Localization of external urethral orifice in coronary sulcus during urethroplasty in case of severe hypospadias accompanied by prostatic utricle cyst.

BACKGROUND: To explore whether opening the external urethral orifice in the coronal sulcus can reduce the incidence of epididymitis after operating on hypospadias with prostatic utricle cyst (PUC) connecting to the vas deferens. Group A consisted of 3 patients with severe hypospadias and PUC undergoing cystostomy, hypospadias correction and urethroplasty, along with the relocation of the external orifice of the urethra to the coronal sulcus. Group B consisted of 4 patients having initial hypospadias repaired with meatus in the orthotopic position in the glans, presenting with multiple epididymitis after hypospadias surgery and unsuccessful conservative treatment. MR confirmed that all the Group B patients had PUC connecting to the vas deferens. Group B patients underwent urethral dilatation along with urethral catheterization, cutting of the original corpus cavernosum that encapsulated the urethra, and extension of the position of the external urethral orifice to the coronal sulcus. RESULTS: In group A, 3 children underwent bladder fistula removal 2 weeks after the operation. The penis developed normally without any complications. Four children in group B underwent stent removal 12 weeks after operation, and one patient was still stenosed and dilated again. All patients in group B were followed without epididymitis recurrence. CONCLUSIONS: For patients with hypospadias complicating with a PUC, connecting to one side of the vas deferens, the positioning of the external urethral orifice in the coronary sulcus would be helpful to reduce the occurrence of epididymitis.

Ectopic Intravesical Ejaculatory Ducts: Case Report of Bulking Agent Injection for Treatment of Recurrent Epididymitis in a Patient With Anorectal Malformation.

As far as we know this is the first report on bulking agent injection into intravesical ectopic ejaculatory orifices reported in the English literature. During a follow-up period of 23 months, the child was free of episodes of epididymo-orchitis. Deflux injection in this rare anomaly of intravesical refluxing ducts had prevented irreversible damage to the testes from recurrent EO. Thus, it may be a better option than vasectomy when antibiotic treatment fails.

Melatonin protects against lipopolysaccharide-induced epididymitis in sheep epididymal epithelial cells in vitro.

Melatonin has protective effects against inflammation but its role in epididymitis is unknown. We addressed this in the present study using lipopolysaccharide (LPS)-stimulated sheep epididymal epithelial cells as an in vitro inflammation model. We found that interleukin (IL)-1ß, IL-6, tumor necrosis factor α, and cyclooxygenase (COX)-2 mRNA levels; COX-2 and Toll-like receptor (TLR)-4 protein levels; and nuclear factor (NF)-κB p65 phosphorylation were increased by LPS treatment. These effects were reversed in a dose-dependent manner by melatonin (10-11-10-7 M). Quantitative reverse transcription PCR and immunofluorescence analyses showed that the melatonin receptors MT1 and MT2 were expressed in sheep epididymal epithelial cells. The inhibitory effect of melatonin on inflammation was abrogated by the MT1 and MT2 receptor antagonist luzindole and the MT2 ligand 4-phenyl-2-propanamide tetraldehyde. Thus, melatonin exerted anti-inflammatory effect in epididymal epithelial cells by inhibiting TLR4/NF-κB signaling, suggesting its potential as an effective drug for the treatment of epididymitis in sheep.

Modulation of the inflammatory response after sclerotherapy for hydrocoele/spermatocoele.

OBJECTIVE: To investigate the modulation of the inflammatory response after sclerotherapy for hydrocoele/spermatocoele. PATIENTS AND METHODS: All patients with hydrocoele or spermatocoele presenting at the Department of Urology, University Hospital, Linköping, Sweden, from 2006 to 2012, were included in this prospective observational study of sclerotherapy for hydrocoele/spermatocoele using polidocanol as a sclerosing agent and adjuvant antibiotic and anti-inflammatory medication (AAAM) for modulation of the inflammatory response. Patients were clinically evaluated within 24-48 h after a complication or adverse event possibly related to sclerotherapy. Evaluation of cure was scheduled after 3 months and re-treatment, if necessary was carried out in the same manner as the first treatment. Groups of patients were compared using the chi-squared test and logistic regression analysis. RESULTS: From a total of 191 patients, AAAM was given to 126, of whom 5% had subclinical epididymitis/swelling (SES) compared to 26% of the patients without AAAM (P < 0.001). No other complication was observed. The rate of cure for the whole group of patients was 93% after one or two treatments and significantly higher in the group with AAAM than in the group without AAAM (96% vs 88%, P = 0.03). CONCLUSIONS: Modulation of the inflammatory response after sclerotherapy resulted in a lower incidence of SES and an increased cure rate.

