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PubMed2000

Recurrent epididymo-orchitis in patients with Behçet's disease.

PURPOSE: We study the clinical features of epididymo-orchitis in patients with Behçet's disease. MATERIALS AND METHODS: Of 57 men with Behçet's disease 7 had epididymo-orchitis during the course of disease. A questionnaire was applied to all cases and the clinical features were recorded. HLA class 1 was determined and a pathergy test was performed. RESULTS: All 7 patients fulfilled the international study group criteria for Behçet's disease. All patients had recurrent oral ulcers, skin lesions (folliculitis, erythema nodosum-like lesions) and uveitis, and 6 had recurrent genital ulcers, 2 arthritis, 1 vasculitis and 4 central nervous system involvement. The pathergy test was positive in 4 patients and all had B5(51). The allele B5101 was present in 6 patients and 1 had B5102. Recurrences were observed in 5 patients. Concurrent symptoms with epididymo-orchitis consisted of oral ulcers, fever, uveitis, arthritis and penile ulcer. Colchicine, glucocorticoids, nonsteroidal anti-inflammatory drugs and cyclosporine were administered. CONCLUSIONS: Epididymo-orchitis in patients with Behçet's disease is not as infrequent as believed. It was not the first manifestation of the disease but developed during followup. In any patient with epididymo-orchitis Behçet's disease should be considered, particularly in regions with a high prevalence of the disease.

Adult↗

PubMed2001

Serum sperm antibodies unrelated to mumps orchitis.

In order to determine whether there is an association between mumps orchitis and serum sperm antibodies, we tested patients at the time orchitis was diagnosed (n = 7) and individuals who had had orchitis at least 1 month previously (n = 14). Data were compared with the results for a control group of blood donors (n = 20). Sperm antibodies were detected by the gelatin agglutination test of Kibrick, the tray agglutination test of Friberg and the ELISA. Clinically significant sperm antibody levels were not found in patients in the early stages of the disease. Four subjects tested post-disease were positive in the Friberg test and one was positive in the ELISA. One control serum was also positive in the latter test. Significant differences were not found between levels in patients in the early stages of the disease and levels in individuals post-disease, although the results of the Friberg test differed significantly between controls and former mumps orchitis cases. These data do not support the assumption of an involvement of humoral immunity against spermatozoa in mumps orchitis patients.

Agglutination Tests↗

PubMed2006

Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?

OBJECTIVE: To report clinical findings associated with an increased incidence of mumps orchitis in Liverpool, UK, as in the last 2 years there has been a four-fold increase in the number of notified viral mumps cases in the UK. PATIENTS AND METHODS: In the 8 months before April 2005, patients presenting to the Accident and Emergency/Urology Departments of the Royal Liverpool University Hospital with a diagnosis of epididymo-orchitis were identified from the emergency urological admission database. RESULTS: Of 195 males presenting with an acute history of testicular pain and swelling, 25 gave a history of mumps parotitis 4-11 days earlier. Three had bilateral orchitis and two needed scrotal exploration to exclude torsion. Scrotal ultrasonography findings varied from increased vascularity to abnormal testicular echo texture. Treatment included analgesia, scrotal support, re-hydration and broad-spectrum antibiotics. Of the 10 patients followed-up to date, four had testicular abnormalities; one had persistent testicular pain, one a change in testicular consistency, one a noticeably reduced size of one testis, and one significant testicular atrophy. CONCLUSION: As postpubertal mumps in males is associated with a 40% incidence of orchitis, parents should be made aware that failing to immunize their children threatens the future fertility of their sons. Young men not immunized as children should be counselled and offered urgent vaccination. Clinicians should be aware that epididymo-orchitis may be secondary to mumps infection even with no history or clinical evidence of parotitis.

Adolescent↗

PubMed1980

Bacterial epididymo-orchitis in children and adolescents.

Five cases of bacterial epididymo-orchitis are presented. These patients demonstrate three distinct mechanisms of bacterial infection of the intrascrotal structures: epididymo-orchitis as a presentation and a complication of urinary tract infection; epididymo-orchitis associated with sexually transmitted disease; and epididymo-orchitis associated with systemic infection. We recommend urine, urethral, and blood bacterial cultures, in addition to viral serologic studies, as an appropriate evaluation for any patient with epididymo-orchitis.

Adolescent↗

PubMed2005

Involvement of CD44 in leukocyte recruitment to the rat testis in experimental autoimmune orchitis.

