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PubMed1997

Sonographic findings in tuberculous epididymitis and epididymo-orchitis.

PURPOSE: This paper presents the sonographic findings in scrotums of patients affected with tuberculous epididymitis or epididymo-orchitis. METHODS: Eighteen patients with a total of 22 abnormal hemiscrotums (4 patients had bilateral lesions) underwent scrotal sonography. Pathologic confirmation was obtained via epididymectomy in 10 cases, epididymo-orchiectomy in 7 cases, and scrotal exploration and biopsy in 3 cases. The histopathologic diagnosis was tuberculous epididymitis in 12 cases and epididymo-orchitis in 8 cases. RESULTS: Lesions involved the head of the epididymis in 8 cases, the tail in 5 cases, and the entire epididymis in 9 cases. The enlarged epididymis was hypoechoic in 13 cases, hyperechoic in 2 cases, and of mixed echogenicity in 7 cases. The echotexture was heterogeneous in 17 cases and homogeneous in 5 cases. Testicular involvement in 7 cases appeared as a diffusely enlarged hypoechoic testis in 2 cases, an ill-defined hypoechoic lesion in 1 case, a well-demarcated hypoechoic lesion in 2 cases, and multiple small hypoechoic nodules in an enlarged testis in 2 cases. Hydrocele, sinus tract, and extratesticular calcifications were seen in 12, 4, and 2 cases, respectively. CONCLUSIONS: The heterogeneous and hypoechoic swelling of the epididymis or the concomitant hypoechoic lesion of the testis with associated sinus tract or extratesticular calcifications may be helpful in the diagnosis of tuberculous epididymitis or epididymo-orchitis, especially in patients with known genitourinary tuberculosis.

Adolescent↗
PubMed1994

Epididymal glycoprotein involved in rat sperm association.

Recently, a new head-to-head sperm association was described in the rat during epididymal transit. This association was called a rosette and a filamentous and PAS-positive material was also described joining the sperm heads. The beginning of rosette formation in the epididymis and the linking material between heads have remained unclear. Epididymides of adult rats were fixed by vascular perfusion and thin sections of the principal regions were studied by transmission electron microscopy (TEM). The first evidence of rosette formation was observed in the distal corpus. Rosettes were isolated from the distal corpus and processed for immunogold and immunofluorescence microscopy to detect an epididymal glycoprotein called DE. This glycoprotein is secreted by the corpus epididymis and appears to be involved in sperm maturation. Colloidal gold marks and fluorescence were observed in the linking material between the sperm heads. The results presented here show that rosettes begin to appear following the sites of DE secretion and permit us to postulate that DE is involved in rosette formation and constitutes another example of gamete-epididymal interaction.

Animals↗
PubMed1977

The value of routein intravenous urography in acute epididymitis.

The urographies of 106 patients with acute epididymitis are reviewed. In 71 cases the urogrpahy was completely normal, while in the remaining 35 patients abnormalities were found. In 25 patients the findings were consistent with hypertrophy of the prostate. More than half of the patients had known urological diseases and had undergone cystoscopy and/or catheterization prior to the onset of acute epididymitis. All 35 patients had demonstrated symptoms that would otherwise have resulted in intravenous urography independent of the epididymitis. No cases of urogenital tuberculosis were found. The authors conclude that routine urography under the age of 50 is not recommended. Over the age of 50 concomitant urological diseases are so common that urography is often indicated, but acute epidiymitis in itself is only a relative indication.

Acute Disease↗
PubMedDate not supplied

Tissue penetration of sparfloxacin in a rat model of experimental Escherichia coli epididymitis.

The epididymal, testicular, and prostatic tissue penetration of sparfloxacin, a new quinolone, was assessed in a rat model of acute epididymitis. Seventy-two hours after injection of 0.1 ml (10(6) cfu/ml) of an Escherichia coli suspension into the right epididymis via the right ductus deferens, a single oral dose of sparfloxacin 50 mg/kg body weight was administered. One, 2, 4, 8, 12, and 24 h after administration the animals were sacrificed and the sparfloxacin concentrations and "areas under the curve" (AUC0-24) in both epididymides, both testes, the prostate gland and in the serum were measured by bioassay. The highest mean AUC0-24 was found in the prostate gland, followed by left epididymis, right epididymis, serum, right testis, and left testis (190, 79, 60, 28, 12, and 9 mg/kg x h, respectively). Though there was no statistically significant difference in the sparfloxacin concentration of both epididymides (p = 0.09), the mean AUC0-24 was significantly higher in the non-infected left epididymis (p < 0.0001). The AUC0-24 and sparfloxacin concentrations of the right infected epididymis were significantly higher than those observed in the serum (p < 0.0001). In both testes, the AUC0-24 and sparfloxacin concentrations were lower than in the serum (p < 0.0001), however, the concentration exceeded the MIC tenfold for approximately 20 h. It is concluded that the pharmacokinetic properties of sparfloxacin (good in vitro activity, high penetration into the prostate gland, testes, infected and non-infected epididymides) make this drug a recommendable choice for the initial treatment of acute epididymitis caused by E. coli.

