The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report.

BACKGROUND: Genitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male. CASE PRESENTATION: A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department. CONCLUSIONS: Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.

Activation of PTH1R alleviates epididymitis and orchitis through Gq and ß-arrestin-1 pathways.

Inflammation in the epididymis and testis contributes significantly to male infertility. Alternative therapeutic avenues treating epididymitis and orchitis are expected since current therapies using antibiotics have limitations associated to side effects and are commonly ineffective for inflammation due to nonbacterial causes. Here, we demonstrated that type 1 parathyroid hormone receptor (PTH1R) and its endogenous agonists, parathyroid hormone (PTH) and PTH-related protein (PTHrP), were mainly expressed in the Leydig cells of testis as well as epididymal epithelial cells. Screening the secretin family G protein-coupled receptor identified that PTH1R in the epididymis and testis was down-regulated in mumps virus (MuV)- or lipopolysaccharide (LPS)-induced inflammation. Remarkably, activation of PTH1R by abaloparatide (ABL), a Food and Drug Administration-approved treatment for postmenopausal osteoporosis, alleviated MuV- or LPS-induced inflammatory responses in both testis and epididymis and significantly improved sperm functions in both mouse model and human samples. The anti-inflammatory effects of ABL were shown to be regulated mainly through the Gq and ß-arrestin-1 pathway downstream of PTH1R as supported by the application of ABL in Gnaq± and Arrb1-/- mouse models. Taken together, our results identified an important immunoregulatory role for PTH1R signaling in the epididymis and testis. Targeting to PTH1R might have a therapeutic effect for the treatment of epididymitis and orchitis or other inflammatory disease in the male reproductive system.

Epididymitis with Pasteurella multocida isolated from two male Japanese Black beef calves.

Two male Japanese Black calves developed an enlarged scrotum and testis. Orchiectomy was performed and pus was collected during surgery. After removal of the testis, bacteriological and histopathological examinations were conducted to investigate the cause and confirm the diagnosis. Based on the results obtained, both cases were diagnosed with epididymitis caused by an infection with Pasteurella multocida. This is the first study to show that P. multocida causes epididymitis in male calves. Further studies are required to clarify the details underlying the infection of calves with P. multocida.

Association between left-sided varicocele and epididymo-orchitis with sonographic findings.

OBJECTIVE: The aim of this study was to investigate the relationship between left-sided varicocele and epididymitis or epididymo-orchitis. MATERIALS AND METHODS: The study included 72 patients with left side epididymitis (EP) or epididymo-orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP-EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter. RESULTS: The average age was 38 ± 8.4 years (range, 18-50 years) in Group 1, and 36 ± 9.1 years (range, 16-47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO (p < 0.001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively (p < 0.001). CONCLUSIONS: Left-sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis.

Multimodal ultrasound diagnosis of epididymo-orchitis with secondary testicular infarction: A case report.

We report a case of a 48-year-old man with testicular infarction caused by epididymo-orchitis (EO). Multimodal ultrasound showed extensive necrosis of the testis, and the patient underwent right orchiectomy. Postoperative pathology confirmed extensive necrosis of the testis. After 3 months of follow-up, the examination of scrotal ultrasound showed that the left testis and epididymis had no obvious abnormality.

Outcome of acute epididymo-orchitis: risk factors for testicular loss.

PURPOSE: Acute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups. METHODS: A retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period. RESULTS: 140 patients were identified, the age range was 0-89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0-15-year-olds), sexually active young men (Group 2a, 16-35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b. CONCLUSION: Overall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%).

Diagnostic nomogram to differentiate between epididymal tuberculosis and bacterial epididymitis.