Experimental autoimmune orchitis (EAO) is characterized by an interstitial mononuclear cell infiltrate and a severe lesion of the seminiferous tubules with germ cells that undergo apoptosis and sloughing. The aim of this study was to determine the role of CD44 in testicular leukocyte recruitment in EAO. The biological functions of CD44 have been attributed to the generation of a functionally active hyaluronan-binding phenotype. Orchitis was induced in Sprague-Dawley adult rats by active immunization with an emulsion of testicular homogenate and complete Freund's adjuvant using Bordetella pertussis as co-adjuvant. Control rats (C) injected with saline and adjuvants and normal (N) untreated rats were also studied. CD44 expression was analyzed by flow cytometry in peripheral blood mononuclear cells (PBMC) and lymph node cells isolated from rats at different times after the first immunization. We observed an increase in the mean fluorescence intensity of both samples in the C and experimental (E) groups only after the immunization period. A significant decrease in percentage of CD44+PBMC and in mean fluorescence intensity was observed in rats with orchitis compared with the C group. By in vitro hyaluronic acid-binding assay we demonstrated that the percentage of PBMC adhesion was higher in the E group compared with the C and N groups. By immunohistochemistry, we observed a significant increase in the number of CD44+cells in the testicular interstitium of rats with severe orchitis compared with the N and C groups. These results suggested that the CD44 molecule is involved in the homing of lymphomonocytes into the testes of rats with autoimmune orchitis.

Acute Disease↗

PubMed2001

Correlation between inhibin secretion and damage of seminiferous tubules in a model of experimental autoimmune orchitis.

The aim of the present study was to evaluate inhibin secretion in rats with autoimmune orchitis. As we have previously described, experimental autoimmune orchitis (EAO) induced in rats by active immunization with testis homogenate and adjuvants is characterized by an interstitial mononuclear cell infiltrate and sloughing of the germinal epithelium. At 120 days after the first immunization 60% of the rats exhibited a severe orchitis with large areas of aspermatogenic seminiferous tubules in which only spermatogonia and Sertoli cells with cytoplasmic vacuolization remained attached to the tubular wall. None of the untreated (N) or control (C) rats revealed pathological alterations. Sixty percent decrease in testis weight was observed in rats with EAO compared with N or C groups. A 3-fold increase in serum FSH levels was observed in rats with EAO compared with N or C groups (19.8+/-3.7 vs 5.6+/-0.3 and 5.9+/-0.1 ng/ml respectively). A significant decrease in inhibin B levels was observed in rats with EAO when compared with N or C groups (40+/-4.6 vs 207+/-38.8 and 221.4+/-28.6 pg/ml respectively). An inverse correlation between inhibin B and FSH serum levels and a direct correlation between inhibin B and testis weight were found. Strong expression of the inhibin alpha-subunit in Sertoli cells of untreated and control rats was observed; this subunit was undetectable or poorly detectable in rats with orchitis. Positive staining for the inhibin alpha-subunit was also observed in Leydig cells of all groups studied. In conclusion, using a model of autoimmune orchitis our results show that circulating inhibin B levels and inhibin alpha-subunit expression in Sertoli cell cytoplasm closely correlate with the degree of damage of the germinal epithelium.

Analysis of Variance↗

PubMed1979

The effect of neonatal thymectomy on the induction of autoimmune orchitis in rats.

The objective of these experiments was to determine the effects of neonatal thymectomy on the induction of experimental autoimmune orchitis in inbred rats of the Fischer 344 and Lewis strains. It was found that thymectomy alone in Lewis rats, and thymectomy followed by immunization with testicular extract in both Lewis and Fischer 344 rats, led to the development of autoimmune orchitis, as indicated by decreased testes weights, increased serum spermagglutinating antibody titers and histopathological changes in the testes. These data indicate that rats of the Lewis strain are genetically predisposed to the development of autoimmune orchitis, and thymectomy alone leads to active manifestations of the disease, which are further enhanced by subsequent immunization with testicular extract. In Fischer 344 rats, thymectomy followed by immunization leads to indications of early signs of experimental autoimmune orchitis. This is in contrast to experimentally induced autoimmune diseases in other model systems, where previous investigators have reported that thymectomy lessens or prevents induction of autoimmune disease. It is suggested that these differences may be related to the timing of thymectomy with regard to differences in the time of appearance of sperm antigens (at puberty) as compared to pre-natal and early neonatal appearances of other autoantigens.

Animals↗

PubMed1992

Mumps orchitis among soldiers: frequency, effect on sperm quality, and sperm antibodies.

This study reports on 72 young soldiers who suffered from a recent epidemic of acute mumps, with special emphasis on 19 who suffered from mumps orchitis and whose spermograms were in the fertility range. The immunological work-up for antibodies in sera or seminal plasma gave normal results for the patients diagnosed with orchitis, as well as the controls. The only remarkable finding was an increased risk of borderline significance for orchitis in smokers. The present study has proven that the presence of antisperm antibodies does not play a role in the etiology of mumps orchitis.

