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PubMed1982

The surgical management of acute bacterial epididymitis with emphasis on epididymotomy.

During the course of acute bacterial epididymitis of nonvenereal origin, severe epididymal inflammation and edema can produce compression of adjacent branches of the spermatic vessels, which can compromise the testicular vascular system. Scrotal fixation over the involved testicle heralds this event and indicates actual or impending epididymal suppuration. At this crucial moment either surgical decompression of the epididymis or epididymectomy is indicated to prevent ischemia of the testis and subsequent development of gangrenous epididymo-orchitis with testicular slough. Between 1956 and 1980, 14 epididymotomies were done, which resulted in salvage of 12 testicles (86 per cent). During the same period 10 patients with acute epididymitis had progression of the disease to gangrenous epididymo-orchitis, which necessitated orchiectomy. Epididymotomy can prevent progression of acute epididymitis to gangrenous epididymo-orchitis in many instances and is believed to have a role in the management of this troublesome affliction.

Acute Disease↗
PubMed1979

Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.

Adolescent↗
PubMed1997

Acute epididymitis in boys: are antibiotics indicated?

OBJECTIVES: To report the results of using supportive therapy only, rather than antibiotics, in managing boys with acute sterile epididymitis. PATIENTS AND METHODS: From 1991 to 1995, 48 boys presented with acute epididymitis. The diagnosis was confirmed by radionuclide scan in 43 cases, ultrasonography in one, surgical exploration in one and physical examination in three. Urine was collected for microscopy and culture: if pyuria was detected, antibiotics were prescribed. If the urine analysis was normal, the patient was advised to minimize physical activity and analgesics were prescribed. RESULTS: Of the 48 boys, five (10%) had pyuria; seven patients with either no urine tested or negative urine culture were given antibiotics. The remaining 36 were managed with supportive therapy only. The mean follow-up was 87 days (with three patients lost to follow-up). No boys showed any evidence of testicular atrophy or other complications. CONCLUSION: Only a minority of boys with acute epididymitis, as defined by increased flow on radionuclide scanning of the scrotum, have a bacterial aetiology. For those without pyuria or positive urine culture, the condition is self-limiting and does not lead to testicular atrophy. We recommend that for boys with acute epididymitis who have no urinary abnormalities, antibiotics are not indicated. The aetiology of acute sterile epididymitis in boys remains obscure.

Acute Disease↗
PubMed1978

Chlamydia trachomatis as a cause of acute "idiopathic" epididymitis.

To assess the etiologic role of C. trachomatis and other micro-organisms in "idiopathic" epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. Eleven of 13 men under the age of 35 years had C. trachomatis infection whereas eight of 10 over 35 had coliform urinary-tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in five of six men under 35, and coliform bacteria alone in five of 10 over 35. These results suggest that C. trachomatis is the major cause of "idiopathic" epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae.

Acute Disease↗
PubMed2004

Acute epididymitis in boys: evidence of a post-infectious etiology.

PURPOSE: We studied the etiology and management of pediatric epididymitis. MATERIAL AND METHODS: We performed 1-year prospective study in children with epididymitis. All patients underwent an immediate sonographic study of the scrotum. Microbiological studies included throat and urine cultures as well as viral cultures of nasopharyngeal and stool specimens. Serological tests for group A streptococcus and Mycoplasma pneumoniae as well as for enteroviruses, adenoviruses, influenza and parainfluenza viruses in the appropriate seasons were performed in patients and controls. RESULTS: A total of 44 patients 2 to 14 years old (mean age 9.8 +/- 3.2) were studied. Hospital admissions peaked during the summer and winter. The incidence of epididymitis was around 1.2/1,000 boys yearly. One patient had familial Mediterranean fever and another had Henoch-Schonlein purpura. Microbiological studies of the urine, throat, nasopharynx and stool yielded bacterial/viral growth in 9 patients (20.4%). Serological studies revealed significantly elevated titers to certain pathogens in patients with epididymitis compared with controls, including M. pneumoniae (53% vs 20%), enteroviruses (62.5% vs 10%) and adenoviruses (20% vs 0%). Most patients were treated with analgesics and 3 patients received antibiotics intravenously. Systemic and local signs and symptoms resolved gradually in 1 to 7 days. CONCLUSIONS: Our results suggest that epididymitis in boys is not rare and it is mostly an inflammatory phenomenon (presumably post-infectious) with a benign course. The treatment of these patients is basically with analgesics with a little role for antibiotics.