Animals↗
PubMedDate not supplied

Serious complications of tuberculous epididymitis.

Tuberculous epididymitis is a rare entity associated with minor complications. We present two cases of tuberculous epididymitis associated with serious complications (bilateral psoas abscesses and Addison's disease with psoas abscess). A review of the literature disclosed six additional cases associated with serious complications (Addison's disease, inappropriate antidiuretic hormone secretion, central nervous system involvement) which are discussed and compared to these cases. We conclude that tuberculous epididymitis represents a grave sequela of genital tract involvement and may be associated with serious and even fatal complications.

Addison Disease↗
PubMed1985

Cutaneous vasostomy: technique for treatment of chronic and recurrent epididymitis.

We describe a method for treatment of patients with chronic and recurrent epididymitis. Six of 7 patients (86%) treated with this procedure between 1977 and 1980 have had no recurrent episodes of epididymitis to date. We discuss the comparative benefits of this procedure as related to other surgical treatments for acute, chronic, and recurrent epididymitis.

Aged↗
PubMed1987

Chlamydia trachomatis epididymitis diagnosed by fluorescent monoclonal antibody.

Two cases are described of atypical presentation of epididymitis requiring surgical exploration to rule out the presence of testicular tumor. In each case epididymal biopsy confirmed the diagnosis of epididymitis, and the causative organism, Chlamydia trachomatis was identified by fluorescent monoclonal antibody technique.

Adolescent↗
PubMed2004

Management of acute epididymitis: are European guidelines being followed?

OBJECTIVE: Acute epididymitis is increasing in men aged 35 years or under due to sexually-transmitted Chlamydia trachomatis. This study examines whether Urological surgeons are following European guidelines for the management of acute epididymitis in these patients. METHODS: A postal questionnaire survey was conducted of specialists in Urology in two regions of the UK. RESULTS: Of 79 completed replies, 41 (52%) take a detailed sexual history but only 34 (43%) refer patients to a Genitourinary medicine clinic. Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) respondents, principally ciprofloxacin. CONCLUSIONS: The current management of acute epididymitis in young men must be improved. Ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection. We recommend that all such patients be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners.

Acute Disease↗
PubMed2006

Expression of a fluorescent recombinant form of sperm protein phospholipase C zeta in mouse epididymal sperm by in vivo gene transfer into the testis.

OBJECTIVE: To use in vivo gene transfer into the testis by electroporation to express a fluorescent recombinant form of a testis-specific gene in the mature epididymal sperm of mice and thus study the pattern of gene localization. DESIGN: Controlled animal study. SETTING: Research laboratory at the University of Oxford. ANIMAL(S): Four- to 6-week-old male mice. INTERVENTION(S): Phospholipase C zeta (PLCzeta), the putative mammalian egg activation factor, was fused to enhanced yellow fluorescent protein (EYFP), and in vivo gene transfer by electroporation was used to introduce this transgene (PLCzeta-EYFP) into mouse testis. Transgene expression in testis and sperm were analyzed at 20 and 40 days after electroporation. MAIN OUTCOME MEASURE(S): Transgene expression in testis and epididymal sperm was analyzed by fluorescence microscopy and an excitation light source suitable for EYFP. RESULT(S): Phospholipase C zeta-EYFP was successfully expressed in epididymal sperm when analyzed 40 days after gene transfer and was localized to the head and midpiece regions. CONCLUSION(S): Our results provide the first demonstration that in vivo gene transfer can be used to study the localization of proteins in mature sperm and that this represents a powerful new technique for studying male infertility and gene function in sperm.

Animals↗
PubMed1987

Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities.

