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PubMed1983

Elevated serum follicle-stimulating hormone levels in men with normal seminal fluid analyses.

Three men who volunteered as normal subjects were found to have abnormally high levels of serum follicle-stimulating hormone (FSH) despite having normal seminal fluid analyses and fertility. Two of the men had a history of previous orchitis, and one had an atrophic testis. Serum luteinizing hormone and testosterone levels were normal. These cases appear to represent compensated primary testicular disease, with normal sperm counts and fertility maintained at the expense of chronically elevated FSH levels. These results imply that in certain situations, the measurement of serum FSH levels may be a more sensitive index of testicular disease than the performance of seminal fluid analyses.

Adult↗

PubMed1995

Effectiveness of crossover transseptal vasoepididymostomy in treating complex obstructive azoospermia.

OBJECTIVE: To review the indications, surgical technique, and results of crossover transseptal vasoepididymostomies for treatment of complex obstructive azoospermia and oligospermia. DESIGN: Retrospective review of our experience with crossover transseptal end-to-side vasoepididymostomies in 10 men. INTERVENTIONS: Ten men underwent crossover transseptal end-to-side vasoepididymostomies. Nine men had primary and one had secondary infertility. Seven men were azoospermic, and the remaining 3 had severe oligospermia (sperm density < 1 x 10(6)/mL). All had a combination of irreparable ipsilateral ductal obstruction or agenesis with a normal testis and a poorly functional or absent contralateral testis. Contralateral testicular atrophy was associated with a prior hernia repair in 3 men, varicocele-induced atrophy in 2, and severe orchitis in 2. Cryptorchidism, testicular torsion, and one unknown cause were reported for three others. Congenital absence of the vas deferens caused the ipsilateral ductal pathology in 5 men. Three men had a vas injury from pediatric inguinal surgery, and 2 had an idiopathic vas obstruction. RESULTS: Twelve microsurgical crossover transseptal vasoepididymostomies were performed (2 men had repeat procedures). Anastomosis was performed to the caput in five men, the corpus in two, and the cauda in three men. Eight of nine men followed for 6 months or more had sperm in their ejaculate. Two of seven couples have established pregnancies. Total sperm counts ranged from 18 to 201 x 10(6) (mean, 98.1 x 10(6)) with motility of 5% to 37% (mean, 13%). Men with congenital absence of the vas deferens had significantly lower postoperative total sperm counts than men with all other causes of ductal pathology: 37.8 x 10(6) versus 135 x 10(6). No other characteristics (type of infertility, preop semen analysis, cause of testicular pathology, site of epididymal anastomosis) were useful predictors of postoperative sperm counts. CONCLUSIONS: If there is a solitary functioning testis with irreparable excurrent ductal obstruction or agenesis, a crossover transseptal vasoepididymostomy can restore patency in most men.

Adult↗

PubMed1993

Multiple hepatic cavernous lymphangioma in an aged male cat.

A 10-year-old male Domestic Longhair cat with weight loss, enlarged left testicle, icterus and mild liver enlargement showed, at necropsy, two white, raised, firm, circumscribed masses in the liver and striking enlargement of the left testicle. The histological features of the liver masses were consistent with lymphangioma. Severe, diffuse, coalescing to multifocal, subacute, necrotizing orchitis of the left testicle also was diagnosed. A literature review and examination of the epidemiology of lymphangioma in small domestic animals demonstrated the rarity of this tumour in cats.

Age Factors↗

PubMed1988

Scrotal ultrasonography: a predictor of complicated epididymitis requiring orchiectomy.