Acute Disease↗
PubMed1988

IgG and IgA antibodies specific for Chlamydia trachomatis in acute epididymitis.

The possibility of using elevated Chlamydia trachomatis-specific serum IgG and IgA as a screening test for Chlamydia-associated epididymitis was analyzed in 28 acute epididymitis patients and 42 apparently healthy men by the single antigen (L2) immunoperoxidase assay. The prevalence rates of C. trachomatis IgG antibody titer greater than or equal to 64 and elevated C. trachomatis IgG titers (greater than or equal to 128) were significantly higher in the epididymitis patients (75 vs. 40%, p less than 0.01, and 39 vs. 14%, p less than 0.025, respectively) than in controls. The prevalence rate of C. trachomatis IgA antibodies (titer greater than or equal to 8) was significantly higher (p less than 0.001) in epididymitis patients as compared to controls (46 vs. 10%, respectively). The potential application of elevated serum C. trachomatis IgG and IgA antibodies as a noninvasive screening marker in epididymitis patients is discussed.

Adult↗
PubMed1989

Developmental expression of an androgen-regulated epididymal protein.

Acidic epididymal glycoprotein (AEG), an androgen-regulated secretory protein of rat epididymis, was quantitated by RIA in epididymal extracts of rats of increasing age. Although detectable at 1 day of age, significant concentrations of AEG were not measured until 20 days; concentrations increased steadily, so that by 120 days of age, AEG represented 10% of total soluble protein. AEG mRNA was detected by Northern blot analysis of RNA from epididymides of 5-day-old animals and rapidly increased in amount between 20 and 35 days, reaching a maximum at 45 days. Using immunohistochemistry, AEG was localized in epididymal epithelial cells at 1 day of age. The number of cells staining for AEG increased markedly after 15 days. At 120 days, the immunoreactivity was predominantly localized to the lumen of the epithelial duct. To delineate factors that may influence AEG expression in the developing epididymis, we measured concentrations of androgen and androgen receptor mRNA in tissue extracts prepared from animals of various ages. Androgen receptor mRNA was detectable in epididymal extracts isolated from 1- to 90-day-old animals. Epididymal androgen concentrations were high at all ages (range, 6.0-31.2 ng/g tissue). The marked increase in AEG mRNA concentration at 20 days of age was not associated with an increase in either androgen or androgen receptor mRNA concentrations, suggesting that other factors may be necessary for AEG expression.

Aging↗
PubMed1979

Acute epididymitis: etiology and therapy.

Fifty patients with acute epididymitis were evaluated prospectively by history, examination, and microbiologic studies, including cultures for aerobes, anaerobes, N. gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum. E. Coli was the predominant pathogen isolated from the urine of men over 35 years old and C. trachomatis and N. gonnorrheae were the predominant pathogens isolated from the urethra of men under 35. The etiologic role of E. Coli and C. trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine of urethral cultures for these agents. C. trachomatis epididymitis accounted for two thirds of "idiopathic epididymitis" in men, and was often associated with oligozoospermia. Of nine female sexual partners of men with C. trachomatis infection, six had antibody to C. trachomatis, of whom two had positive cervical cultures for this organism, and the others had nongonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with C. trachomatis epididymitis, and should be offered to their female sex partner.

Adolescent↗
PubMed1998

The specificity of epididymal secretory proteins.

Early studies in which the electrophoretic profiles of fluid from different regions of the epididymis were compared with other body fluids, such as blood serum, suggested that many proteins present in epididymal fluid were not found in other secretions and thus might be tissue specific. Comparative studies of epididymal fluid from different species further emphasized differences so that some epididymal proteins are considered both tissue and species specific. Such proteins are the putative molecular agents responsible for the array of changes undergone by spermatozoa during maturation. Thus a complete characterization of all the specific proteins secreted by the epididymis would yield important information for understanding the molecular events of maturation. Comparison of these proteins across species would determine whether the proteins and mechanisms at the centre of changes such as acquisition of fertilizing ability are conserved during evolution. This review critically examines the evidence for both tissue and species specificity of epididymal secreted proteins, describes how advances in molecular biology can be used to clarify this issue and concludes with a description of some preliminary work with different lagomorph species involving the REP 52 protein, an epididymal secretory protein that binds specifically to spermatozoa in New Zealand white rabbits.

Animals↗
PubMed1998

The use of epididymal spermatozoa in assisted reproduction.