Lipopolysaccharide-induced testicular dysfunction and epididymitis in mice: a critical role of tumor necrosis factor alpha†.

Systemic inflammation may impair male fertility, and its underlying mechanisms remain poorly understood. The present study investigates the effect of lipopolysaccharide (LPS)-induced systemic inflammation on the testis and epididymis in mice. Intraperitoneal injection of LPS significantly impaired testicular functions, including testosterone production, spermatogenesis, and blood-testis barrier permeability. The epididymitis characterized by leukocyte infiltration and fibrosis was observed in the cauda epididymis after LPS injection. LPS-induced testicular dysfunction and epididymitis were abolished in tumor necrosis factor alpha (Tnfa) knockout mice. Pomalidomide, a TNFA inhibitor, blocked the detrimental effects of LPS on the testis and epididymis. The results indicate that LPS-induced systemic inflammation impairs male fertility through TNFA production, suggesting that the intervention on TNFA production would be considered for the prevention and treatment of inflammatory impairment of male fertility.

Rosa damascena Mill. Essential Oil Has Protective Effect Against Testicular Damage in Diabetic Rats.

This study investigates the protective effect of Rosa damascena essential oil on diabetes-induced testicular damage in rats. Thirty-six male Wistar rats were randomly divided into 6 equal groups: Group I: negative control (no treatment); Group II: positive control (diabetic by alloxan injection); Groups III-VI that rendered diabetic and received, respectively, 50, 100, 200, and 400 µg/kg/day rose oil, orally for 28 days. Rose oil did not significantly change body weight and blood glucose level as compared to positive control. Serum testosterone level of rose oil-treated rats remained statistically the same with both negative and positive control groups (Groups I and II). Rats treated with rose oil especially at 2 higher dosages (Groups V and VI) had higher sperm count and increased diameters of seminiferous tubules as compared to Group II. Rose oil even at the lowest dosage significantly increased cell count of spermatogonia, primary spermatocytes, Sertoli cells, and Leydig cells, with better outcomes for higher dosages. It appears that short-term repeated dose administration of rose oil can dose-dependently improve structural deteriorations of testes and epididymal sperm count in diabetic rats.

The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland.

OBJECTIVE: The objective of this study was to estimate the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. METHODS: Prospective cost analysis of an opportunistic screening programme delivered jointly in three types of healthcare facility in Ireland. Incremental cost-effectiveness analysis was performed using an existing dynamic modelling framework to compare screening to a control of no organised screening. A healthcare provider perspective was adopted with respect to costs and included the costs of screening and the costs of complications arising from untreated infection. Two outcome measures were examined: major outcomes averted, comprising cases of pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in women, neonatal conjunctivitis and pneumonia, and epididymitis in men; and quality-adjusted life-years (QALY) gained. Uncertainty was explored using sensitivity analyses and cost-effectiveness acceptability curves. RESULTS: The average cost per component of screening was estimated at €26 per offer, €66 per negative case, €152 per positive case and €74 per partner notified and treated. The modelled screening scenario was projected to be more effective and more costly than the control strategy. The incremental cost per major outcomes averted was €6093, and the incremental cost per QALY gained was €94,717. For cost-effectiveness threshold values of €45,000 per QALY gained and lower, the probability of the screening being cost effective was estimated at <1%. CONCLUSIONS: An opportunistic chlamydia screening programme, as modelled in this study, would be expensive to implement nationally and is unlikely to be judged cost effective by policy makers in Ireland.

Self-catheterization during adolescence.

