Clinical features of testicular torsion and epididymo-orchitis in infants younger than 3 months.

BACKGROUND/PURPOSE: Testicular torsion (TT) and orchitis/epididymo-orchitis (EO) are confusing and difficult for physicians to diagnose in infants younger than 3 months. The aim of the study was to delineate the etiology and the clinical features of TT and EO in this age group. METHODS: During the period between April 1994 and September 2004, medical charts of infants younger than 3 months with TT and EO were reviewed retrospectively. RESULTS: Sixteen patients were eligible for the study, including 9 with TT and 7 with orchitis/EO. Two infants had postnatal torsion, and the testicles were salvaged by emergent surgery. Eighty-six percent (6/7) of infants with EO/orchitis had either abnormal physical signs (fever or scrotal tenderness) or abnormal laboratory findings (leukocytosis or elevated C-reactive protein level). The sensitivity of color Doppler ultrasound to diagnose TT and EO/orchitis was 88% (7/8) and 100% (6/6), respectively. All infants (6/6) with EO/orchitis who were checked for urinary tract infection and sepsis had positive test results. CONCLUSIONS: Pediatricians should examine the testicles meticulously after a baby is born. Orchitis/EO is highly suspected for patients associated with abnormal physical signs and laboratory findings. Prompt prescription of antibiotics is mandatory to avoid serious sequelae.

Quistes epididimarios en la infancia / Epididymal cysts in childhood

OBJETIVO: Hemos realizado una revisiónretrospectiva de los casos atendidos en los últimos 5años; se han recogido un total de 15 casos. Los quistessimples de epidídimo son patología poco frecuenteen la infancia diagnosticándose la mayoría en la pubertad.Actualmente y debido a la escasa casuística noexiste consenso en la terapéutica más adecuada.METODOS/RESULTADOS: La edad media de presentaciónfue de 11,5 años (1-16).El 50% fueron diagnosticadosde forma incidental y un 29% cursó conaumento de tamaño escrotal. El 46% de los casos presentabanvaricocele izquierdo asociado (n=6) y un26% presentaba antecedentes de orquiepididimitis. Eldiagnóstico se basó en la exploración física con con-firmación ecográfica. Un 40 % fue tratado quirúrgicamentey el resto fue subsidiario de tratamiento conservadorsin constatarse la presencia de complicacionesen estos en los controles posteriores.CONCLUSIONES: Dada la benignidad y la buenaevolución de todos los casos de quistes de epidídimotratados de forma conservadora, y la ausencia debeneficio con el tratamiento quirúrgico, creemos que eltratamiento debe ser conservador con controles clínicosy ecográficos reservando el tratamiento quirúrgico paraaquellos quistes que presenten complicaciones. La frecuenteasociación encontrada entre el quiste epididimarioy el varicocele responde a una coincidencia deambas patologías en la edad peripuberal

OBJECTIVES: To retrospectively review all cases of epididymal cysts registered over the last five years; 15 cases have been included. Simple epididymal cysts are a rare pathology in childhood, being most of them diagnosed in puberty. Currently, due to the scarce case series, there is not consensus about the most adequate therapy. METHODS/RESULTS: Mean age at presentation was 11.5 yr. (1-16). 50% were diagnosed incidentally and 29% presented increased scrotal size. 46% of the cases had associated left varicocele (n = 6) and 26% had history of orchiepididymitis. Diagnosis was based on physical examination and confirmed by ultrasound. 40% of the patients underwent surgery and the remainder received conservative treatment without evidence of complications on follow-up. CONCLUSIONS: Due to the benign character and good evolution of all cases of epididymal cysts treated conservatively and the absence of benefit after surgical treatment, we believe that management should be conservative with clinical and ultrasound controls, leaving surgery for cysts with complications. The frequent association between epididymal cysts and varicocele is related to coincidence of both pathologies in the prepuberal age

[Urogenital malformation complex including the Mullerian system]. / Urogenitaler Missbildungskomplex mit Einbeziehung des Müller-Systems.

Symptomatic cystic epididymis in a 21-year-old man led to the detection of several genital malformations, including a partially obstructing pelvic cyst, prostatic and bilateral testicular atrophy and penoscrotal hypospadias. These malformations are probably due to a deficiency of either testosterone or müllerian inhibiting hormone (MIH). Development of the male genitalia is influenced by testosterone secreted in the Leydig cells during weeks 8-16 of gestation, while regression of the müllerian ducts is induced by MIH secreted in the Sertoli cells from weeks 9-12 of gestation.

Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities.

Of 47 children diagnosed as having epididymitis between 1975 and 1985, 8 of 17 prepubertal patients (47 per cent, or 17 per cent of the total group), including 3 of 4 infants (75 per cent), had an underlying urogenital anomaly. Thus, patients with epididymitis secondary to an underlying anomaly present at an earlier age. The common finding in patients with underlying anomalies was a pathological connection between the urinary tract and the genital duct system or bowel. Coliform urinary infections predominated in patients with underlying anomalies (4 of 6). Although a positive urine culture suggested an underlying anomaly (positive predictive value 0.60), a negative culture virtually ruled out an anomaly (negative predictive value 1.00). Of the 8 patients with underlying anomalies 6 underwent voiding cystourethrography and 6 underwent excretory urography, and the diagnosis was established in 6 (100 per cent) and 4 (67 per cent), respectively. Thus, voiding cystourethrography has the greatest diagnostic yield. Any prepubertal patient with epididymitis merits a complete urological evaluation, including a urine culture, voiding cystourethrography and excretory urography to rule out an underlying urogenital anomaly, which often is amenable to an operation. Surgery often involves severance of the pathological urogenital or urinary-fecal connection and it was successful in 7 of our 8 patients.