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PubMed1975

Immunologic studies of male infertility.

Infertile men with azo- or oligospermia of unknown cause were investigated for evidence of testicular autoimmunity. Testicular germinal cell antibodies were found in 14% of the patients, compared with 5% of normal men, and 21% had spermatozoal antibodies, compared with 5% of the normal subjects. One-third had positive macrophage inhibitory factor tests, compared with 5% of normal subjects. However, of autoantibodies against thyroid, stomach, and nuclear material, only the prevalence of thyroid cytoplasmic antibodies was significantly greater than in normal subjects; serum IgG, IgM, and IgA levels were normal in all cases tested. Furthermore, there was no excess of lymphoid tissue on biopsy and no evidence of antibody deposition in the testicular tissue. The evidence for autoimmunity is less impressive than that for leprous orchitis, which has been proposed as a model for testicular organ-specific autoimmunity. Nevertheless, it is possible that certain germinal cell or spermatozoal antibodies may be directed against factors necessary for orderly spermatogenesis. If so, they may play a role in some cases of maturation arrest and shedding defects.

Adult↗
PubMed1982

Impairment of rat spermatogenesis following unilateral experimental ischemia.

When one testis in a rat is rendered ischemic, histologic damage occurs in the contralateral testis, which can be explained on immunologic grounds. An increase in the quantity of a naturally circulating cytotoxic antitestis antibody or an alteration in the specificity of this antibody was observed via cytotoxic antibody tests. Immunocytochemical techniques further demonstrated this phenomenon, showing binding of fluorescein-labeled antibody to sections of normal control testis or to sections of contralateral testis. It appeared that the ischemic testis presented altered ischemic cells or normal cells to the immune system as its blood-testis barrier was broken down. It is suggested that to leave a necrotic testis within the scrotum following prolonged torsion of the testis in the human may be a reason for subfertility or infertility in this type of condition, and a similar result may occur following unilateral testicular damage caused by varicocele or orchitis.

Animals↗
PubMed1997

Lesions in the reproductive tract of boars experimentally infected with porcine rubulavirus.

"Blue eye" disease of pigs in Mexico is caused by porcine rubulavirus and characterized by infertility in sows and boars, nervous signs in young pigs, and corneal opacity in pigs of all ages. The pathogenesis of reproductive tract lesions in rubulavirus-infected boars has not previously been investigated. In a first experiment, four 9-month-old boars were inoculated with porcine rubulavirus and killed 5, 15, 30 or 45 days post-inoculation (pi). In a second experiment, four similar boars were inoculated with the same virus and two animals were killed on each of days 70 and 80 pi. Swelling of the head of the epididymis developed in all inoculated boars at approximately day 15 pi. Reduced spermatozoan motility and concentration were detected in semen samples collected from one boar from day 21 pi. At post-mortem examination, nodules were seen in the head of the epididymis of the boars killed 15, 30 or 45 days pi and the right testis of the pig killed 30 days pi was atrophic. Corresponding histopathological epididymal alterations included formation of spermatic granulomas and vacuolar degeneration of ductular epithelium. These lesions were associated with mononuclear cell infiltration and interstitial fibroplasia. Degeneration of seminiferous tubules and interstitial mononuclear cell infiltration were seen in the atrophic testis of the pig killed 30 days pi. There was fibrosis of the head of the epididymis in all boars killed 70 or 80 days pi and one of these animals also had right testicular atrophy associated with degeneration of seminiferous tubules, lymphocytic infiltration and giant cell formation. Porcine rubulavirus antigen was detected by immunofluorescence labelling in the head of the epididymis of the pigs killed 15, 30 or 45 days pi and in one animal killed on day 70 pi. These results indicate that porcine rubulavirus can cause severe epididymo-orchitis and reduced semen quality in sexually mature boars.

Animals↗
PubMed1998

Cystic dysplasia of the testis associated with ipsilateral renal agenesis and high anorectal anomalies.

