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Disorders of bladder function characterized by physiological urethral obstruction were identified in nearly 50% of patients with non-specific epididymitis and anatomically normaly urinary tracts. This association supports the concept that reflux of urine into the ejaculatory ducts may occur and produce epididymitis. The pathophysiology of retrograde urination is reviewed and the predisposing conditions are discussed.
This article reviews lamb epididymitis and epididymitis caused by Brucella ovis. Pathogenesis, occurrence, signs and lesions, diagnosis, prevention, and treatment are discussed.
PURPOSE: Our purpose was to investigate the influence of previous tuberculous epididymitis in patients with obstructive azoospermia on the outcome of sperm retrieval and intracytoplasmic sperm injection (ICSI). METHODS: Eighty-eight cycles of ICSI were performed in 44 patients with obstructive azoospermia; 16 cycles (7 patients) with tuberculous obstructive azoospermia and 72 cycles (37 patients) with nontuberculous obstructive azoospermia. RESULTS: The rates of fertilization and embryo cleavage were comparable, and there was no significant difference in the clinical pregnancy rate per fresh transfer between the two groups. The rates of embryo implantation and clinical miscarriage were also comparable. CONCLUSIONS: Embryo quality and pregnancy outcome in sperm retrieval and ICSI were comparable in both the tuberculous and the nontuberculous obstructive azoospermia patients. Although there was a preponderance of testicular sperm used in the tuberculous obstructive azoospermia group, our results suggest that previous tuberculous epididymitis in patients with obstructive azoospermia does not affect the outcome of sperm retrieval and ICSI.
Proteins, synthesized by the epididymal epithelium, are secreted sequentially into the lumen of the ducts epididymis where they effect sperm maturation and enable functional motility and fertilizing capacity. EP1 is a major secretory glycoprotein of chimpanzee (Pan troglodytes) epididymis. The epididymal duct exhibits diverse histology (Smithwick & Young, 1997). Epithelia I-V of the efferent ducts show no characteristic anti-EP1 binding. The densest granules of anti-EP1 reaction product appear in epithelium VI adjacent to the basal lamina in the infranuclear region of the principal cells (PCs), in the cytoplasm of the apical half of the PCs, and in the perinuclear and perivacuolar cytoplasm of the basal cells. In epithelia VII-XIV of the ductus epididymis proper, anti-EP1 binding decreases distally and is localized in the cytoplasm of the PCs and basal cells, among the stereocilia of the luminal border, within various microvillar borders, and in the luminal fluid. Therefore, EP1 appears to be synthesized and secreted primarily in the caput region of the ductus epididymis and may be reabsorbed nonselectively across epithelia with apical microvilli, including the non-ciliated cells of efferent ducts, the distal corpus and cauda of the ductus epididymis, and the proximal ductus deferens.
This study assessed the possible relationship between methyl chloride (MeCl)-induced epididymal inflammation and the formation of dominant lethal mutations in sperm of Fischer 344 rats. Groups of 40 males were exposed to MeCl (3000 ppm 6 hr/day for 5 days), with or without concurrent treatment with the anti-inflammatory agent 3-amino-1-[m-(trifluoromethyl)phenyl]-2-pyrazoline (BW 755C; 10 mg/kg, i.p. 1 hr pre- and postexposure); BW 755C was shown previously to inhibit MeCl-induced epididymal inflammation. Control groups (n = 20) were either untreated, injected as described above with BW 755C, or injected on the afternoon of day 5 with triethylenemelamine (0.2 mg/kg), a known dominant lethal mutagen. Each male was caged with one female weekly for 3 weeks; 12-18 days after mating, females were killed to assess dominant lethal parameters. In females bred to MeCl-exposed males, significant increases were observed in postimplantation loss at postexposure week 1 (0.84 dead implants per female vs. 0.29 in untreated controls) and in dead implants/total implants at both week 1 (0.10 vs. 0.04 control) and week 2 (0.24 vs. 0.06 control). These increases were not observed in females bred to males treated with BW 755C during MeCl exposure. Coadministration of BW 755C to males along with MeCl also reduced the percentage of mated females with two or more postimplantation losses from 31% to 8% (week 1) and 30% to 12% (week 2). Therefore, the dominant lethal mutations induced by MeCl appear to be a consequence of its induction of inflammation in the epididymis. These data demonstrate the potential genotoxicity of inflammatory processes in vivo.
