Acute orchitis deciphered: Coxsackievirus B strains are the main etiology and their presence in semen is associated with acute inflammation and risk of persistent oligozoospermia.

Although various viruses are considered to be the clinical cause for acute orchitis, it is completely unclear to what extent and which viruses are etiologically involved in acute orchitis and what the clinic and course of these patients are like. Therefore, a prospective study was set up to decipher acute isolated orchitis. Between July 2007 and February 2023, a total of 26 patients with isolated orchitis were recruited and compared with 530 patients with acute epididymitis. We were able to show for isolated orchitis, that (1) orchitis is usually of viral origin (20/26, 77%) and enteroviruses with coxsackievirus B strains (16/26, 62%) are predominant, (2) virus isolates could be received from semen indicating the presence of replication-competent virus particles, (3) a polymerase chain reaction (PCR) for enteroviruses should be conducted using semen provided at the onset of disease, because the virus is not detectable in serum/urine, (4) there is a circannual occurrence with the maximum in summer, (5) orchitis is associated with a characteristic inflammatory cytokine panel in the semen and systemic inflammation, (6) orchitis is usually rapidly self-limiting, and (7) about 30% of patients (6/20) suffer ongoing oligozoospermia. These seven emerging aspects are likely to fundamentally change thinking and clinical practice regarding acute isolated orchitis.

The utility of diffusion-weighted imaging and ADC values in the characterization of mumps orchitis and seminoma.

BACKGROUND: Diffusion-weighted imaging (DWI) can quantitatively reflect the diffusion characteristics of tissues, providing a theoretical basis for qualitative diagnosis and quantitative analysis of a disease. PURPOSE: To characterize testicular lesions that present as a hypointense signal on magnetic resonance imaging (MRI) T2-weighted images using DWI. MATERIAL AND METHODS: Study participants were divided into three groups. Group A were healthy controls (n = 35), group B included patients with mumps orchitis (n = 20), and group C included patients with seminoma (n = 15). DWI sequences used b-values of 0, 1000, and 2000 s/mm2. Apparent diffusion coefficient (ADC) values between 1000 and 2000 s/mm2 were calculated by MRI postprocessing software. The Kruskal-Wallis test and receiver operating characteristic analysis were performed to evaluate how well ADC values distinguished between mumps orchitis and seminoma. RESULTS: Normal testicular tissue showed a hyperintense signal on DWI and hypointensity on the ADC map: mean ADC value was 0.77 (0.69-0.85) ± 0.08 ×10-3 mm2/s. Mumps orchitis and seminoma showed slight hyperintensity on DWI: mean ADC values were 0.85 (0.71-0.99) ± 0.15 ×10-3 mm2/s and 0.43 (0.39-0.47) ± 0.04 × 10-3 mm2/s, respectively. There were statistically significant differences in mean ADC values between normal testicular tissue and seminoma and between mumps orchitis and seminoma. The cutoff ADC value for differentiating seminoma from mumps orchitis was 0.54 × 10-3 mm2/s. The sensitivity, specificity, and Youden Index for diagnosing seminoma were 99%, 31%, and 30%, respectively. CONCLUSION: High b-value DWI has potential utility for differentiating mumps orchitis from seminoma in the clinical setting.

Autoimmune experimental orchitis and chronic glomerulonephritis with end stage renal disease are controlled by Cgnz1 for susceptibility to end organ damage.