Scrotal masses in young children are often caused by hydrocoeles and hernias. When they arise from the testis, testicular tumor or orchitis, although rare in this age group, is often the diagnosis. Cystic dysplasia of the testis, a rare condition frequently associated with renal anomalies, is another possible differential diagnosis. Herein the authors describe a case in which cystic dysplasia of the testis is associated with ipsilateral renal agenesis as well as high anorectal anomalies.

Abnormalities, Multiple↗
PubMed2003

Hyperimmunoglobulinemia D and periodic fever syndrome (HIDS) in a child with normal serum IgD, but increased serum IgA concentration.

This report describes a boy with hyperimmunoglobulinemia D and periodic fever syndrome (HIDS). The serum IgD level was normal, but the serum IgA concentration was markedly elevated. In addition, he had a history of orchitis on two occasions, a previously unreported manifestation of HIDS. This report expands the clinical and laboratory features associated with HIDS and serves to emphasize that a normal serum IgD level does not exclude the diagnosis of HIDS.

Anti-Inflammatory Agents↗
PubMed2000

The lion of the union: the pelvic wound of Joshua Lawrence Chamberlain.

PURPOSE: Major General Joshua Lawrence Chamberlain is a true American hero. His medical history and war wounds provide a rare snapshot of Civil War era medicine. In particular the most devastating injury was a rifle shot through the pelvis rupturing the bladder and urethra. We describe this injury and how it affected his life to provide insight into late 19th century urological care. MATERIALS AND METHODS: All available references, including biographies, letters, surgical reports, military documents and prior medical summaries, were reviewed regarding Chamberlain's urological history. RESULTS: While leading the Union charge to Petersburg, Virginia on June 18, 1864, Chamberlain was struck with a minié ball anteriorly below the right greater trochanter. The ball coursed obliquely upward disrupting the bladder and urethra, and embedded behind the left acetabulum. An unprecedented wound exploration in the field hospital was performed to extract the bullet and "reconnect severed urinary organs." Hope for recovery was nonexistent as urine was seen exiting the lower wound postoperatively. This genitourinary injury required 4 subsequent repairs during Chamberlain's lifetime and ultimately left him with a draining urethrocutaneous fistula at the penoscrotal junction. CONCLUSIONS: Survival from catastrophic Civil War wounds was rare, especially from "gut wounds" which had a mortality rate of greater than 90%. Chamberlain not only survived but thrived with his sense of duty carrying him back to the battlefield and beyond. He was plagued during his life with recurrent cystitis and epididymo-orchitis, which in an era without antibiotics was especially miserable. Urosepsis is listed as the cause of death on his death certificate and whether this was true is debatable. However, even if this wound did not cause his death, it surely contributed to it.

Famous Persons↗
PubMed1994

Recurrent episodes of acute scrotum with ischemic testicular necrosis in a patient with familial Mediterranean fever.

The tunica vaginalis is 1 of the sites involved in the recurrent febrile attacks of serositis, which are the hallmark of familial Mediterranean fever. The attacks present clinically as "orchitis." We report on a patient with familial Mediterranean fever in whom recurrent episodes of scrotal attacks were complicated by testicular necrosis requiring orchiectomy. The case emphasizes the challenge of recognizing and differentiating these attacks from other causes of acute scrotum.

Acute Disease↗
PubMed1994

Toxoplasmosis of the bladder: case report and review of the literature.

Toxoplasma gondii is an intracellular parasite that is responsible for an asymptomatic or minimally symptomatic lymphadenopathy syndrome, which in the immunocompromised host can be life threatening. Toxoplasmosis commonly affects the central nervous system. Genitourinary involvement is uncommon with reported cases limited to Toxoplasma orchitis and the nephrotic syndrome. To our knowledge we report the first case of toxoplasmosis of the bladder as an intravesical mass without central nervous system or other organ involvement in a young man with the acquired immunodeficiency syndrome.