PURPOSE: We developed and validated a diagnostic nomogram for differentiating epididymal tuberculosis (TB) from bacterial epididymitis. METHODS: In this retrospective study, we developed a prediction model based on demographics and clinical characteristics. Eligible patients were randomly divided into derivation and validation cohorts (ratio 7:3). Univariate and multivariate regression analyses were used to filter variables and select predictors. Multivariate logistic regression was used to construct the nomogram. Concordance index (C-index), calibration plots, and decision curves analysis (DCA) were used to assess the discrimination, calibration, and clinical usefulness of the nomogram. RESULTS: We included 147 patients (epididymal TB, 93; bacterial epididymitis, 54). The derivation cohort included 66 patients with epididymal TB and 38 with bacterial epididymitis; the validation cohort included 27 patients with epididymal TB and 16 with bacterial epididymitis. One regression model was built from three differential variables: body mass index, purified protein derivative, and chronic infection. Accordingly, one nomogram was developed. The model had good discrimination and calibration. C-indexes of the derivation and validation cohorts were 0.89 and 0.98 (95% confidence intervals, 0.83-0.95 and 0.94-1.01), respectively. DCA showed that the proposed nomogram was useful for differentiation. CONCLUSION: The nomogram can differentiate between epididymal TB and bacterial epididymitis.

CX3CR1 deficiency leads to impairment of immune surveillance in the epididymis.

Mononuclear phagocytes (MPs) play an active role in the immunological homeostasis of the urogenital tract. In the epididymis, a finely tuned balance between tolerance to antigenic sperm and immune activation is required to maintain epididymal function while protecting sperm against pathogens and stressors. We previously characterized a subset of resident MPs that express the CX3CR1 receptor, emphasizing their role in antigen sampling and processing during sperm maturation and storage in the murine epididymis. Bacteria-associated epididymitis is the most common cause of intrascrotal inflammation and frequently leads to reproductive complications. Here, we examined whether the lack of functional CX3CR1 in homozygous mice (CX3CR1EGFP/EGFP, KO) alters the ability of MPs to initiate immune responses during epididymitis induced by LPS intravasal-epididymal injection. Confocal microscopy revealed that CX3CR1-deficient MPs located in the initial segments of the epididymis displayed fewer luminal-reaching membrane projections and impaired antigen capture activity. Moreover, flow cytometry showed a reduction of epididymal KO MPs with a monocytic phenotype under physiological conditions. In contrast, flow cytometry revealed an increase in the abundance of MPs with a monocytic signature in the distal epididymal segments after an LPS challenge. This was accompanied by the accumulation of CD103+ cells in the interstitium, and the prevention or attenuation of epithelial damage in the KO epididymis during epididymitis. Additionally, CX3CR1 deletion induced downregulation of Gja1 (connexin 43) expression in KO MPs. Together, our study provides evidence that MPs are gatekeepers of the immunological blood-epididymis barrier and reveal the role of the CX3CR1 receptor in epididymal mucosal homeostasis by inducing MP luminal protrusions and by regulating the monocyte population in the epididymis at steady state as well as upon infection. We also uncover the interaction between MPs and CD103+ dendritic cells, presumably through connexin 43, that enhance immune responses during epididymitis. Our study may lead to new diagnostics and therapies for male infertility and epididymitis by identifying immune mechanisms in the epididymis.

Myd88 Signaling Is Involved in the Inflammatory Response in LPS-Induced Mouse Epididymitis and Bone-Marrow-Derived Dendritic Cells.

Epididymitis is an epididymal inflammation that may lead to male infertility. Dendritic cells (DCs) and myeloid differentiation primary response gene 88 (Myd88) were associated with epididymitis in rodents. However, the functions of Myd88 on epididymal DCs remain unclear. This study investigated the role of Myd88 in DCs for epididymitis. The Myd88 signaling pathway, phenotypes of DC subsets, and cytokines were investigated in lipopolysaccharide (LPS)-induced epididymitis in mice. CRISPR-Cas9 was used to knockout Myd88 in bone-marrow-derived dendritic cells (BMDCs) and immortalized mouse epididymal (DC2) cell line. In the vivo experiments, levels of the proinflammatory cytokines IL-1α, IL-6, IL-17A, TNF-α, IL-1ß, MCP-1, and GM-CSF, mRNA for MyD88 related genes, and the percentages of monocyte-derived DCs (Mo-DCs) were significantly elevated in mice with epididymitis. In the vitro experiments, LPS significantly promoted the apoptosis of BMDCs. In addition, the concentration of inflammatory cytokines in BMDCs and DC2s were increased in the LPS group, while decreasing after the knockout of Myd88. These findings indicate that Myd88 on DCs is involved in the inflammation of epididymitis in mice, which may be a potential target for better strategies regarding the treatment of immunological male infertility.