Cgnz1 on chromosome 1 mapped into a 1.34 Mb region of chromosome 1 in NZM2328 confers the progression of immune complex (IC)-mediated glomerulonephritis (GN) from acute GN (aGN) to chronic GN (cGN) with severe proteinuria and end stage renal disease in female mice. This genetic locus mediates podocyte susceptibility to IC-mediated damage. Taking advantage of the published observation that Cgnz1 is derived from NZW and that NZW is susceptible to orchitis, epididymitis and vasitis while C57L/J is resistant to these diseases, the possibility that this genetic region also confers germ cells susceptible to damage with aspermatogenesis and sterility in an active experimental autoimmune orchitis (EAO) model was investigated. Male mice from multiple intrachromosome (chromosome 1) recombinant strains were subjected to immunization with a sperm homogenate in CFA with concomitant administration of Bordetella pertussis toxin. There was concordance of the progression from aGN to cGN, severe proteinuria and end stage renal disease with susceptibility of EAO in NZM2328 and its congenic strains with various chromosome 1 genetic intervals introgressed from C57L/J to NZM2328. Both resistant and susceptible strains made comparable anti-testis and anti-sperm Abs. Thus the genetic interval that determines susceptibility to EAO is identical to that of Cgnz1 and mapped to the 1.34 Mb region in chromosone 1. This region likely confers germ cells in the male gonad susceptible to damage by immunologically mediated inflammation. This region has been tentatively renamed Cgnz1/Eaoz1. These observations further emphasize the importance of end organ susceptibility to damage in the pathogenesis of both systemic and organ specific autoimmune diseases.

Comparison between microsurgical varicocelectomy with and without testicular delivery for treatment of varicocele: A systematic review and meta-analysis.

The present study was conducted to assess the semen parameters, complications and clinical effect of microsurgical varicocelectomy with testicular delivery (TD) for treatment of varicocele. Relevant studies were collected and reviewed systemically from PubMed, Medline, Embase, Web of Science, China National Knowledge Infrastructure databases and the Cochrane Library and a meta-analysis was performed. Relative ratio (RR), standardised mean difference (SMD) and their 95% confidence intervals (CIs) were adopted to estimate the outcome measures. Eight articles and a total of 1,139 subjects including 487 patients with TD in microsurgical varicocelectomy and 652 patients without TD were enrolled in this meta-analysis. The pooled RR indicated that microsurgical varicocelectomy with TD increased the incidence of orchiepididymitis (RR = 4.36, 95% CI = 1.12-16.99, p = 0.034) and scrotal oedema (RR = 4.25, 95% CI = 2.40-7.54, p = 0.000) than microsurgical varicocelectomy without TD postoperatively. In conclusion, compared to microsurgical varicocelectomy without TD, TD to further ligate the gubernacular veins in microsurgical varicocelectomy results in a higher incidence of orchiepididymitis and scrotal oedema and take longer operation time. However, TD may not have any beneficial influences on semen parameters, serum testosterone, varicocele occurrence, wound infection and natural conception.

[High Orchidectomy and Histopathology to Differentiate Granulomatous Orchitis from Testicular Malignancy : Case Report and Literature Review].

A 59-year-old man presented with pain and swelling of the right scrotum. Magnetic resonance imaging revealed a mass withsignal intensity similar to background on an apparent diffusion coefficient (ADC)-map of the upper region of the right testis. Inflammation was considered, but a testicular tumor could not be ruled out. Right high orchidectomy and histopathological assessment revealed granulomatous orchitis. The cause, clinical course and treatment of rare granulomatous orchitis remain unknown. Granulomatous orchitis and testicular tumor are difficult to discriminate, and high orchidectomy is usually applied along with histopathological assessment to achieve a definitive diagnosis. On the other hand, some patients who were only medically treated for granulomatous orchitis have recovered. We recently found that diffusionweighted imaging and ADC values derived from magnetic resonance images can differentiate testicular tumor from orchitis. We suggest an algorithm for the diagnosis and treatment of granulomatous orchitis considering the present patient and previous reports.

Rives Technique for the Primary Larger Inguinal Hernia Repair: A Prospective Study of 1000 Repairs.