AIDS-Related Opportunistic Infections↗
PubMed1992

Cutaneous fistulas to the vas deferens.

Cutaneous fistulas to the vas deferens are a rare occurrence. A careful review of the literature revealed only 16 cases reported within the last 70 years. We present a case of such a fistula occurring after inguinal orchiectomy for suppurative epididymo-orchitis and review the etiologies of all reported cases to provide recommendations for management.

Aged↗
PubMed1989

Prostatitis associated with Chlamydia trachomatis in 6 patients.

A number of studies have shown that Chlamydia trachomatis bacteria are important pathogens in urogenital tract infections, such as acute urethritis, acute epididymo-orchitis in male patients and pelvic inflammatory disease in female patients. We confirm a previously reported association between Chlamydia trachomatis and prostatitis. We report on 6 patients with definitive confirmation via tissue culture and an immunofluorescent technique. The results demonstrate that chlamydial prostatitis occurs in patients with nonbacterial disease. Efforts should be made to detect and eradicate the organisms from the prostate.

Adult↗
PubMed1986

Seminal vesiculography in chronic bacterial prostatitis.

A total of 15 patients with proved chronic bacterial prostatitis underwent bilateral seminal vesiculography to determine the morphological appearance of the seminal vesicles and the ampulla ducti deferentis in this condition. A pathological condition, such as segmental stenosis or complete shriveling of the seminal vesicles, was obvious in 21 of 24 vesiculograms (87.5 per cent), while malformations of the ampulla were seen in 7 (29.1 per cent). The role of chronic bacterial prostatitis as an important pathogenetic factor in the history of epididymo-orchitis is discussed.

Adult↗
PubMed1986

Complications of bacillus Calmette-Guerin immunotherapy in 1,278 patients with bladder cancer.

Our series of 195 patients, plus 134 reported on in the literature and 949 reviewed by various physicians provide 1,278 patients for review of bacillus Calmette-Guerin therapy complications. Cystitis occurred in 91 per cent of the patients. Complications identified included fever more than 103F in 50 patients (3.9 per cent), granulomatous prostatitis in 17 (1.3 per cent), bacillus Calmette-Guerin pneumonitis or hepatitis in 12 (0.9 per cent), arthritis or arthralgia in 6 (0.5 per cent), hematuria requiring catheterization or transfusion in 6 (0.5 per cent), skin rash in 5 (0.4 per cent), skin abscess in 5 (0.4 per cent), ureteral obstruction in 4 (0.3 per cent), epididymo-orchitis in 2 (0.2 per cent), bladder contracture in 2 (0.2 per cent), hypotension in 1 (0.1 per cent) and cytopenia in 1 (0.1 per cent). Most of the severe irritative side effects and subsequent systemic complications can be prevented with prophylactic isoniazid given for 3 days, beginning the morning of treatment. Patients with life-threatening systemic bacillus Calmette-Guerin infection or anaphylaxis should receive 500 mg. cycloserine twice daily for 3 days in addition to combination antituberculous therapy because the rapid action of this drug may be life-saving. Direct intralesional bacillus Calmette-Guerin immunotherapy can produce sepsis and death, and should be avoided but intravesical bacillus Calmette-Guerin generally is well tolerated and has produced no complication in more than 95 per cent of the patients treated.

Biological Products↗
PubMed1985

Transseptal crossed vasovasostomy.