125I-labeled protein D was shown to bind to whole rat epididymal sperm in a time-dependent, saturable, and reversible manner. Scatchard analysis indicates that there are 3.4 x 10(5) binding sites/sperm cell with a binding efficiency (Kd) of 2.3 x 10(-10) M. Binding of protein D to sperm reaches equilibrium by 95 min. and is reversible by 30 min. Specific binding of protein D to sperm pre-treated with a dilute trypsin solution is reduced significantly when compared with controls. Our findings establish that protein D-specific binding proteins displaying characteristics of a true receptor are present on the surface of rat epididymal sperm.
BACKGROUND: We have recently shown that patients with prostato-vesiculo-epididymitis (PVE) have a greater reactive oxygen species (ROS) overproduction than patients with prostatitis or prostato-vesiculitis. Since this biochemical stress persists even after treatment with antimicrobials, it may relate to an imbalance between pro- and anti-oxidant factors at the epididymal level. METHODS: To evaluate the effects of antioxidant treatment of patients with PVE, whether in the presence or absence of pro-oxidant factors, abacterial PVE infertile patients with normal (<1x10(6)/ml, group A, n = 34) or abnormal (>1x10(6)/ml, group B, n = 20) seminal white blood cell (WBC) concentrations received carnitines (L-carnitine 1 g and acetyl-carnitine 0.5 g twice/day) for 3 months followed by a wash-out period of 3 months. Semen parameters, ROS production and pregnancy outcome were evaluated before, during and following carnitine treatment. RESULTS: Carnitines increased sperm forward motility and viability in group A patients. This was associated with a significant reduction in ROS production which persisted during wash-out. Carnitines increased only the percentage of viable spermatozoa in group B patients. Within 3 months after the discontinuation of carnitines, the rate of spontaneous pregnancy in group A patients was significantly higher than that of group B patients, being 11.7% (4/34) compared with 0%. CONCLUSION: These results indicate that carnitines are only an effective treatment in patients with abacterial PVE and elevated ROS production when seminal WBC concentration is normal.
A case of acute epididymitis evolved into testicular infarction. Scrotal scintigraphy identified the initial epididymitis and subsequent evolution into infarction.
A 17-year-old boy underwent a radionuclide scan for testicular torsion. The scan demonstrated a cold defect with a warm ring, indicating a "missed" testicular torsion. Operative findings, however, demonstrated epididymitis. A false-positive radionuclide study is described in a patient with epididymitis and the literature of scintigraphy in testicular torsion is reviewed.
BACKGROUND: Epididymitis and orchitis (EO) are the primary sequelae of acute chlamydia and gonorrhea in men. Existing estimates of the cost per episode of epididymitis are over 10 years old or are based on limited data. OBJECTIVE: The objective of this study was to estimate direct medical costs of EO from insurance claims data. STUDY DESIGN: We used 1998 and 1999 insurance claims taken from a national database. We used International Classification of Diseases, 9th Revision codes to identify inpatient and outpatient claims for EO treatment. Prescription drug claims were identified with National Drug Codes. To capture episodes of EO that were most likely sequelae of sexually transmitted diseases, we categorized claims based on age at the time of the initial EO claim. RESULTS: The total cost per episode was US dollars 368 for males <13 years of age, US dollars 242 for those > or =13 and <41 years of age, and US dollars 291 for those > or =41 years of age. The cost for both younger and older men was significantly different from men > or =13 and <41 years of age. Inpatient claims were relatively rare, occurring in < or =1.2% of total episodes. CONCLUSION: The cost per episode we calculated was lower than previously published estimates and can be attributed to a lower rate of inpatient care than previously observed or estimated.