The use of epididymal spermatozoa in assisted reproduction (ART) permits fertility in men with surgically irremediable obstructive azoospermia. When used for conventional IVF (sperm-oocyte co-culture), epididymal spermatozoa show reduced fertilization and pregnancy rates (compared with ejaculated spermatozoa from men with a range of spermatogenic disorders) as evidence of their functional immaturity. However, when used with intracytoplasmic sperm injection (ICSI) either fresh or frozen-thawed epididymal spermatozoa produce ART success rates similar to those of ejaculated spermatozoa. The clinical place of epididymal sperm retrieval for ICSI has come under review as a result of data showing similarly good outcomes with testicular spermatozoa obtained by needle aspiration. In Australia ICSI using epididymal or testicular spermatozoa is an increasingly favoured option for vasectomy-related infertility and in other types of obstructive azoospermia for a number of reasons including better pregnancy outcomes, the less invasive nature of the procedures and less expense involved; however, this cost-benefit analysis will vary in other health systems.

Constriction, Pathologic↗
PubMedDate not supplied

Role of Chlamydia trachomatis in epididymitis. Part I: Direct and serologic diagnosis.

The aim of the study was to evaluate the role of Chlamydia trachomatis (C.t.) in the etiopathogenesis of epididymitis. 39 patients with symptoms of acute epididymitis were examined. They were divided into two age groups: 1st--patients aged below 35 (24 patients) and 2nd--patients older than 35 yrs (15 patients). The patients' urethral swabs were examined and C.t., mycoplasma and other Gram-positive and Gram-negative bacteria were searched for as well as leukocyte count was assessed. Anti-Chlamydia trachomatis antibodies of IgG and IgM classes were assayed in serum. Direct immunofluorescence (antigen detection) and immunoenzymatic (antibodies detection) methods were used in C.t. infection diagnostics. C.t. infection in urethra was found in 30.8 percent of patients suffering from epididymitis, whereas in the control group in 2 percent. C.t. infection was significantly more commonly found in patients below 35 (45.8 percent) as compared with the older men (6.7 percent). The most common etiological factor in the younger group was C.t., while in the older group it was E. coli. IgG anti-C.t. antibodies were detected in the serum of 51.3 percent of the patients with acute epididymitis, as compared with 5.8 percent of the men in the control group. Specific IgG antibodies were found significantly more often in patients under 35 (66.7 percent) than in the older men (26.7 percent). Specific IgM antibodies were found in 15.4 percent of the patients, that is in 20.8 percent of the younger patients and in 6.7 percent of the older ones. C.t. is the main etiologic agent of epididymitis in men under 35.

Adolescent↗
PubMed2001

Epididymitis in childhood: a clinical retrospective study over 5 years.

BACKGROUND: Acute scrotal pain in children presents a major diagnostic and therapeutic challenge. Epididymitis has been considered uncommon in childhood. The clinical spectrum and therapeutic policy of the acute scrotum in children is continually being reassessed. OBJECTIVES: To determine whether there has been an increase in the incidence of epididymitis in children and to advocate a more selective surgical approach to the acute scrotum. METHODS: We conducted a retrospective review of 65 children admitted to our department of pediatric surgery with the diagnosis of acute scrotum during a 5 year period. RESULTS: Of the 65 children admitted with the diagnosis of acute scrotum, epididymitis was diagnosed in 42 (64.6%). The remaining cases included torsion of the testis in 12 patients (18.5%), torsion of the appendix testis in 5 (7.7%), scrotal pain and minimal physical findings in 4 (6.1%), and scrotal hematoma and idiopathic scrotal edema in one patient each. Doppler ultrasound of the groin, color Doppler ultrasound of the testis and testicular nuclide scintigraphy (Tc-99m scan) examinations were performed on 49, 30 and 57 occasions, respectively; the Tc-99m scan was the most effective tool. All the patients with epididymitis were diagnosed before surgical intervention and were treated conservatively. CONCLUSIONS: We observed an increasing frequency of epididymitis in children admitted with the diagnosis of acute scrotum.

Acute Disease↗
PubMed2002

[Diagnostic value of high frequency color Doppler ultrasonography for epididymitis].