OBJECTIVE: We report a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. A mesh placed in the preperitoneal space can reduce recurrences and chronic pain. METHODS: For the larger primary inguinal hernias (Types 3, 4, 6, and some 7), we favour preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach. The Rives technique was performed on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery. RESULTS: The mean operative time was 31.8 min. Pain assessment after 24 h with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad. Surgical wound complications were below 1%, and urinary retention was 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation. There was spermatic cord and testicular oedema with some degree of orchitis in 17 patients. The clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12-192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3-10). CONCLUSIONS: The Rives technique requires a sound knowledge of inguinal preperitoneal space anatomy, but it is an excellent technique for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.

Prostatitis, other genitourinary infections and prostate cancer: results from a population-based case-control study.

PURPOSE: We relied on a population-based case-control study (PROtEuS) to examine a potential association between the presence of histologically confirmed prostate cancer (PCa) and history of genitourinary infections, e.g., prostatitis, urethritis, orchitis and epididymitis. PATIENTS AND METHODS: Cases were 1933 men with incident PCa, diagnosed across Montreal hospitals between 2005 and 2009. Population controls were 1994 men from the same residential area and age distribution. In-person interviews collected information about socio-demographic characteristics, lifestyle and medical history, e.g., self-reported history of several genitourinary infections, as well as on PCa screening. Logistic regression analyses tested overall and grade-specific associations, including subgroup analyses with frequent PSA testing. RESULTS: After multivariable adjustment, prostatitis was associated with an increased risk of any PCa (OR 1.81 [1.44-2.27]), but not urethritis (OR 1.05 [0.84-1.30]), orchitis (OR 1.28 [0.92-1.78]) or epididymitis (OR 0.98 [0.57-1.68]). The association between prostatitis and PCa was more pronounced for low-grade PCa (Gleason ≤ 6: OR 2.11 [1.61-2.77]; Gleason ≥ 7: OR 1.59 [1.22-2.07]). Adjusting for frequency of physician visits, PSA testing frequency or restricting analyses to frequently screened subjects did not affect these results. CONCLUSION: Prostatitis was associated with an increased probability for detecting PCa even after adjustment for frequency of PSA testing and physician visits, but not urethritis, orchitis or epididymitis. These considerations may be helpful in clinical risk stratification of individuals in whom the risk of PCa is pertinent.

Neonatal testicular cell transplantation restores murine spermatogenesis damaged in the course of herpes simplex virus-induced orchitis.

Genital tract infection and inflammation may affect male fertility, causing germ and Sertoli cell loss. We determined if testicular cell transplantation is effective at repairing testicular injury induced by herpes simplex virus (HSV) orchitis. ROSA26 mice were used as donors and the recipients were C57BL/6 mice after HSV testicular inoculation; some of the recipients were treated with the antiviral drug acyclovir (ACV). ACV reduced the amount of HSV antigen in testes on Day 3 after transplantation and enhanced the efficacy of transplantation at Day 30. In recipient testes, donor Sertoli cells formed new seminiferous tubules; significantly more new tubules were observed in the testes of ACV-treated mice compared with mice not treated with ACV (17.8% vs 3.6%). Over half (50.4%) of new tubules in ACV-treated testes contained germ cells and round spermatids were detected in 14.2% of new tubules compared with 15.9% and 5.3% in testes not treated with ACV, respectively. At Day 150 the seminiferous epithelium was completely recovered in some donor tubules and elongated spermatids were observed inside it. Thus, our findings reveal the effectiveness of the combination of antiviral therapy with neonatal testis-cell transplantation for the restoration of spermatogenesis damaged by viral infection.

Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/05.

Mumps outbreaks in highly vaccinated populations continue to be reported globally. Therefore, quantifying the burden of mumps morbidity accurately will be necessary to better assess the impact of mumps vaccination programmes. We aim to estimate the true morbidity resulting from mumps complications in terms of hospitalised orchitis, meningitis, oophoritis and pancreatitis in England during the outbreak in 2004/05. This outbreak in England led to a clear increase in hospitalisations coded to mumps for complications of orchitis in those born in the 1970s and 1980s and possibly for meningitis in those born in the 1980s. A simple statistical model, based on analysing time trends for diagnosed complications in hospital databases with routine laboratory surveillance data, found that the actual morbidity was much higher. There were 2.5 times (166 cases) more mumps orchitis cases in the 1970s cohort and 2.0 times (708 cases) more mumps orchitis cases in the 1980s cohort than complications coded to mumps in hospital databases. Our study demonstrated that the mumps outbreak in England 2004/05 resulted in a substantial increase in hospitalised mumps complications, and the model we used can improve the ascertainment of morbidity from a mumps outbreak.