One hundred and forty-two patients were admitted to the Jordan University Hospital with acute epididymitis between 1973 and 1983. Sixty-five had intravenous urograms which revealed renal tuberculosis in 1 patient, renal or ureteric stones in 10, bladder neck obstruction in 3, unrelated congenital anomalies in 10 and no abnormalities in 41. Twelve patients developed epididymal abscesses.
To the authors' knowledge, this case is unique to the emergency medicine literature. Although testicular infarction from epididymitis is rare, it should be considered as a complication of severe or unresolving epididymitis. These patients should be placed on broad spectrum antibiotics, i.e., quinolones; color flow Doppler of the testes should be obtained; and urologic consultation should be considered for possible admission and surgical exploration.
The in vivo efficacy of ofloxacin was compared with those of cefotaxime and doxycycline in a rat model of epididymitis due to Escherichia coli. Treatment was started 24 h after infection and was continued for 7 days. Ofloxacin reduced the numbers of E. coli organisms in the epididymides significantly more than the other therapeutic regimens and cured the infection more frequently. Histopathological changes in the epididymides of ofloxacin-treated animals were significantly less severe than those observed in untreated animals. Doxycycline was less effective than ofloxacin but significantly reduced the titers of organisms in rat epididymides. In contrast, despite excellent in vitro activity, cefotaxime failed to reduce the magnitude of infection. The results of this study suggest that ofloxacin may be a very effective antimicrobial agent for the treatment of epididymitis due to E. coli.
A simple gel-diffusion technique is described for the diagnosis of ram epididymitis caused by Brucella ovis. The results are shown to be very similar to those obtained by the complement-fixation test, which is currently the standard method of diagnosis. The method is suitable for use in the field and is expected to facilitate the control of ram epididymitis in areas where laboratory facilities are not available.
Antisera against Actinobacillus seminis, Brucella ovis and Corynebacterium pseudotuberculosis were prepared in adult female goats. Specific immunofluorescence was observed in cultural smears of A seminis, B ovis and C pseudotuberculosis by the direct technique and in smears of A seminis also by the indirect technique. Individual organisms could be recognised. Specific fluorescence of A seminis was readily detected in semen. The results indicate that immunofluorescence may offer an effective method for rapidly and accurately diagnosing bacterial epididymitis in sheep, especially before epididymal lesions are palpable.
Torsion knot and whirlpool patterns result from the twisting of the spermatic cord, which produces distortion of cord structures. These two findings, along with spermatic cord vascularity, were used to prospectively differentiate testicular torsion from epididymitis in 11 patients with subacute scrotal pain who underwent magnetic resonance (MR) imaging. The final diagnosis was established clinically in four patients and surgically in five. MR imaging enabled the recognition of each entity without error. Retrospective review of findings highlighted other potential discriminating features, the most important of which were testicular size and vascularity. Because of its ability to highlight vessels and detail normal and abnormal intrascrotal anatomy, MR imaging in this small series enabled the differentiation of subacute torsion from epididymitis with 100% accuracy. This high degree of accuracy warrants further investigation.
Conventional and anaphylactic autoantibodies to rabbit epididymal and seminal spermatozoa were detected in sera of rabbits autoimmunized by several procedures. Antibodies against epididymal spermatozoa were found in 85% of rabbits showing lesions of varying degrees in testes. When the comparison was made with antibodies to antigens of spermatozoa from semen, the correlation was markedly lower. The data prove the importance of a proper selection of the antigenic material when looking for antibodies to spermatozoa in studies of autoimmunity and fertility.
Male Wistar rats were infected with the chlamydial agent of guinea pig inclusion conjunctivitis by inoculation of chlamydiae into the vas deferens. Epididymitis was observed in all infected animals clinically and histologically. Chlamydiae were detected in the epithelium of epididymal tubules by immunohistochemical staining (alkaline phosphatase anti-alkaline phosphatase technique). Inflammation progressed from the cauda to the corpus and caput epididymidis leading to fibrosis of the cauda epididymidis 28 days after infection. Animals responded to the infection with a rise of both serum IgM and IgG antibodies.