OBJECTIVES: To evaluate the diagnostic value of color Doppler ultrasonography for epididymitis. METHODS: High frequency color Doppler ultrasonography was performed in 42 patients with epididymitis and 21 health volunteers. RESULTS: Compared with control group, epididymis enlarged significantly all in head, body and tail in 92% of patients with epididymitis. Bilateral epididymitis occurred in 73% of patients. Color Doppler flow imaging (CDFI), in patient group, showed the markedly increased flow signals bright in bundle in epididymis. Mild hydroccele of testis and orchitis were companied in most patients(93%). Orchitis was often complicated in the patients with long history. CONCLUSIONS: High frequency color Doppler ultrasonography can be a preferred exam method and has diagnostic value for epididymitis.

Adolescent↗
PubMed2003

[Acute epididymitis].

Epididymitis may be acute (symptoms last less than 6 weeks) or chronic (more than 3 months). Acute epididymitis is almost always unilateral. In sexually active men under 35 years of age, acute epididymitis is frequently caused by Chlamydia trachomatis and less frequently by Neisseria gonorrhoeae and is usually associated with overt or subclinical urethritis. Acute epididymitis in older men, children or following urinary tract instrumentation is commonly caused by gram-negative bacilli. The epididymis is sometimes the site of metastatic infection, such as tuberculosis. It is important to differentiate epididymitis from other causes for acute scrotum, such as testicular torsion and tumor. The cause of acute scrotum especially in children cannot always be identified. Therefore, Doppler ultrasonography and radionuclide scans are often used. In infants and young boys, genitourinary abnormalities are causative factors, and therefore should be excluded by imaging. Supportive measures and antimicrobial agents are the mainstay of therapy.

Acute Disease↗
PubMed2006

Tuberculous epididymitis presenting with Addison's disease: a rare case.

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.

Addison Disease↗
PubMed1988

Serodiagnosis of Histophilus ovis-associated epididymitis in rams.

An ELISA for the detection of antibodies to Histophilus ovis was used to evaluate the association of epididymal lesions in rams with serologic response to His ovis. Comparison of ELISA results for His ovis in groups of rams with epididymal lesions with ELISA results of clinically normal rams (control group) revealed a significant difference (P less than 0.01) between the control group and those rams from which His ovis was isolated. A significant difference (P less than 0.01) was noticed between the control group and rams with lesions from which an organism other than His ovis or Brucella ovis was isolated. Additionally, a significant difference (P less than 0.01) was noticed in ELISA results between the control group and affected rams from which no organism was recovered and in which the epididymal lesion was not limited to the head of the epididymis. A difference was not detected in the His ovis ELISA results between control rams and rams with lesions associated with a B ovis infection or rams from which no organism was recovered and in which the epididymal lesion was limited to the head of the epididymis. The serologic findings in our study suggest that His ovis is more important in the development of epididymitis in rams than culture results alone would indicate.

Animals↗
PubMed1995

Epididymitis in older boys: dysfunctional voiding as an etiology.

Although male infants and young boys with epididymitis have a high incidence of anatomical pathology, dysfunctional voiding is not a well established cause of epididymitis. In our series 36 boys with epididymitis underwent noninvasive urodynamic studies to determine whether a physiological defect could be assigned as an etiology. The 2 mechanisms proposed are similar to that in children with vesicoureteral reflux associated with dyssynergia or bladder instability and to a cause of recurrent urinary tract infection in children (the infrequent voider syndrome). Urinalysis and urine culture are recommended in all children with epididymitis and urethral swabs are obtained from those who are sexually active. We recommend renal/bladder ultrasound and voiding cystourethrography in all infants and young children with epididymitis. In the older child we advocate detailed questioning regarding voiding symptoms and the performance of noninvasive urodynamic studies.

Adolescent↗
PubMedDate not supplied

[Epididymitis in children: cause of acute scrotum].

The acute epididymitis in children is an uncommon disease which occurs mainly in adolescents. The pediatric surgeon must remember this illness whenever he observes a child with acute scrotum. The aim of this study is to review our experience at the Pediatric Surgery Department in Siena with 17 children (mean age: 7.53 years) underwent to surgery for acute scrotum and affected by primitive acute epididymitis without any other local or systemic associated disease. Our study shows that in children the acute epididymitis is more common than testicular torsion. It is often quite difficult to find the origin of epididymitis in children with no genito-urinary anomalies; so the acute scrotum and in particular the epididymitis require a standardized diagnostic and therapeutic approach based on an accurate physical exam, quickly feasible diagnostic procedures and a prompt surgical exploration of the scrotum.

Acute Disease↗