Panscleritis After Blunt Ocular Trauma in A Child with Epididymitis.

We reported an 8-year-old boy with panscleritis in left eye and right epididymitis after falling on the ground. Etiologic diagnosis played a key role in this case. Systemic examinations ruled out systemic autoimmune diseases, tumors, and infections as the cause of scleritis and suggested that the disease was caused by a local delayed-type hypersensitivity (DTH) induced by ocular trauma and was non-infectious. Still, the right epididymitis was infectious. Both conditions were treated successfully using steroids and antibiotics, respectively. Thus, early etiologic diagnosis and reasonable treatment are crucial to prevent visual loss.

[Action mechanisms of Xiaoluowan (II) in the treatment of epididymitis: A network pharmacology-based study].

OBJECTIVE: To explore the potential action mechanisms of Xiaoluowan (II) (XLW-II) in the treatment of epididymitis through a network pharmacology approach. METHODS: We searched various databases for relevant targets associated with epididymitis and XLW-II and obtained the common targets of epididymitis and XLW-II on the Venny platform. We acquired the protein-protein interactions (PPI) using the STRING data and had them visualized with the Cytoscape software. After topological analysis, we retrieved the key targets, followed by gene ontology (GO) and KEGG pathway enrichment analyses using the DAVID database. RESULTS: A total of 2 38 drug targets, 2 150 disease targets and 85 common targets were identified. The core targets for the treatment of epididymitis with XLW-II identified by PPI network analysis included TNF, IL6, IL1B, MMP9, AKT1, PTGS2 and TP53. GO function analysis revealed the involvement of the common targets in such biological processes as response to hypoxia, regulation of apoptotic processes, inflammatory response, and positive regulation of the MAPK cascade. KEGG pathway analysis suggested that the signaling pathways such as the cancer pathway, PI3K-Akt pathway, protein glycosylation pathway in cancer, Ras pathway and chemokine pathway might be related to the action mechanisms of XLW-II in the treatment of epididymitis. CONCLUSION: The potential targets and signaling pathways of Xiaoluowan (II) in the treatment of epididymitis were identified on the basis of network pharmacology, which has provided a novel insight into its action mechanisms and offered a new direction for further relevant studies.

[Mechanism of Xiaoluanwan(II) in treating mouse epididymitis through the regulation of NLRP3 inflammasome].

OBJECTIVE: This study aimed to investigate the mechanism of Xiaoluanwan(II) in treating lipopolysaccharide(LPS)-induced epididymitis and its impact on the NLRP3 inflammasome. METHODS: The murine epididymitis model was established through local injection of LPS. The study included a control group (n=5), a model group (n=5), a model group treated with Xiaoluanwan(II) (Ⅱ) (n=5), and a saline group treated with Xiaoluanwan(II) (n=5). After 14 consecutive days of oral administration of Xiaoluanwan(II) or physiological saline, pathological changes in the epididymal tissues, expression levels of NLRP3 inflammasome and Caspase-1, as well as associated protein levels were examined. RESULTS: Compared to the model group, Xiaoluanwan(II) significantly alleviated inflammatory cell infiltration and lesions, as evidenced by a reduction in the protein expression levels of NLRP3, Caspase-1, Cleaved-Caspase-1, IL-1ß, IL-18, GSDMD, and p-p38 MAPK (P<0.05 or P<0.01), thereby mitigating the inflammatory response. CONCLUSION: Xiaoluanwan(II) alleviates epididymal inflammation and ameliorates mouse epididymal epithelial injury by modulating the NLRP3-mediated cell pyroptosis pathway.