Of 47 children diagnosed as having epididymitis between 1975 and 1985, 8 of 17 prepubertal patients (47 per cent, or 17 per cent of the total group), including 3 of 4 infants (75 per cent), had an underlying urogenital anomaly. Thus, patients with epididymitis secondary to an underlying anomaly present at an earlier age. The common finding in patients with underlying anomalies was a pathological connection between the urinary tract and the genital duct system or bowel. Coliform urinary infections predominated in patients with underlying anomalies (4 of 6). Although a positive urine culture suggested an underlying anomaly (positive predictive value 0.60), a negative culture virtually ruled out an anomaly (negative predictive value 1.00). Of the 8 patients with underlying anomalies 6 underwent voiding cystourethrography and 6 underwent excretory urography, and the diagnosis was established in 6 (100 per cent) and 4 (67 per cent), respectively. Thus, voiding cystourethrography has the greatest diagnostic yield. Any prepubertal patient with epididymitis merits a complete urological evaluation, including a urine culture, voiding cystourethrography and excretory urography to rule out an underlying urogenital anomaly, which often is amenable to an operation. Surgery often involves severance of the pathological urogenital or urinary-fecal connection and it was successful in 7 of our 8 patients.

Adolescent↗
PubMed1986

Systemic necrotizing vasculitis presenting as epididymitis.

Epididymitis is an uncommonly recognized complication of systemic necrotizing vasculitis. We report 2 cases in which epididymitis heralded the onset of more severe visceral organ involvement. Early biopsy of atypical epididymitis in patients with hypertension or constitutional symptoms is important if effective therapy is to be instituted before irreversible organ damage occurs.

Adult↗
PubMed1986

Cytomegaloviral epididymitis in a patient with the acquired immune deficiency syndrome.

We report on a patient with cytomegaloviral epididymitis and the acquired immune deficiency syndrome. The diagnosis was suggested by epididymitis that was refractory to antibiotics, and by isolation of cytomegalovirus from the urine and semen. The definitive diagnosis was made with immunohistochemical staining for cytomegaloviral antigens in the epididymal ductal cells. Because of the ineffectiveness of antimicrobial agents in this disorder, epididymectomy is the current treatment of choice.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Aetiology of acute epididymitis.

24 patients with acute epididymitis were examined and underwent urethral and urine cultures for Neisseria gonorrhoeae, Ureaplasma urealyticum, herpes-simplex virus, Chlamydia trachomatis, cytomegalovirus, and gram-negative aerobic bacteria. The results suggest that in young men the sexually transmitted organisms which cause urethritis (N. gonorrhoeae, C. trachomatis, and possibly U. urealyticum) may also lead to acute epididymitis, whereas in older men coliforms and Pseudomonas are the predominant causes of epididymitis.

Acute Disease↗
PubMed2003

Cloning and characterization of boar epididymal secretory proteins by homology to the human.

Northern blot analysis suggested that the boar epididymis produces closely related counterparts to human epididymal proteins HE1, HE3, HE4, HE5 and HE12. 'Full-length' cloning by nucleic acid and amino acid sequence similarity was achieved by RT-PCR methods in the case of the porcine counterparts of HE3 and HE4, while the homologues of HE5 and HE12, despite their cross-hybridization during Northern blot analysis, have not yet been cloned. The two novel porcine cDNAs were derived from moderately abundant epididymal mRNAs that were 75 and 83% identical to HE3 and HE4 cDNAs, respectively. To emphasize their relationship to the corresponding HEs, they were named Se3 and Se4 cDNAs. Their open reading frames predicted small secretory proteins with 55% (Se3) and 76% (Se4) conserved amino acids. Monospecific antipeptide antibodies to HE secretory proteins identified He3- and HE12-related proteins on Western blots of porcine epididymal fluid and semen. Both Northern and Western analyses indicated that the Se proteins were produced in a regionalized pattern and accumulated in the cauda fluid.

Amino Acid Sequence↗
PubMed1999

A double-blind, randomized, controlled multicentre study to compare the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age.