Antibodies↗

PubMed1998

Acute scrotum due to edidymo-orchitis associated with vasal anomalies in children with anorectal malformations.

Epididymo-orchitis, an uncommon cause of acute scrotum in prepubertal boys, is infection or inflammation of epididymis and testis. Epididymo-orchitis may be associated with urinary tract infections or reflux of urine predisposed by an underlying vasal anomaly. Two infants with anorectal malformations who presented with acute scrotum are reported. The surgical exploration of the testes showed findings consistent with epididymo-orchitis. Further radiological investigations of urinary tract showed vasal anomalies in both patients. If a patient with anorectal malformation presents with acute scrotum, epididymo-orchitis should be suspected initially. Evaluations should be directed toward defining predisposing vasal anomaly, and appropriate therapeutic measures should be undertaken to prevent recurrences.

Anal Canal↗

PubMed1991

Systemic treatment with interferon-alpha 2B: an effective method to prevent sterility after bilateral mumps orchitis.

In men orchitis represents the most common complication of mumps infection and occurs in 5 to 37% of this population. Bilateral manifestation is observed in 16 to 65% of the patients. The most important danger is the risk of testicular atrophy which results in sterility. Four patients with bilateral mumps orchitis received systemic treatment with interferon-alpha 2B (3 x 10(6) IU per day) for 7 days. All acute symptoms of mumps orchitis disappeared within 2 to 4 days of hospitalization. During 6 to 15 months of followup no incidence of testicular atrophy was observed. In 3 of 4 patients pre-treatment examination revealed subfertility (oligoasthenospermia), while 2 to 4 months after interferon treatment, as well as during the entire followup period normospermia was found. No severe adverse effects occurred during treatment. The flu-like symptoms could be prevented by concomitant administration of paracetamol (500 mg. 3 times a day). Systemic treatment with interferon-alpha 2B appears to be highly effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. Further investigations involving larger populations should be performed to establish the present promising results.

Acetaminophen↗

PubMed1980

Lepromatous leprosy presenting as orchitis.

Two patients with lepromatous leprosy presenting initially because of lepromatous orchitis are reported. These cases are unusual because they were diagnosed as lepromatous orchitis at a stage when no other evidence of leprosy was present. Generalized skin lesions characteristic of lepromatous leprosy subsequently developed in one of these patients. It is suggested that lepromatous orchitis should be actively considered in the differential diagnosis of orchitis and infertility.

Adult↗

PubMedDate not supplied

Epididymitis, orchitis, and related conditions.

Epididymitis is the most common intrascrotal inflammation. Retrograde ascent of pathogens is the usual route of infection. Nonspecific bacterial epididymitis is caused by various aerobic bacteria, is frequently associated with anatomic abnormalities, and represents the most common type of epididymitis in older men. Sexually transmitted epididymitis is usually caused by Chlamydia trachomatis or Neisseria gonorrhoeae and represents the most frequent cause of acute scrotal swelling in men younger than 35 years of age. Underlying urologic abnormalities are uncommon in patients with sexually transmitted epididymitis. Systemic infections and trauma are unusual causes of epididymitis. Orchitis is less common than epididymitis. Blood-borne dissemination is the major route of testicular infection. With the exception of viral diseases, genitourinary tract infections seldom involve the testis primarily. Mumps is the most frequent cause of viral orchitis. Pyogenic orchitis usually results from an inflammatory process in the epididymis. Systemic dissemination of granulomatous infections may occasionally cause orchitis.

Adult↗

PubMed1986

An unusual presentation of tuberculous epididymo-orchitis: case report.

An Asian man initially presented with a urethral discharge caused by lower urinary tract infection, which was followed by acute epididymo-orchitis. This responded well to antibiotics but was followed by a less acute form of epididymo-orchitis, which did not respond to antibiotics and which tissue biopsy showed to be tuberculous. The inflammatory injury of acute epididymo-orchitis may have activated a silent tuberculous focus in the epididymis, which led to the subsequent subacute tuberculous epididymo-orchitis.

Adult↗

PubMed2005

Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh.