The decision between continued medical therapy and surgical exploration in patients with complicated epididymitis is difficult. We evaluated scrotal ultrasonography as a noninvasive aid in such problematic cases. During a 48-month period 95 patients were hospitalized for treatment of epididymitis; 23 underwent scrotal ultrasonography and 10 required orchiectomy. Analysis of the 21 cases with abnormal findings demonstrated that orchiectomy was necessary in 1 of the 10 patients (10 per cent) with epididymal enlargement only, in 2 of 8 (25 per cent) with epididymal enlargement plus hypoechoic testes and in all 3 with epididymal enlargement plus testicular inhomogeneity (p equals 0.0099). Patients with progressive testicular changes on serial ultrasound examinations uniformly required orchiectomy (5 of 5). Sonographic findings of testicular inhomogeneity correlated with testicular infarction and findings of decreased testicular echogeneity correlated with acute or chronic orchitis. In the appropriate clinical setting gray scale ultrasonography provides objective information supporting the need for surgical intervention in selected patients with complicated epididymitis.

Epididymitis↗

PubMed1981

Testicular scanning: clinical experience with 72 patients.

Testicular scanning with 99mtechnetium pertechnetate is a well established, useful and readily available technique for the rapid assessment of patients with scrotal pain. Its use allows accurate differentiation of testicular torsion from other entities, such as epididymo-orchitis and, thus, obviates scrotal exploration in a large number of cases. We herein report our experience with 72 cases. Only 1 falsely positive scan was obtained in 15 patients thought to have torsion, this being secondary to an incarcerated hernia extending into the scrotum. Of the remaining 14 patients undergoing scrotal explorations for testicular torsion the scan was accurate in 100 per cent of the cases.

Adolescent↗

PubMed1980

Granulomatous disease of the testis.

Granulomatous disease of the testis may have a specific cause or it may be idiopathic. We found 3 specific agents as the cause of the disease in a retrospective review of 17 cases of granulomatous disease of the testis. Mycobacterium tuberculosis was the most common cause of subsequent granulomatous orchitis. The clinical presentations of the patients varied but several clues often were present that led to the diagnosis of granulomatous reaction. The patients were treated with orchiectomy. The acid-fast lipid of the tubercle bacillus and spermatozoa is suggested as a possible common denominator in the pathogenesis of the granulomatous reaction.

Adult↗

PubMed1979

Doppler flowmeter in the differential diagnosis of the acute scrotum in children.

A Doppler flowmeter was used to evaluate an acute scrotum in 23 children. A diminished or absent flow was noted in cases of torsion of the testis. Orchitis, epididymitis and torsion of the testicular appendix were accompanied with an increased blood flow. Inflammatory and ischemic lesions could be detected and in all operated cases the diagnosis proved to be correct. Unnecessary operations in cases of torsion of the testicular appendix can be avoided with this accurate non-invasive method.

Acute Disease↗

PubMed1984

Complications of inguinal hernial repair.

The complications specific to inguinal hernioplasty are addressed with an emphasis on their incidence, importance to the patient, and avoidance, if possible. The major portion of this article discusses ischemic orchitis, as this complication may be very disappointing to the patient if it results in testicular atrophy.

Atrophy↗

PubMed2001

[Brucellar orchiepididymitis].

The brucellosis is an unusual entity whose incidence has diminished due to the improvement in preventive measures. We have carried out a retrospective study of all the patients admitted in our service between 1996 and 1998, with diagnosis of orchitis. Two of the 31 patients admitted for this reason presented a final diagnosis of brucellar orchiepididymitis. Both patients presented clinic of affectation from the general state accompanied by resistance to habitual antibiotic treatment. The patient's epidemic antecedents, accompanied by the suitable clinical evolution took to the suspicion of orchiepididymitis of brucellar etiology, with change in the antibiotic rule. The diagnosis of the process was obtained by means of serologic tests and blood cultures.

Adult↗

PubMed1999

[Relapse in brucella orchiepididymitis].

This paper describes a case of systemic brucellosis accompanied by brucellar orchitis that resolved favourably. There was however a relapse at the testicular level inappropriately treated that triggered a new episode of systemic brucellosis.

Adult↗

PubMedDate not supplied

[Tuberculous orchiepididymitis as clinical onset of human immunodeficiency virus (HIV) infection].

The emergence of acquired immunodeficiency syndrome has changed the natural history of tuberculosis which has now become the second most common infection associated to human immunodeficiency virus infection. It is only rarely that a tuberculous infection has an urogenital location, and extrapulmonary locations are generally related to severe immunosuppression. This paper presents one case of tuberculous orchitis that presented as the clinical onset of acquired immunodeficiency syndrome. Discussion of the clinical evolution and the therapeutic approach that consisted in orchiectomy associated to treatment with tuberculostatics.

