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Canadian Urological Association Journal... Feb 2024Chronic epididymitis imposes significant physical and psychosocial distress on affected patients. Despite being a commonly encountered urologic condition, there remains...
INTRODUCTION
Chronic epididymitis imposes significant physical and psychosocial distress on affected patients. Despite being a commonly encountered urologic condition, there remains a paucity of understanding and literature surrounding the management and natural history of isolated epididymal pain. Typically, patients who do not respond to conservative management undergo an epididymectomy.; however, the literature on its efficacy is also scarce, with success rates varying widely from 10-90% in existing studies. Our goal was to better describe the etiology, and natural history of isolated epididymal pain. Furthermore, we aimed to describe the rates of success associated with epididymectomy.
METHODS
A retrospective case-control study was conducted at the Manitoba Men's Health Clinic, with the approval of the University of Manitoba Research Ethics Board. All patients presenting with chronic epididymitis, defined as discomfort or pain localized to the epididymis for at least three months, were identified. Information regarding patient demographics, past medical and surgical history, duration of pain, localization of pain, findings on previous ultrasounds, prior conservative therapies trialed and response rates, as well as response rates to surgical therapy were collected.
RESULTS
From April 2022 to 2023, a total of 275 patients with chronic orchialgia were identified, and among them, 74 patients specifically presented with chronic isolated epididymal pain. The average duration of symptoms was as follows: 22.9% of patients experienced symptoms for 3-6 months, 10% for 6-12 months, and 67.1% for over 12 months; 13.5% (n=10) had associated ejaculatory pain, 8.1% (n=6) had lower urinary tract symptoms, and 4.1% (n=3) had erectile dysfunction. Ultrasound findings were observed in 68.9% of patients, with 31.1% having an epididymal cyst, 27.1% having a varicocele, 5.4% having a spermatocele, and 4.1% having a hydrocele. Among those who underwent conservative therapy, only 36.2% of patients reported a positive response. Surgical intervention was performed on 23 patients, including 16 who underwent an epididymectomy, three who underwent cord denervation, and two who underwent vasovasostomy and spermatocelectomy each. Most (81.3%, n=13) patients who underwent an epididymectomy had a positive response to the surgical intervention, defined as no pain on followup, while all patients undergoing other surgical interventions experienced a positive response.
CONCLUSIONS
Chronic epididymal pain is a condition with limited data surrounding its management. Prior to referral, a large proportion of patients did not undergo any conservative treatment, and of those that did, there was limited response. For those who underwent surgical intervention, all were pain-free on followup, except three patients who underwent epididymectomy.
PubMed: 38381926
DOI: 10.5489/cuaj.8701 -
Clinical Medicine Insights. Case Reports 2022We report a case of a post-aspiration giant unilocular spermatocele in a young man. A 27-year-old man sought medical advice for a huge right scrotal swelling. The...
We report a case of a post-aspiration giant unilocular spermatocele in a young man. A 27-year-old man sought medical advice for a huge right scrotal swelling. The swelling first appeared following scrotal trauma and was aspirated. Shortly after, it reappeared and persisted for several years with a sense of heaviness, infrequent periods of right scrotal pain, and cosmetic concerns. Ultrasonography of the scrotum revealed a huge fluid cyst pushing the testis antero-inferiorly in the right hemi-scrotum. Scrotal exploration suggested the spermatocele nature of the cyst that emerged from the head of the epididymis. The cyst was excised, and its fluid content and wall underwent pathological examination for confirmation.
PubMed: 35591974
DOI: 10.1177/11795476221097218 -
Urology Case Reports Nov 2022Spermatocele is a common cause of benign scrotal swelling that mostly arises from the head of the epididymis. It is a fluid-filled swelling containing spermatozoa....
Spermatocele is a common cause of benign scrotal swelling that mostly arises from the head of the epididymis. It is a fluid-filled swelling containing spermatozoa. Torsion of a spermatocele is a very rare encounter for a urologist. It is poorly described in the English literature and there are only seven cases reported so far. There is no specific clinical feature suggesting spermatocele torsion and the diagnosis is often made during an emergency scrotal exploration. We report the eighth case of torsed spermatocele in a young adult diagnosed during emergency scrotal exploration for a suspected testicular torsion.
PubMed: 35959225
DOI: 10.1016/j.eucr.2022.102172 -
Folia Medica Cracoviensia Dec 2023Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15....
Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.
Topics: Male; Child; Adolescent; Humans; Adult; Spermatocele; Epididymis; Cysts; Scrotum; Ultrasonography
PubMed: 38578344
DOI: 10.24425/fmc.2023.148757 -
Urology Case Reports Nov 2020Ketamine related urinary tract complications were first reported in Hong Kong since 2007. The current case report describes a 37 years old male with long history of...
Ketamine related urinary tract complications were first reported in Hong Kong since 2007. The current case report describes a 37 years old male with long history of ketamine abuse, renal impairment, hypertension and HCV hepatitis, presented to us with insidious onset of painful scrotal swelling post bilateral nephrectomy, prostate and seminal vesicle preserving cystectomy. Radiological imaging and intraoperative finding revealed that it was a large spermatocele with urethroscrotal fistula, which was likely due to urethra stricture. The review of literature showed no guidelines for treatment, a symptoms based and multidisciplinary team approach is recommended.