Epididymo-orchitis among men younger than 35 years is mainly caused by chlamydial infection. National guidelines for the management of this condition have been published. The aim of this study was to audit the management of epididymo-orchitis in a major teaching hospital. To this end we performed a retrospective study of patients with epididymo-orchitis admitted to the Department of Urology in the Western General Hospital, Edinburgh between 1998 and 2003. Case-notes of 108 cases of epididymo-orchitis were reviewed. The diagnosis was established by ultrasound in 94% of cases. Patients were not tested routinely for chlamydial infection and the majority of men younger than 35 years were treated inappropriately with ciprofloxacin. The management of patients younger than 35 years was not in accordance with the recommendations of national guidelines. Chlamydia trachomatis is sexually transmissible and is not responsive to ciprofloxacin. As a result of this audit, each patient will be tested for chlamydial infection and men younger than 35 years will be treated with ofloxacin. Sexual partners of patients with chlamydial infection will be treated in the department of genitourinary medicine.

Adult↗

PubMed2000

Epididymo-orchitis following intravesical bacillus Calmette-Guérin therapy.

OBJECTIVE: To describe a case of epididymo-orchitis that developed four years after treatment with intravesical bacillus Calmette-Guérin (BCG) and to review the incidence of this adverse effect. DATA SOURCES: Information about the patient was obtained from the medical chart. A MEDLINE search of English-language literature (from January 1976 to April 1999) was conducted. STUDY SELECTION: All case reports of BCG-related epididymo-orchitis were evaluated. Review articles describing complications of BCG therapy for bladder cancer and the prevention and treatment of these complications were reviewed. DATA EXTRACTION: Studies were evaluated for reports of BCG-related epididymo-orchitis and its treatment. DATA SYNTHESIS: Our case report is compared with others reported in the literature. The incidence of BCG-associated epididymoorchitis is rare. CONCLUSIONS: Epididymo-orchitis should be considered as a late complication of BCG therapy for bladder cancer. Proper patient selection may help decrease the risk of complications from BCG therapy.

Adjuvants, Immunologic↗

PubMed2001

[A case report of granulomatous orchitis--review of 20 cases in Japan].

We report a case of granulomatous orchitis. A 31-year-old male complained of right lumbago and scrotal pain. The ultrasonographic finding was multiple hypo-echoic areas in the right testis as highly suggestive of testicular cancer. The diagnosis was made after orchiectomy. Granuromatous orchitis is a rare disease which true etiology remains obscure. Only 20 cases have been reported in Japan. The clinical, radiological and pathological features of 20 cases are presented and discussed. Patients' age ranged from 29 to 79 years, an average of 55 years. The left testis was involved in 7 patients, the right in 9 and 4 cases were bilateral. Ultrasonographic examination of the affected testis revealed hypoechoic mass, so little value in differentiating granulomatous orchitis from neoplasm. The correct diagnosis of granulomatous orchitis has never been made prior to surgery, because it clinically bears a lot of resemblance to testicular cancer. The diagnosis usually is made on histological examination. Orchiectomy is the main form of treatment to date, because antibiotics have little effect on the course of the disease and at the time of diagnosis, the testis is already destroyed and there is hardly any viable testicular tissue in the removed specimens.

Adult↗

PubMed2002

[A case of orchitis following vaccination with freeze-dried live attenuated mumps vaccine].

In Japan, freeze-dried live attenuated mumps vaccine has been used optionally since 1981. The effectiveness of mumps vaccination has been established by worldwide research since 1971. On the other hand, because of it's live activity several untoward effects have been reported. Vaccination-related mumps orchitis is a rare adverse effect of mumps vaccine. Only 9 cases of vaccination-related mumps orchitis have been reported in Japan. We describe a case of orchitis following mumps vaccination in adolescence. A 16 years-old male has admitted because of acute orchitis with high fever and painful swelling of right testis. The patient had received vaccination with freeze-dried live attenuated mumps vaccine 16 days before admission. After admission, the bed-rest had completely relieved the symptoms on 6th hospital day. The impaired testis has maintained normal size and consistency 6 months after discharge.

Adolescent↗

PubMed1990

[Spermatological disorders in patients with postmumps orchitis].

The author studied spermatozoa parameters in 27 patients, undergone postparotitic orchitis with fertile problems. Unilateral localization of the damaged testis was established in 21 men, but bilateral localization--in 6 men. The author divided the patients into two groups--the first group included patients, who underwent orchitis before 10 years of age and the second group of patients, who underwent the complication orchiepididymitis after 10 years of age. After examination of the ejaculate he found disturbances following disturbances with unilateral localization of orchitis in the first and second group in respect to the number of spermatozoa mil/ml in the following ratio 32:12, the ration of spermatozoa motility, described in percentage, was 39:10, but the ratio of velocity mic/sec was 8:5. Spermatogram showed azoospermia with definitive sterility in both groups of patients, who had bilateral localization of postparotitic orchitis.

Adult↗