Aged↗

PubMed1999

Outcome and safety of transrectal US-guided percutaneous cryotherapy for localized prostate cancer.

OBJECTIVES: To assess the effectiveness and safety of ultrasound (US)-guided cryotherapy as a primary treatment for localized prostate cancer. MATERIALS AND METHODS: A prospective study of percutaneous transrectal US (TRUS)-guided cryotherapy was performed on 71 patients with T1-T3, N0, M0 prostatic cancer: 10 patients underwent two or more procedures. All cases were newly diagnosed and patients had no previous treatment for cancer. For all patients, TRUS biopsies were performed at 5-6 months. Patients were monitored at 6 weeks; 3, 6, 9, and 12 months; and twice yearly thereafter for prostate specific antigen (PSA) levels, complications, and clinical evidence of residual disease. RESULTS: Follow-up from 10 to 36 months was available for 70 of 71 patients; one patient died of unrelated disease. Initially, 10 of 69 patients had positive postcryotherapy biopsy results. After repeated treatment, nine of these 10 patients had negative biopsy results and one patient had no follow-up. Overall, 68 of 69 patients had negative biopsy results. At 1 year, 43 of 64 (67%) had an undetectable PSA level. Two patients had proven metastases. Complications include three cases with urethral sloughing requiring transurethral resection of the prostate (TURP). One patient had orchitis. Two patients had persistent incontinence, one as the result of a TURP. There was no death, acute serious morbidity, or fistula formation. Impotence was universal at 6 months, but many patients demonstrated late recovery. CONCLUSION: Cryoablation is an imaging-guided percutaneous intervention for prostate cancer that can safely yield disease-free status in a high percentage of patients with localized disease.

Adenocarcinoma↗

PubMed1987

Testicular cancer and antecedent diseases.

A case-control study of the aetiology of testicular cancer was conducted using information obtained by interview and from case-notes of 259 cases with testicular cancer and two sets of control patients -238 men with diagnoses other than testicular cancer attending the same radiotherapy centres as those attended by the cases, and 251 hospital in-patients not attending radiotherapy departments. Logistic regression analyses were performed, after stratifying by age and region of residence, to estimate the relative risks (RRs) associated with various aspects of prior medical history. The risk of testicular cancer was found to be raised for men with a history of cryptorchidism (RR based on comparison with all controls = 6.3; P less than 0.001), inguinal hernia (RR = 1.6; P = 0.14), mumps orchitis (RR = 12.7; P = 0.006), atopy (RR = 1.8; P = 0.03), and meningitis (RR = 3.0; P = 0.21). Inguinal herniorrhaphy before the age of 15 years was particularly a risk factor for seminoma, whereas the relative risks were similar for seminoma and teratoma for the other factors. The results add to the growing evidence that congenital abnormalities involving the process of testicular descent and closure of the processus vaginalis are risk factors for testicular cancer, and that some types of testicular damage later in life may also be important. The findings of associations with previous atopy and certain infections suggest a possible second aetiological mechanism - that immunological abnormalities may be associated with an increased risk of testis cancer.

Adolescent↗

PubMed1998

Gamma delta T cells in infection-induced and autoimmune-induced testicular inflammation.

In a previous report, we investigated inflammatory responses induced by injecting Listeria monocytogenes into one testis of a mouse. We demonstrated that the contralateral testis also developed an orchitis despite the absence of bacteria, indicating that the inflammation on the uninfected, contralateral side was of autoimmune character. In both infected and autoimmune testes, gammadelta and alphabeta T cells infiltrated during the inflammation. In this paper, we present the data of a comparison of the character of gammadelta T cells of the infected and autoimmune testes. In both testes, gammadelta T cells appeared to be activated, as assessed by high CD44 and low l-selectin expression. Analysis of T-cell receptor (TCR) usage in both inflammation types revealed the same gammadelta TCR repertoire. Finally, the semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) demonstrated that gammadelta T cells in both types of inflammation were capable of producing interleukin-2 (IL-2), IL-4, interferon-gamma (IFN-gamma), IL-10 and transforming growth factor-beta (TGF-beta). These results imply that gammadelta T cells present in infected-induced and autoimmunity-induced inflammation have the same characteristics and could work as immunoregulatory cells.