[Clinical observation of Xiaoluowan (II) in treating epididymitis].

OBJECTIVE: To observe the clinical efficacy of Xiaoluowan (II) on epididymitis. METHODS: 61 patients with epididymitis were divided into two groups, acute group (23 cases) and non-acute group (38 cases) . Both groups of patients were treated with Xiaoluowan (II) 6g twice a day orally, while acute group patients were given antibiotics intravenously. The treatment period is 4 weeks. The acute group evaluates the therapeutic efficacy comprehensively based on changes in clinical symptoms and signs, while recording changes in visual pain score (VAS). Chronic epididymitis symptom index (CESI) was used to evaluate the clinical symptoms before and after treatment in the non-acute group, and the curative efficacy was evaluated. RESULTS: After treatment, the VAS scores in the acute group decreased from 7.08 ± 1.09 to 2.10 ± 1.37 (P<0.05). Total efficiency is 82.60% . In the non-acute group, the scores of pain before and after treatment were 7.08 ± 1.09 and 2.10 ± 1.37, the scores of quality of life were 7.28 ± 1.14 and 1.87 ± 1.56, the total scores were 14.37 ± 1.78 and 3.97±2.73, respectively. The difference was significant(P<0.05). Total efficiency is 84.21% . CONCLUSION: Xiaoluowan (II) is an effective method to treat epididymitis and an effective supplement to modern medicine.

[Progress in the clinical application of centipede in andrology].

Centipede is an important traditional Chinese medicine with a long history of clinical application and a wide range of effects, and its use in the field of andrology is also expanding.In this study, the drug experience and clinical research progress of centipede in erectile dysfunction, chronic prostatitis, prostate cancer, varicocele, chronic epididymitis, epididymal nodules, functional non-ejaculation, scrotal eczema and other diseases were reviewed.

[Exploring the mechanism of levocarnitine in the treatment of epididymitis based on network pharmacology and molecular docking technology].

OBJECTIVE: To explore the potential mechanism of action of levocarnitine in the treatment of epididymitis based on network pharmacology and experimental research. METHODS: The target proteins related to epididymitis and levocarnitine were retrieved through multiple databases, and the common targets were obtained using Venny software. The protein-protein interactions were obtained using the STRING database. Cytoscape software was used for visualization, and key targets were selected after topological analysis. GO and KEGG pathway enrichment analysis was performed using the DAVID database. Molecular docking was performed using Autodock Vina. RESULTS: A total of 130 drug targets and 2 151 disease targets were obtained, with 47 common targets. Protein-protein interaction network analysis identified core targets of levocarnitine in the treatment of epididymitis, including AKT1, HSP90AA1, ALB, CASP3, GSK3B, and GSR. KEGG pathway analysis suggested that metabolic pathways, lipid metabolism and atherosclerosis, cancer pathways, fluid shear stress and atherosclerosis, measles, chemical carcinogens-reactive oxygen species, purine metabolism, PI3K-Akt, and other signaling pathways may be associated with the mechanism of levocarnitine in the treatment of epididymitis. CONCLUSION: This study revealed through network pharmacology that levocarnitine may act on multiple signaling pathways by targeting AKT1, HSP90AA1, ALB, CASP3, GSK3B, GSR, etc., thereby potentially exerting therapeutic effects on epididymitis.

Pathogenesis of Brucella epididymoorchitis-game of Brucella death.