OBJECTIVE: It has been suggested that clean intermittent catheterization (CIC) during the teenage years is associated with poor motivation to comply with the treatment, recurrent urinary tract infections and epididymitis. The aim of this study was to identify the main problems and complications associated with self-CIC in a group of adolescents with no overt neurological problems. MATERIAL AND METHODS: The medical records of 24 boys and girls aged >/=12 years on self-CIC with severe bladder dysfunction and intact perineal sensibility and motor function in the lower limbs were reviewed. The median age of the patients was 16.5 years (range 12-24 years) and they had been on CIC for a median of 11 years (range 2-16 years). RESULTS: No urethral damage was reported. Of the 11 patients (46%) who had good CIC routines, two had cystitis and none had epididymitis. Thirteen patients (54%) reported a poor CIC regimen at a median age of 11.5 years (range 9-16 years). In this group, 10 had recurrent cystitis, five had pyelonephritis, four had increasing creatinine levels and three of nine boys had epididymitis. CONCLUSIONS: One of the main problems associated with CIC during adolescence is poor compliance with the treatment. Epididymitis and recurrent urinary tract infections were seen more frequently in connection with poor CIC routines.

Epididymitis after transrectal ultrasound-guided needle biopsy of prostate gland.

OBJECTIVES: To evaluate the incidence, predisposing factors, and time-course of epididymitis after transrectal ultrasound-guided (TRUS) needle biopsy of the prostate gland. METHODS: A total of 739 consecutive patients underwent TRUS-guided biopsy of the prostate gland from January 2000 through December 2002 using a systematic approach, 18-gauge needles, and antibiotic prophylaxis. A median of 9 biopsies was obtained per patient (range 4 to 16). All cases of epididymitis occurring within 6 months of biopsy were attributed to the TRUS procedure. The parameters evaluated for epididymitis included patient age, prostate-specific antigen, prostate volume, prostate-specific antigen density, number of biopsies obtained, and number of biopsies positive for malignancy. RESULTS: Five patients (0.7%) developed biopsy-related epididymitis with a median onset of 85 days (range 13 to 143) after biopsy. Patients developing epididymitis were statistically older, with a trend for a greater number of prostate biopsies (P = 0.071 on linear regression analysis). Only 1 patient developed epididymitis within 3 weeks of biopsy. All cases of epididymitis responded to therapeutic antibiotics. CONCLUSIONS: Epididymitis after TRUS-guided biopsy is a relatively uncommon event, with an incidence of approximately 1% and an onset of weeks to months after the procedure. Patients who developed epididymitis were statistically older, with a trend for a greater number of prostate biopsies taken.

1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention.

These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by CDC staff members after consultation with a group of invited experts who met in Atlanta on February 10-12, 1997. The information in this report updates the "1993 Sexually Transmitted Diseases Treatment Guidelines" (MMWR 1993;42[no. RR-14]). Included are new recommendations for treatment of primary and recurrent genital herpes and management of pelvic inflammatory disease; a new patient-applied medication for treatment of genital warts; and a revised approach to the management of victims of sexual assault. Revised sections describe the evaluation of urethritis and the diagnostic evaluation of congenital syphilis. These guidelines also include expanded sections concerning STDs among infants, children, and pregnant women and the management of patients who have asymptomatic human immunodeficiency virus infection, genital warts, and genital herpes. Guidelines are provided for vaccine-preventable STDs, including recommendations for the use of hepatitis A and hepatitis B vaccines.

Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases.

OBJECTIVE: To determine the incidence of complications, including recanalization, in a series of 6248 consecutive vasectomies performed with a section-fulguration-fascial interposition technique. PATIENTS AND METHODS: Over a 38-year period, 6248 vasectomies were performed by one surgeon (S.S.S.) as a clinic procedure under local anaesthesia with no resection of a vasal segment. The mucosa of the cut ends of the vas was destroyed by cauterization and the fascial sheath of the vas was interposed as a barrier. Semen specimens were examined until two specimens, one month apart, showed no sperm. RESULTS: Complications were minimal, with few cases of haematoma or wound infection. Spermatic granulomas were uncommon. No post-vasectomy pregnancies were reported and no patient showed a persistence of sperm. CONCLUSION: The section-fulguration-fascial interposition technique of vasectomy was uniformly effective, with few post-operative problems.