Animals↗

PubMedDate not supplied

Retrospective review of paediatric patients with acute scrotum.

BACKGROUND: The purpose of the present study was to evaluate the historical features and physical examination findings in boys presenting with acute scrotum and to determine the reliability of these modalities to make the correct clinical diagnosis. METHODS: A retrospective review of all boys presenting with acute scrotal/testicular pathology between January 1994 and December 1998 was performed. RESULTS: Two hundred and four boys were included in the study: 110 with torsion of the testicular appendage (TA), 40 with testicular torsion (TT), 29 with epididymo-orchitis (EO) and 25 with other diagnoses. Seventeen boys were managed conservatively. With the exception of symptom duration, there was no statistically significant difference between boys with TA, TT and EO. Boys with TT sought medical attention significantly earlier (median: 9.5 h) than those with TA (median: 48 h). Boys requiring an orchidectomy (n = 8) presented later than those who did not (median 30 vs 9 h; P < 0.05): seven (88%) were under 7 years of age. The testicular salvage rate was 88% and 36% with a pain duration of <12 h and >12 h, respectively. The preoperative clinical diagnosis was correct in 80% of those boys who underwent surgical exploration. Testicular torsion was misdiagnosed clinically in five boys. Late testicular atrophy was not observed in the present study. CONCLUSIONS: Most boys presenting with acute scrotum have TA. The history and physical examination can reliably identify those boys who can be managed conservatively. Routine surgical exploration is no longer justified in all boys with acute scrotum.

Acute Disease↗

PubMed1997

B-mode and colour-flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?

OBJECTIVE: To determine the value of ultrasonography (US) and colour-flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. PATIENTS AND METHODS: The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the "gold standard' (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. RESULTS: The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. CONCLUSION: For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.

Adolescent↗

PubMed2000

A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats.

OBJECTIVE: To define the histopathological changes occurring as a result of open and percutaneous needle testicular biopsy in adult rats. MATERIALS AND METHODS: Percutaneous needle and open testicular biopsies were taken from 35 male albino rats (120-140 days old). Nine of the rats were killed 10 days after the biopsy, eight after 30 days and the other eight 60 days after the biopsy. A control group of six rats underwent orchidectomy with no preceding testicular biopsy. RESULTS: Significant tubulitis and obstructive findings were detected 10 days after needle biopsy (P < 0.05); epididymo-orchitis was frequent after open biopsy during this period. At 10-30 days after needle biopsy the mean seminiferous tubule diameters were significantly greater than in either the control group or after open biopsy (P < 0.05). The histopathological damage recovered 60 days after open and needle biopsy. CONCLUSION: Although percutaneous, a needle biopsy (as an alternative to open biopsy) causes tubulitis and frequent obstructive findings in the early period; therefore, repeat testicular procedures should be planned after these changes have resolved.

Animals↗

PubMed1983

[A new simple procedure for immersion sonography of the scrotal contents in real time technic. II: contribution to the differential diagnosis of diseases of the scrotal contents].

In this communication the experiences obtained in 221 patients with a newly developed immersion method for scrotal sonography are analysed. The specific criteria for testicular neoplasms are derived from 22 patients with 100% true-positive diagnosis. In this context, the diagnostic difficulties in defining and identifying the benignity of an affection are discussed. The typical sonographic alterations of scrotal structures in diseases like epididymitis, epididymo-orchitis, spermatocele, varicocele and trauma are also described. An approach to calculating the testicular volume and hydrocele volume is given. The increase in diagnostic reliability makes this method suitable for pre-invasive diagnosis. The simple and non-hazardous procedure can be recommended as a routine method.

Epididymitis↗