Mumps outbreak in Orthodox Jewish communities in the United States.

BACKGROUND: By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010. METHODS: Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated. RESULTS: From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine. CONCLUSIONS: The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.

Elevation of Serum Levels of High-Sensitivity Procalcitonin, C-reactive Protein, and Amyloid A in a Prepubertal Child with Mumps Orchitis.

BACKGROUND: Serum CRP concentrations are significantly elevated at the acute phase in patients with mumps orchitis, but little is known currently about other inflammatory biomarkers. METHODS: We report the measurements of serum inflammatory biomarkers [high-sensitivity procalcitonin (hs-PCT), C-reactive protein (CRP) and amyloid A] in a child with mumps orchitis. RESULTS: The patient's serum levels of CRP, hs-PCT, and amyloid A were highly increased at the acute phase, but returned to normal levels at convalescence. CONCLUSIONS: This case suggests that hs-PCT and amyloid A may not be useful for distinguishing between mumps orchitis accompanied by highly elevated serum concentrations of CRP and systemic bacterial infections.

Distribution of Epididymal Involvement in Mumps Epididymo-orchitis.

OBJECTIVES: To evaluate characteristic sonographic findings for mumps orchitis with epididymal involvement. METHODS: This study included 18 patients (aged 12-18 years) with mumps orchitis. We assessed the volume, echogenicity, and vascularity of the testes and the transverse diameter, echogenicity, and vascularity of the epididymal head, body, and tail. We classified 4 types of epididymal involvement: 1A, focal swelling of the epididymal head with hypervascularity only on the swollen head; 1B, focal swelling of the epididymal head with hypervascularity on the entire epididymis; 1C, diffuse swelling of the entire epididymis with hypervascularity; and 2, no epididymal involvement. The Student t test was used to evaluate the significance of the size of each part of the epididymis and the epididymal head-to-tail diameter ratio. RESULTS: Orchitis was unilateral in 13 patients and bilateral in 5. Of 23 affected hemiscrotums, 7 (30.4%) were type 1A, 4 (17.4%) type 1B, 2 (8.7%) type 1C, and 10 (43.5%) type 2. In 11 patients with unilateral epididymal involvement, the mean diameters ± SDs of the epididymal heads on the affected and contralateral sides were 1.11 ± 0.19 (range, 0.7-1.7) and 0.65 ± 0.14 (0.3-0.9) cm (significantly different, P <.001). The diameters of the epididymal tails on the affected and contralateral sides were 0.51 ± 0.41 (0.2-0.8) and 0.46 ± 0.21 (0.3-0.6) cm (not statistically different, P = .106). The mean head-to-tail ratios on the affected and contralateral sides were 2.28 ± 0.49 (1.29-3.00) and 1.41 ± 0.22 (1.00-1.75; significantly different, P < .001). In all types 1A and 1B, the ratio was higher than 2.00; in 22 of 23 unaffected epididymides, the ratio was lower than 2.00. CONCLUSIONS: Focal swelling of epididymal heads was a characteristic sonographic finding of mumps epididymo-orchitis, and a head-to-tail ratio higher than 2.00 can be a useful diagnostic finding.

[EPIDIDYMO-ORCHITIS IN PREPUBERTAL CHILDREN--PREVALENCE, ETIOLOGY, SUGGESTED DIAGNOSIS ALGORITHM].