[Diffusion of norfloxacin in epididymal tissue]. / Etude de la diffusion épididymaire de la norfloxacine.

Norfloxacin, a "second generation" compound of the quinolone group, was administered orally, before surgery, every 12 h during successive three-day periods at dose of 400 mg to ten patients hospitalized for prostatic adenoma or for prostatic cancer. On the day of surgery, a 400 mg-last dose was administered. Unchanged norfloxacin was assayed by high performance liquid chromatography with fluorescence detection. The Cmin value was 1.2 +/- 0.77 mg/l. Concurrent norfloxacin concentrations in plasma and epididymal tissue (left and right) were determined, about 4 h after the last drug intake, the epididymal level was 3.4 +/- 1.9 micrograms/g. This value was above the MIC90 for most sensitive organisms. The ratio (+/- SD) of drug concentration in epididymal tissue and in plasma was 3. 74 +/- 2.10 (range 1.66-10.2). The epididymal level of norfloxacin was strongly correlated with, area under curve (p less than 0.001) and plasma concentration (p less than 0.01).

Trial of ibuprofen to prevent post-vasectomy complications.

Sperm granuloma and epididymitis remain 2 of the most common and incapacitating complications of vasectomy. A study was designed to evaluate the possibility of reducing these inflammatory complications with a prophylactic course of a nonsteroidal anti-inflammatory drug. Patients undergoing outpatient vasectomy were randomized into 2 groups. Group 1 received a prophylactic course of ibuprofen and group 2 received no medication. The ibuprofen was tolerated well and no adverse reactions were noted. There was no increase in postoperative bleeding or hematoma formation. There was no clinical benefit or decrease in complication rate in the ibuprofen-treated group.

PIP: The potential use of ibuprofen, a nonsteroidal anti-inflammatory drug, after vasectomy was examined effort to decrease inflammatory complications -- sperm granuloma and epididymitis. 102 men 25-46 years underwent vasectomy in an outpatient setting between July 1986 and May 1987. The patients alternately were selected randomly into 2 groups, Group 1 received a 7-day course of 800 mg ibuprofen 3 times daily; group 2 was given no medication. All patients returned for followup 2 weeks later. During this examination, specific attention was directed to the possible presence of a hematoma, early granuloma, epididymitis, or infection. A semen analysis was obtained at 6-8 weeks. 95 (93.1%) of the men returned for followup examination: 46 were in group 1 and 49 in group 2. Significant postoperative complications included hematoma, sperm granuloma, and epididymitis. No patients suffered any reactions or complications while on the ibuprofen. There was no increase in postoperative bleeding or hematoma formation. Complications occurred in 8.4% of the patients. There was no statistically significant difference in the total complication rate or individual complications between groups 1 and 2. The ibuprofen was tolerated well, and no adverse reactions to the medication were noted. There was no increase in postoperative bleeding or hematoma formation. There also was no obvious benefit or reduction in complication rates with this regimen. Its use for prophylaxis after vasectomy cannot be recommended.

[Clinical and statistical study on recent cases of suprapubic prostatectomy].

Results of operation were analyzed statistically in 123 patients who underwent suprapubic prostatectomy for benign prostatic hypertrophy from 1974 through 1981. Age of the patients ranged from 48 to 89 years and the mean age was 70.1 years. The average amount of blood loss during operation was 590 ml. Amount of blood loss in patients operated under epidural anesthesia was less than that in the patients operated under general anesthesia. Furthermore, significant correlation was observed between amount of blood loss and the weights of enucleated prostate glands. The average weight of enucleated prostate glands was 33.4 g and the weight increased as the patient's age increased. Histological examination of the enucleated specimens revealed occult carcinoma in 4.1% of the patients. Association of bladder neck sclerosis was observed in 27% of the patients whose prostate weighed less than 20 g. Significance of prophylactic vasectomy for the prevention of postoperative epididymitis was considered to be low. Incidence of postoperative bacteriuria was higher in patients who had bacteriuria preoperatively than those without preoperative bacteriuria. Therefore, eradication of preoperative bacteriuria seemed important in the prevention of postoperative bacteriuria. No significant correlation was observed between postoperative residual urine volume and the weight of the enucleated prostate glands.