OBJECTIVE: To compare the efficacy and safety of ciprofloxacin 500 mg orally twice daily with pivampicillin 700 mg orally twice daily for 10 days in men with acute epididymitis and over 40 years of age. PATIENTS AND METHODS: The study comprised 172 men who entered a prospective, controlled, randomized, double-blind, trial of pivampicillin and ciprofloxacin. The median (range) age of the 158 patients eligible for the efficacy analysis was 58 (41-85) years; 41% had previously had a urinary tract infection and 27% had previously had epididymitis. Only one patient had a urethral catheter and 38% were sexually active. About half of the patients were admitted to hospital. RESULTS: No bacteria could be cultured from samples in 53% of the patients; Escherichia coli could be cultured from 35% and the remaining isolates were the expected urinary pathogens. None of the patients had Gonococci and only one in each group had Chlamydia. Mycoplasma hominis was detected in three patients only and M. genitalium was detected in three, while Ureaplasma was detected in 24 (15%). The treatment failed in 48 patients; in 15 of 76 (20%) receiving ciprofloxacin and in 33 of 82 (40%) receiving pivampicillin. This corresponds to a reduction in the risk of failure of 20.5% (95% confidence limits 6.6-40.2%, P=0. 006). The principal cause of failure was an unsatisfactory clinical response requiring changed antibiotic treatment in 27 patients; adverse events were responsible for failure in 14. The in vitro resistance of cultured bacteria was low in both groups, at approximately 4%. Adverse events, mainly gastro-intestinal, occurred in 17 of 83 (21%) patients starting on ciprofloxacin and in 33 of 89 (37%) receiving pivampicillin (P=0.04). CONCLUSION: For epididymitis in men over the age of 40 years ciprofloxacin 500 mg orally twice daily is more effective than pivampicillin 700 mg orally twice daily. Furthermore, ciprofloxacin has a lower incidence of adverse events.

Administration, Oral↗
PubMed1997

[Differential diagnosis of acute testicular pain using color-coded duplex ultrasonography: difference between testicular torsion and epididymitis].

OBJECTIVE: To assess retrospectively the accuracy of colour-coded duplex sonography (CCDS) in distinguishing testicular torsion from epididymitis as the cause of acute testicular pain. PATIENTS AND METHODS: The results of CCDS were analysed for all 81 patients (mean age 27.2 years [6 weeks to 60 years]), admitted between 1.1.1995 and 30.6.1996 with the diagnosis of acute testicular pain. Testicular torsion was diagnosed when CCDS failed to detect perfusion in one testis. Regular arterial and venous perfusion of both testes excluded torsion. Epididymitis was diagnosed when hyperperfusion of the epididymis was demonstrated by CCDS. RESULTS: 20 of 22 cases of torsion, subsequently diagnosed at surgery, had been correctly diagnosed by CCDS (sensitivity 90.9%, specificity 98.3%). 55 patients had epididymitis, confirmed by the clinical course and follow-up having excluded torsion. Other causes (trauma, tumour, inguinal hernia) were found in the remainder of patients. CONCLUSION: With a positive predictive value of 95.2% and a negative one of 96.6% CCDS is a highly suitable method for recognizing or excluding testicular torsion and thus clarifying the cause of acute testicular pain.

Acute Disease↗
PubMed1984

[Epididymitis. Studies on its etiology and pathogenesis with special reference to Chlamydia trachomatis and Ureaplasma urealyticum].

A standardized clinical and microbiological diagnostic examination was conducted on 137 patients with acute or chronic epididymitis (cardinal symptom: painful swelling of the epididymis). Patients with spontaneous secretion from the urethra were examined according to the methods of urethritis diagnosis, patients without it with the four-glass test. Gram-negative bacteria and enterococci were responsible for 27.7% of the infections. Additional tests for Chlamydia trachomatis and mycoplasmas increased the microbiological rate of diagnosis to 65.7%. Demonstration of Ureaplasma urealyticum in significant numbers was always associated with urethritis or prostatitis. Chlamydia trachomatis was demonstrated especially in younger, sexually active men with epididymitis but without accompanying urethritis or prostatitis. The most striking clinical finding was a disturbance in bladder emptying in about one third of all patients with epididymitis, regardless of age.

Adult↗
PubMed1999

The novel epididymal secretory protein ESP13.2 in Macaca fascicularis.

Newly synthesized mammalian spermatozoa undergo critical modifications as they pass along the epididymis. The modifications endow spermatozoa with fertilizing ability and occur largely as a consequence of epididymal gene expression. With this in mind, we here employed a cDNA cloning strategy designed to identify key epididymal gene products. We describe a novel cynomolgus monkey (Macaca fascicularis) epididymal transcript designated cy-ESP13.2, of 690 nucleotides. The putative human ortholog was cloned and is highly conserved. Both cDNA sequences predict small, secretory proteins with a disulfide-stabilized core. Anti-peptide polyclonal antibodies were raised to a predicted cy-ESP13.2 surface loop. Western blotting with these antibodies revealed high-level, epididymis-specific expression of cy-ESP13.2, consistent with the pattern of cy-ESP13.2 mRNA expression assessed by Northern blotting. cy-ESP13.2 protein was of 30 kDa and was readily detectable in epithelial cells lining the efferent ductules, initial segment, and cauda regions of the epididymis, but not on spermatozoa. Similarities to members of the four-disulfide-core family suggest clues to ESP13.2 function.

Amino Acid Sequence↗