We examined 11 patients with acquired obstructive azoospermia resulting from irreparable obstruction of 1 vas deferens and severe damage to the contralateral testis. All of the patients underwent transseptal crossed vasovasostomy with no morbidity. Of 8 patients evaluated with postoperative semen analyses 4 (50 per cent) demonstrated total sperm counts of 29 to 205 million and 2 pregnancies (25 per cent) have been reported, with followup ranging from 5 months to 2 years. The etiologies of the vasal obstruction included previous inguinal surgery in 7 patients, vasectomy in 1, ejaculatory duct obstruction in 1, ectopic ureter in 1 and vasal agenesis in 1. Factors leading to loss of the contralateral testis were torsion in 5 patients, mumps orchitis in 2, varicocele in 1, pediatric inguinal herniorrhaphy in 1, epididymal blow out in 1 and unknown in 1. A representative case involving a unilateral ectopic ureter emptying into the seminal vesicle and subsequent contralateral testicular torsion is presented. The results indicate that a transseptal crossed vasovasostomy should be done in patients satisfying the criteria presented.

Adult↗
PubMed1983

Diagnosis of acute testicular torsion using radionuclide scanning.

We analyzed retrospectively 99mtechnetium scrotal scan findings in 37 patients with acute scrotal pain. Correlation between scan interpretation, and either surgical findings and/or final clinical diagnosis revealed an accuracy of 89 per cent. Only 1 false negative and 3 false positive results were recorded. Scan data revealed a positive predictive value of 75 per cent, negative predictive value of 96 per cent, sensitivity of 90 per cent and specificity of 89 per cent. An inter-institutional observer study also was conducted to assess reliability of the scan, resulting in an 88 per cent agreement. The testicular scan has been found to be an accurate and reliable method to distinguish between epididymo-orchitis and testicular torsion.

Acute Disease↗
PubMed1982

Testicular malacoplakia.

We report the twentieth case in the world literature of testicular malacoplakia. This lesion occurs mainly in middle-aged men, appearing clinically as epididymo-orchitis or enlargement of the testicle with fibrous consistency and some soft areas. Malacoplakia is now considered a nonspecific inflammatory granulomatous lesion subsequent to an infection by gram-negative bacteria. In our case Escherichia coli was cultured in the urine and testicular tissue. The ultrastructural study shows the histiocytic nature of the cellular infiltrate as well as the morphology of Michaelis-Gutmann bodies. Bacilliform structures were not found. The cellular and humoral immunological studies did not show alterations.

Escherichia coli Infections↗
PubMed1981

The role of chlamydiae in genitourinary disease.

The incidence of chlamydial organisms in early morning urine specimens obtained from 53 men and 50 women without evidence of urinary tract pathology was 2 per cent in both groups. Early morning urine specimens and/or prostatic fluid or semen was examined in 50 patients with chronic prostatitis and 39 (56 per cent) yielded this organism. Of 31 patients with epididymo-orchitis the early morning urine specimens yielded chlamydiae in 12 (39 per cent) and in those with the acute form of disease the incidence was 56 per cent. The chlamydia recovery rate was 27 per cent in 119 women with cystourethritis. Within these groups of patients approximately 50 per cent of sexual partners had urine cultures positive for chlamydia. The importance of reinfection and the need for careful treatment of patients and consort should be stressed. An appropriate transport medium is necessary for specimen collection and adequate culture facilities are required to achieve effective chlamydial recovery. Trimethoprim-sulfamethoxazole and tetracycline were used effectively in the study for primary and secondary drug therapy.

Adolescent↗
PubMed1976

Use of radioisotope scan in evaluation of intrascrotal lesions.

There were 98 patients with a variety of intrascrotal lesions studied with a radioisotope 99mtechnetium-pertechnetate scanning technique. Retrospective analysis in 50 patients subjected to an operation revealed a 94 per cent accuracy of the scan in the differential diagnosis of testicular torsion and epididymitis as compared to a clinical accuracy of 48 per cent. In 7 patients with a scan diagnosis of epididymo-orchitis with abscess the diagnosis was confirmed during the operation or by followup examination. While the scan has been a simple, safe, rapid and reliable technique to differentiate acute and subacute lesions, it has proved to be of limited diagnostic significance in cases of chronic intrascrotal lesions and carcinoma.

Adolescent↗