Gonadal inflammation (GI) is a common disease that may affect prepubertal boys. Neonates may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. This inflammatory process is also prevalent in prepubertal boys. However, in this group, the etiology, the needed imaging modalities and proper management have not yet been clearly defined. This manuscript will systematically review the various etiologies causing GI in pre-pubertal boys, discuss the proper imaging needed, and image interpretation and will provide treatment and follow-up recommendations.

[Inflammatory diseases of scrotal organs in patients with brucellosis: Improvement of therapy].

AIM: To evaluate the efficacy of cycloferon used in the combination treatment of scrotal inflammatory diseases (SID) in patients with brucellosis. SUBJECTS AND METHODS: A total of 150 male patients with chronic brucellosis (CB) were examined. Inquiry, questioning, physical and ultrasound examinations, and spermiogram analysis were used to detect of diseases of the reproductive system. Twenty-two CB patients with SID were examined over time (before and after cycle therapy). In Group 1, combination therapy included 2 cycles of five intramuscular injections of cycloferon 0.25 g in each at a 10-day interval. In Group 2, a package of therapeutic measures meets the generally accepted standards. and Incorporation of cycloferon into the combination therapy of SID patients with CB positively affected the time course of clinical changes and spermatogenesis, declines the number of SID exacerbations, improved quality of life, and failed to cause side effects. CONCLUSION: The findings allow us to recommend cycloferon as the drug of choice in treating CB patients with SID.

Case of mumps orchitis after vaccination.

We present a case of mumps orchitis after vaccination. A 35-year-old man visited the emergency unit of our hospital for fever and right testicular pain on 7 January 2012. Two weeks before the visit, he underwent vaccination for mumps. After 7 days of hospitalization, the patient recovered from fever and testicular pain. Scrotal magnetic resonance imaging suggested right orchitis, and an increased level of serum mumps immunoglobulin M and immunoglobulin G indicated an initial infection of mumps virus. The peak value of immunoglobulin G showed 106 enzyme immunoassay unit 5 weeks after vaccination, which was 10-fold higher than the ordinary rise of a vaccinated individual. This fact leads to two possibilities. One is this happened as an adverse event of vaccination, and the other is that he actually had a wild-type infection at the same time as vaccination. There are some reports regarding adverse events of mumps vaccine; however, they might include wild-type infection.

[Clinical characteristics of mumps infection in children and adult patients].

The aim of the article was to study clinical manifestations of mumps infection (infectious parotitis) - a viral illness that affects glands that produce saliva, pancreas, and nervous system in children and adult patients. 219 patients (42 children and 177 adults) with mumps infection were studied. The investigation showed that parotid salivary gland disorder was the most common in adults; sublinguitis - inflammation of the sublingual gland was the most common in children. Serous meningitis occurred exclusively in preschool and early school age. Pancreatitis was less common in children than in adults. Infectious parotitis involving the parotid salivary gland was taking its normal course with positive outcome. Pancreatitis and serous meningitis occurred at the 3-5 day of illness with infectious parotitis. Pancreatitis was with positive outcome, with the exceptions of adult patients with pain syndrome (repair process delayed to 1-1.5 months). Mean duration of hospitalization for children with infectious parotitis was 7 days, for adults - 10-14 days. Mean duration of hospitalization for patients with serous meningitis was 14 days. Study showed that in 20,1% of 16-27 years old males developed orchitis.

Paediatric acute epididymo-orchitis temporally related to SARS-CoV-2 infection: A case series and review of the literature.