Brucellosis is a worldwide zoonotic disease caused by Brucella spp. Human infection often results from direct contact with tissues from infected animals or by consumption of undercooked meat and unpasteurised dairy products, causing serious economic losses and public health problems. The male genitourinary system is a common involved system in patients with brucellosis. Among them, unilateral orchitis and epididymitis are the most common. Although the clinical and imaging aspect of orchi-epididymitis caused by brucellosis have been widely described, the cellular and molecular mechanisms involved in the damage and the immune response in testis and epididymis have not been fully elucidated. In this review, we first summarised the clinical characteristics of Brucella epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of Brucella epididymoorchitis, we mainly discussed the process of Brucella invading testis and epididymis in temporal and spatial order, including i) Brucella evades innate immune recognition of testicular PRRs；ii) Brucella overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) Brucella breaks through the blood-testis barrier with the help of macrophages, and inflammatory cytokines promote the oxidative stress of Sertoli cells, damaging the integrity of BTB; iv) Brucella inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by Brucella at the tissue level. This review will enable us to better understand the pathogenesis of orchi-epididymitis caused by brucellosis and shed light on the development of new treatment strategies for the treatment of brucellosis and the prevention of transition to chronic form. Facing the testicle with immunity privilege, Brucella is like Bruce Lee in the movie Game of Death, winning is survival while losing is death.HIGHLIGHTSWe summarized the clinical features and pathological changes of Brucellaepididymoorchitis.Our research reveals the pathogenesis of Brucella epididymoorchitis, which mainly includes the subversion of testicular immune privilege by Brucella and a series of destructive reactions derived from it.As a basic framework and valuable resource, this study can promote the exploration of the pathogenesis of Brucella and provide reference for determining new therapeutic targets for brucellosis in the future.

Epstein-Barr virus-associated infectious mononucleosis with acute epididymitis: a case report.

BACKGROUND: Infectious mononucleosis due to the Epstein-Barr virus is an infectious disease that causes the appearance of atypical lymphocytes in the peripheral blood; it mainly presents with fever, tonsillar pharyngitis, and lymphadenopathy. In addition to hepatitis, splenomegaly, and rashes, it can involve different organs. Here, a case of epididymitis as a rare complication in a patient with Epstein-Barr virus-associated infectious mononucleosis was reported. CASE PRESENTATION: A healthy 23-year-old man visited an outpatient clinic with fever and pharyngitis. Tonsillar pharyngitis, lymphadenopathy, atypical lymphocytes in the peripheral blood, liver dysfunction, and splenomegaly were observed. The patient was diagnosed with infectious mononucleosis based on clinical signs. The next day, the patient developed left testicular pain and was immediately transferred to the emergency outpatient ward. Pain, redness, and swelling were observed in the left scrotum. Ultrasonography revealed swelling of the epididymis and increased blood flow, and the patient was hospitalized with a diagnosis of left epididymitis. The patient's symptoms improved with symptomatic treatment and was discharged on day 16 after admission. Changes in antibody titers established a definitive diagnosis of infectious mononucleosis caused by the Epstein-Barr virus. Based on the disease course, the patient was also diagnosed with infectious mononucleosis associated with unilateral epididymitis. CONCLUSIONS: This is the first case report of Epstein-Barr virus-associated infectious mononucleosis complicated with acute epididymitis. Infectious mononucleosis can cause numerous organ-related complications; thus, physicians and healthcare workers should remain cognizant of Epstein-Barr virus-associated complications throughout the body and not just in the primary organs affected by infectious mononucleosis.

Testicular appendage torsion in children.

