient; surgery is rarely required. This case is used to raise awareness of, and formulate a minimally invasive diagnostic approach to, this unusual but important entity.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Male Genital/diagnosis , Diagnosis, Differential , Drug Therapy, Combination , Dysuria/etiology , Humans , Male , Middle Aged , Mycobacterium tuberculosis/genetics , Nucleic Acid Amplification Techniques/methods , Treatment Outcome , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/pathology , Tuberculosis, Male Genital/surgeryABSTRACT
A total of 209 and 188 patients with urogenital tuberculosis were operated on in 1985-1987 (Period 1) and in 2005-2007 (Period 2), respectively. The mean age of patients with nephrotuberculosis has increased by 10 years in the past 20 years. The total number of operations has retained as before: organ-removing operations have decreased from 61.1 to 27.3% and reconstructive plastic ones increased from 9.7 to 23%. Epididymectomy remains to be a major intervention for genital tuberculosis, with thrice-fold reduction in their number. The specific features of the course of tuberculosis of the kidney and upper urinary tract were studied in 158 patients. The disease complicated by obstructive uropathy takes a more severe course than the uncomplicated disease, which causes a rise in the number of nephrectomies from 25 to 40.5%.
Subject(s)
Tuberculosis, Male Genital/surgery , Tuberculosis, Renal/surgery , Age Factors , Aged , Female , Humans , Hydronephrosis/complications , Male , Middle Aged , Nephrectomy , Nephritis/complications , Radiography , Plastic Surgery Procedures , Tuberculosis, Renal/complications , Tuberculosis, Renal/diagnosis , Tuberculosis, Renal/diagnostic imaging , Ureteral Obstruction/complicationsABSTRACT
OBJECTIVE: To improve the diagnosis and the treatment of tuberculous epididymitis. METHODS: Retrospective studies were made of 20 cases of isolated epididymal tuberculosis defined as "tuberculosis infection affecting the epididymis without evidence of renal involvement as documented by the absence of acid fast bacilli in the urine sample and on imaging" among 35 patients with epididymal tuberculosis. Two weeks after the intensified anti-TB treatment by the combined therapy of Isoniazid + Rifampicin + Streptomycin or Ethambutol, all the patients underwent surgical removal of the tuberculous lesion, followed again by the combined therapy for 6-9 months. RESULTS: Of the 20 cases, 16 experienced no recurrence and complications within 0.5-5 years after the surgery, 3 were found with urinary tuberculosis at 3, 3.5 and 5 years, and 1 developed tuberculous epididymitis of the other side at 3.5 years. CONCLUSION: Isolated tuberculous epididymitis may be the sole or the initial presentation of genitourinary tuberculosis, for which timely surgery is the best option and has a good prognosis.
Subject(s)
Epididymis/microbiology , Tuberculosis, Male Genital/therapy , Adolescent , Adult , Aged , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgeryABSTRACT
This report describes a case of tuberculosis with an atypical presentation characterized by epididymitis and Addison's disease in the absence of lung involvement. A 54-year-old male who presented with acute right scrotal pain and a whitish discharge, had been diagnosed four months earlier with acute epididymitis and prescribed ciprofloxacin. The clinical diagnosis was epididymitis and Addison's disease. Hydrocortisone therapy was initiated, and bilateral epididymectomy was undertaken. Biopsy specimen showed the presence of acid-fast bacilli and antituberculous treatment was initiated. On follow-up, the patient was in good clinical condition and free of symptoms. We conclude that tuberculous epididymitis can cause serious complications and should be included in the differential diagnosis for chronic epididymitis of unknown cause that does not respond to routine treatment. A high index of suspicion is required for diagnosis.
Subject(s)
Addison Disease/etiology , Epididymis , Epididymitis/diagnosis , Hydrocortisone/therapeutic use , Tuberculosis, Male Genital , Epididymis/surgery , Humans , Male , Middle Aged , Tuberculosis, Male Genital/complications , Tuberculosis, Male Genital/diagnosis , Tuberculosis, Male Genital/surgeryABSTRACT
We report a case of tubercular prostatic abscess in a patient who had undergone intravesical bacillus Calmette-Guérin immunotherapy for bladder carcinoma in situ. The abscess required surgical drainage and antituberculous treatment.
Subject(s)
Abscess/chemically induced , BCG Vaccine/adverse effects , Carcinoma, Transitional Cell/therapy , Immunotherapy/adverse effects , Prostatitis/chemically induced , Tuberculosis, Male Genital/chemically induced , Urinary Bladder Neoplasms/therapy , Abscess/microbiology , Abscess/surgery , Adjuvants, Immunologic/administration & dosage , Adjuvants, Immunologic/adverse effects , Administration, Intravesical , BCG Vaccine/administration & dosage , Carcinoma, Transitional Cell/pathology , Humans , Male , Middle Aged , Mycobacterium bovis/isolation & purification , Prostatectomy , Prostatitis/microbiology , Prostatitis/surgery , Tuberculosis, Male Genital/microbiology , Tuberculosis, Male Genital/surgery , Urinary Bladder Neoplasms/pathologyABSTRACT
A 65-year-old man visited our hospital with a complaint of a left inguinal mass. He had had a past history of tuberculosis. A left spermatic cord tumor was suspected. Left high orchiectomy was performed. The mass did not connect with the testis or epididymis. The removed mass measured 4 x 2 x 1.5 cm in size. Microscopic examination showed a granulomatous lesion with Langhans giant cells. Tuberculin skin test was moderately positive. From these findings we diagnosed the patient with tuberculosis in spermatic cord. Antituberculous chemotherapy was subsequently initiated. Two months after surgery, recurrence has not been found.
Subject(s)
Spermatic Cord , Tuberculosis, Male Genital/diagnosis , Aged , Antitubercular Agents/therapeutic use , Humans , Male , Orchiectomy , Spermatic Cord/pathology , Tuberculosis, Male Genital/drug therapy , Tuberculosis, Male Genital/surgeryABSTRACT
We report a case of bilateral tuberculous-like epididymo-orchitis occurring 3 years after intravesical bacille Calmette-Guérin instillation therapy in an 83-year-old patient with proven superficial bladder carcinoma. The patient had no previous history of tuberculosis. Because of persistent inflammation and painful swelling of the epididymides and testes, the patient underwent bilateral orchiectomy. This case demonstrates the late adverse effects that can occur after intravesical BCG therapy, which in our patient ended in surgical removal of both gonads.