INTRODUCTION: Acute epididymo-orchitis (AEO) is becoming an increasingly common differential diagnosis in children with acute scrotal pain. It has been noted in adult men that SARS-CoV-2 has a propensity for involving the testis and epididymis, affecting sperm and testosterone production. Our literature search revealed only one case report of COVID-19 presenting with epididymo-orchitis in a child. We present three more children who presented with AEO, all recovering from PCR-confirmed SARS-CoV-2 infection. This article reviews the post-inflammatory aetiology of paediatric epididymo-orchitis, and the propensity SARS-CoV-2 has for the testis. PATIENTS AND METHODS: Two pre-pubertal ten-year-old patients presented to the emergency department with a 48-h history of gradual onset unilateral scrotal pain and increasing erythema of the ipsilateral scrotal skin. One fifteen-year-old boy was referred for ongoing symptoms four days following a diagnosis of AEO made by his General Practitioner. On further questioning, all three had PCR-confirmed COVID infection two weeks prior to the onset of their scrotal symptoms and had just ended their isolation period. A literature search was then performed using the keywords SARS-CoV-2, testes and paediatric acute epididymo-orchitis. DISCUSSION: The SARS-Cov-2 virus has a propensity for affecting the testis and epididymis. This puts patients at increased risk of acute epididymo-orchitis during COVID infections. The inflammation induced by the virus appears to affect the cells responsible for testosterone production and sperm quality. However, there is no evidence that viral transmission can happen via semen. CONCLUSION: SARS-Cov-2 infection can lead to acute epididymo-orchitis. Knowledge of this is clinically significant, firstly to avoid unnecessary surgical intervention due to a mistaken diagnosis of testicular torsion and secondly, due to the potential of the virus to affect sperm quality and testosterone production.

Managing epididymo-orchitis in general practice.

Epididymitis and orchitis normally co-exist with isolated epididymitis being more common than an isolated orchitis. Epididymo-orchitis (EO) can be acute (less than 6 weeks' duration), sub-acute, or chronic if persisting for more than three months and typically presents with testicular pain and swelling. Sexually transmitted infection (STI) is the most common cause in younger men and urinary tract pathogens are the more common culprits in older men. The most common pathogens in the under 35s are N gonorrhoeae and C trachomatis and E coli is the most common cause of acute epididymitis in the over 35s. Acute testicular torsion is the most important differential diagnosis of acute testicular pain especially in younger men. If there is any suspicion of testicular torsion, the patient should be referred to secondary care immediately as surgery is required within four to six hours. Patients who are in severe pain or systemically unwell should be referred for analgesia, IV antibiotics and hydration. Examination of a patient with acute EO classically reveals a swollen, tender testis with swelling of the epididymis which starts at the lower pole and moves up towards the head of the epididymis at the upper pole of the testes. UTI in men is often associated with bladder outflow obstruction. So it is important to examine the bdomen for a palpable bladder and to perform a digital rectal exam to check for BPH, prostate cancer, constipation and prostatitis which can also cause EO.

Epidemiology of mumps, mumps complications, and mumps orchitis in Korea using the National Health Insurance Service database.

PURPOSE: To analyze the presentation of mumps and mumps orchitis using the National Health Insurance Service Database (NHISD). MATERIALS AND METHODS: Using information from the NHISD representing all cases of mumps in Korea, data regarding mumps orchitis were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification codes were used for diagnosis. The incidence estimates of the number of mumps cases were analyzed using the Statistical Analysis System (SAS) software. RESULTS: Based on the NHISD, 199,186 people were diagnosed with mumps, and males accounted for 62.3% cases. Teen males accounted for 69,870 cases, the largest number of patients diagnosed with mumps. The annual incidence of mumps increased every year (poisson regression, hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.024-1.027; p<0.025). The risk of mumps was lower in females than that in males (poisson regression, HR 0.594, 95% CI 0.589-0.599; p<0.001). Of the 199,186 patients diagnosed with mumps, 3,872 patients (1.9%) had related complications. Among the mumps complications, the most diagnosed complication was mumps orchitis, which was seen in 41.8% of the males. Mumps orchitis cases accounted for less than 1.5% of the patients with mumps in minors under the age of 20 years and was somewhat higher in 2009 and 2013-2015. CONCLUSIONS: Among the complications related to mumps, meningitis was most common in females, while orchitis was dominant in males. Mumps orchitis also shows periodic outbreaks but is particularly prevalent in adults, which suggests the potential need for additional vaccination against mumps.