BACKGROUND: Testicular appendage torsion (TAT) is a medical emergency that presents as an acute scrotum, usually in children and preadolescents. In previous reports of TAT, most cases have been treated conservatively, but some necessitate surgical treatment. Our aim was to examine the incidence, clinical examination findings, etiology, and treatment of TAT. METHODS: We retrospectively reviewed records of all patients with TAT (aged ≤15 years) treated at the Juntendo University Urayasu Hospital between January 2012 and September 2020. Surgical treatment was performed when a diagnosis of testicular torsion could not be completely ruled out or if pain recurred after conservative treatment. Patients with a hard scrotum or scrotal erythema were hospitalized for conservative treatment. Data regarding age, diagnosis, blood test results, and clinical findings were analyzed. RESULTS: Among 101 boys with TAT, the median age was 10 years. The incidence of TAT varied significantly according to age and was highest among patients aged 8-11 years. Sixty-seven boys (66.3%) underwent inpatient surgical treatment, 10 boys (9.9%) received inpatient conservative treatment, and 24 boys (23.8%) received outpatient conservative treatment. The median duration of hospitalization was significantly shorter among those who underwent surgery (2.0 days) than among those who received inpatient conservative treatment group (3.5 days). CONCLUSIONS: Operations were short, uncomplicated, and safe; they shortened the hospital stay; and they would certainly prevent recurrence of TAT and testicular torsion on one side. Furthermore, we recommended that TAT patients presenting with signs of severe inflammation, such as hard scrotum or scrotal erythema, receive early surgical treatment to minimize duration of hospitalization.

Antibacterial effects of nano-decoction iron polysulfide in epididymitis and the systematic evaluation of its toxicity on the reproductive health of male mice.

Ferrous iron and polysulfide (Fe(II)Sn aq) is a nano-decoction. It is usually prepared from the suspension of iron sulfide nanomaterial, using autoclave and centrifugation. A previous study conducted in our laboratory revealed that Fe(II)Sn aq was highly antibacterial, and it could efficiently kill more than 90% population of Escherichia coli and Staphylococcus aureus, within 5 min of the treatment. Our study reported that the intravenous administration of Fe(II)Sn aq provided effective treatment against epididymis infection, caused by S. aureus. The results of the study further highlighted its potential for clinical application. However, its effects on the reproductive system and overall health of mammals have not been investigated earlier. The present study assessed the impacts of Fe(II)Sn aq on reproductive health and other aspects of male mice. Briefly, male mice were exposed to Fe(II)Sn aq, either intravenously at the dose of 0.7 mM, 1.4 mM, and 2.8 mM of Fe2+or orally at the dose of 1.4 mM, 2.8 mM, and 5.6 mM of Fe2+. Following this, body weight, organs index, quality of sperm, blood biochemical markers, histopathology of organs, oxidative stress and apoptosis were evaluated, after 1 day and 30 days of exposure. In addition, male reproductivity was evaluated in terms of mating with female mice, and the body weight of the resulting offspring was recorded. Our results showed that the mice processed with Fe(II)Sn aq exhibited normal physiological status and reproductive capability. The present study illustrated the short- and long-term influences of Fe(II)Sn aq on the fertility of male mice for the first time. The findings of the study provided a valuable reference for the application of Fe(II)Sn aq, particularly in terms of reproductive safety.

Scrotal Masses.

Scrotal and testicular masses can be broadly categorized into painful conditions, which include testicular torsion, torsion of the testicular appendage, and epididymitis, and painless conditions, which include hydrocele, varicocele, and testicular cancer. Testicular torsion is a urologic emergency requiring prompt surgical intervention to save the testicle, ideally within six hours of presentation when the salvage rate is about 90%. The Testicular Workup for Ischemia and Suspected Torsion score can be used to help physicians identify patients at high risk of torsion and those at lower risk who would benefit from imaging first. Torsion of the testicular appendage presents with gradual onset of superior unilateral pain, is diagnosed using ultrasonography, and is treated supportively with analgesics. Epididymitis is usually caused by infection with Chlamydia trachomatis, Neisseria gonorrhoeae, or enteric bacteria and is treated with antibiotics, analgesics, and scrotal support. Hydroceles are generally asymptomatic and are managed supportively. Varicoceles are also generally asymptomatic but may be associated with reduced fertility. It is uncertain if surgical or radiologic treatment of varicoceles in subfertile men improves the rate of live births. Testicular cancer often presents as a unilateral, painless mass discovered incidentally. Ultrasonography is used to evaluate any suspicious masses, and surgical treatment is recommended for suspected cancerous masses.