Vasectomy to prevent acute epididymo-orchitis after prostatic adenomectomy: still a controversy.

There has been a controversy for almost 80 years about the usefulness of vasectomy in the prevention of acute epididymo-orchitis (EO) after prostatic adenomectomy (PA). In the last few years, improved surgical equipment and new more effective antibiotics have drastically diminished the incidence of this complication. The purpose of this report is to show that because of the devastating effect of the disease, and in spite of its low incidence there is still a clear indication for vasectomy, and also that infected urine, a preoperative indwelling urethral catheter, duration of postoperative catheterization and postoperative complications do not affect the incidence of post-PA acute EO.

Ovine contagious epididymitis: a review.

Ovine contagious epididymitis is predominantly associated with Brucella ovis, Actinobacillus seminis and a variety of organisms including Histophilus ovis. Transmission occurs venereally or by homosexual activity and, in the case of Actinobacillus seminis, ewe to lamb transmission is probably important. A chronic infection, mainly in the cauda epididymis may result in formation of spermatic granulomata and a reduction in ram fertility. Eradication of ovine brucellosis can be achieved by serological testing using a complement-fixation test in conjunction with palpation of lesions and removal of reactors. Vaccination to control ovine brucellosis is advocated in some countries. The nomenclature of the group of Gram-negative pleomorphic organisms to which Actinobacillus seminis and Histophilus ovis belong is urgently in need of review. This paper reviews the organisms capable of producing ovine contagious epididymitis, the pathogenesis of the condition as well as methods of diagnosis and control.

[Preventive vasectomy. Review of 755 cases]. / In tema di vasectomia preventiva. Revisione di 755 casi.

PIP: The importance of preventive vasectomy during surgery and endoscopy on vescica, prostate, and urethra in those over age 60 is due to the etiopathogenesis of orchiepididymitis which demonstrates the paramount role played by infection via the ascending canalicular route. A series of 755 cases is reported here. (author's modified)^ieng

Vasectomy with transurethral resection of prostate.

A retrospective study was made of 200 patients undergoing transurethral prostatectomy. Half of these patients received bilateral vasectomies. The vasectomized patients had a 5-percent incidence of epididymitis as compared with a 2-percent incidence in the nonvasectomized patients. Vasectomy failed to provide adequate protection against postoperative epididymitis and cannot be recommended as a routine procedure with a transurethral prostatectomy.

PIP: Transurethral prostatectomy was performed on 200 patients from the Lettermen Army Medical Center. The patients were divided into 2 groups: group 1 (N=100) consisted of those who had bilateral vasectomies immediately before transurethral resection, while group 2 consisted of those who did not have vasectomy and had no prior history of vasectomy or epididymitis (defined as tenderness, swelling, and/or induration of the epididymitis with or without fever). The 2 groups were followed up from 3 months to 6 years. Group 1 exhibited a 5% incidence of epididymitis compared with group 2's 2% incidence. A significant difference observed between the 2 groups was the duration of hospital stay: group 1 averaged 16 days while group 2 averaged 13.25 hospital days. Although prolonged hospital stay has been associated with risk of iatrogenic wound infections, it is not known whether it is a factor in postprostatectomy epididymitis. One possible explanation for the mechanism of epididymitis is the reflux of infected urine into the vas deferens; this is the rationale for performing vasectomy to prevent epididymitis. Incidence of postprostatectomy epididymitis can be reduced by using better equipment and optics (for more accurate resectioning), early treatment of prostatism, and shorter hospital stay. The findings of this study suggest that vasectomy does not reduce incidence of epididymitis and hence cannot be used as a routine procedure with a transurethral prostatectomy.

[Epididymitis after prostatectomy (author's transl)]. / Epididymitis nach Prostatektomie.

Complications which prolong hospitalization occur after 10% of prostatectomies, depending on the type of operation. Epididymitis develops after prostatectomy especially in postoperative urinary tract infection, and in patients with risk factors (retention of urine, recurrent residual urine, infected urine, and after adenomectomy). In comparison with the time before specific antibiotic therapy, postoperative epididymitis has fallen by 50% with preliminary antibiotic treatment. Postoperative epididymitis very rarely occurs under treatment with gentamicin.