PubMed: 32514403
DOI: 10.1016/j.eucr.2020.101284 -
Fertility and Sterility Mar 2023To assess the risk of new persistent opioid use in opioid-naïve men who underwent male fertility procedures.
OBJECTIVE
To assess the risk of new persistent opioid use in opioid-naïve men who underwent male fertility procedures.
DESIGN
Retrospective cohort study using a claims database.
SETTING
A database linking electronic medical record data and claims-assessing men who underwent fertility procedures between 2010 and 2021.
PATIENT(S)
Opioid-naïve men who underwent fertility procedures (open or laparoscopic varicocelectomy, spermatocele excision, and testicular excisional or incisional biopsy) without further surgical intervention requiring anesthesia in the 2 years after the index procedure. Those with and without perioperative opioid prescriptions were propensity score matched on age, race/ethnicity, smoking status, mental health diagnoses, and preoperative pain diagnoses.
INTERVENTION(S)
Perioperative opioid prescription.
MAIN OUTCOME MEASURE(S)
The primary outcome was the incidence of new persistent opioid use (opioid prescription 3-9 months after the index fertility procedure). The secondary outcome was prolonged opioid use (opioid prescription 9-24 months after the index fertility procedure).
RESULT(S)
A total of 387,565 men who underwent fertility procedures were identified, of whom 25.1% received an opioid prescription. After propensity score matching, 97,215 men were included; 4.7% of men who received a perioperative opioid prescription developed new persistent opioid use compared with 2.2% of those without a perioperative opioid prescription (risk ratio, 2.16; 95% confidence interval, 2.05-2.27; number needed to harm, 39). When assessing each unique fertility procedure independently, men who received perioperative opioids had statistically higher odds of developing new persistent opioid use for all procedure types. Men with new persistent opioid use were much more likely to go on and develop prolonged opioid use than men without new persistent opioid use.
CONCLUSION(S)
Opioid prescription after male fertility procedures is associated with a significant risk of new persistent opioid use, emphasizing the importance of judicious opioid prescribing for male fertility procedures.
Topics: Humans; Male; Analgesics, Opioid; Retrospective Studies; Pain, Postoperative; Practice Patterns, Physicians'; Opioid-Related Disorders; Drug Prescriptions
PubMed: 36529185
DOI: 10.1016/j.fertnstert.2022.12.015 -
La Pediatria Medica E Chirurgica :... Jun 2019Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually... (Review)
Review
Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually conservative. Many cases (up to 60%) regress spontaneously, especially if below 3 cm. Few cases have been reported in Literature (7 cases/2018). We add our patient as eighth case. He was a 13-year-old boy who was admitted for acute scrotum. Ultrasound excluded torsion of the testis and he was managed for 5 day conservatively. Based on clinical history and physical exam, we decided to perform a prompt surgery that revealed a torsion of epididymal cyst that was confirmed by histological exam.
Topics: Acute Disease; Adolescent; Humans; Male; Scrotum; Spermatic Cord Torsion; Spermatocele; Ultrasonography
PubMed: 31232012
DOI: 10.4081/pmc.2019.210 -
Annals of Medicine and Surgery (2012) Jul 2022Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of death. It is much more common in advanced age and it is rare among the youngest...
INTRODUCTION
Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of death. It is much more common in advanced age and it is rare among the youngest patients (under 45 years of age).
CASE PRESENTATION
we report an unusual presentation of advanced gastric adenocarcinoma in 39-year-old man, who presented to our hospital with inguinal hernia without obvious gastrointestinal symptoms. He had strong family history of cancer, heavy smoking habit and weight loss. The intra-operative procedure identified a cyanotic separate spermatocele which was confirmed by the urologist. During investigation we found multiple liver metastasis in abdominal CT and advanced gastric adenocarcinoma from gastric biopsy and metastasis in spermatic cord sample and peritoneum sample of poorly differentiated adenocarcinoma.
CONCLUSION
Although stomach adenocarcinoma is extremely rare in young patient but it should be kept in mind of physicians as a possible diagnosis if there are many risk factors.
PubMed: 35860116
DOI: 10.1016/j.amsu.2022.103974 -
Frontiers in Veterinary Science 2023A 30-year-old Lusitano stallion presented with an enlarged right epididymis. The ultrasound scan revealed a cyst-like formation and the histopathological examination was...
A 30-year-old Lusitano stallion presented with an enlarged right epididymis. The ultrasound scan revealed a cyst-like formation and the histopathological examination was compatible with epididymal cyst located at the body/tail transition, epididymal spermatocele and sperm granuloma and epididymitis. However, these conditions did not seem to affect the animal's reproductive performance, nor did the semen parameters analyzed over the 8 years after the diagnosis show significant changes. Nevertheless, since the ejaculate contains mostly sperm cells from the tail of the epididymis, where fertile spermatozoa are stored until ejaculated, a deep knowledge of the different conditions that can affect this organ is of the utmost importance.
PubMed: 37065254
DOI: 10.3389/fvets.2023.1145742 -
Anales de Pediatria Jul 2019
Topics: Adolescent; Epididymis; Humans; Male; Spermatic Cord Torsion; Spermatocele
PubMed: 31280817
DOI: 10.1016/j.anpedi.2018.05.019