Indicaciones e histología de 489 orquiectomías analizadas según la edad del paciente / Indications and histology of 489 orchiectomies analyzed by patient age

Objetivo Evaluar indicaciones e histología de nuestra serie de orquiectomías, analizando los resultados dependiendo de la edad del paciente. Métodos Estudio de las orquiectomías realizadas en nuestro centro entre 2005 y 2020 a pacientes mayores de 18 años. Evaluamos: datos demográficos, indicaciones, histología y efectividad del diagnóstico ecográfico según 3 grupos de edad. Resultados Se realizaron 489 orquiectomías, 364 (74%) en los pacientes entre 18-50 años (grupo A), 59 (12%) entre los pacientes de 51-70 años (grupo B) y 66 (13,4%) en mayores de 70 años (grupo C). En el grupo A, 284 (78%) orquiectomías fueron indicadas por sospecha tumoral, 261/284 (91,9%) fueron neoplasias malignas, 253 (89%) germinales. La ecografía testicular tuvo un valor predictivo positivo (VPP) para tumor testicular maligno del 90%. En el grupo B, 34 (57%) orquiectomías fueron indicadas por sospecha tumoral y 25/34 (73,5%) presentaron neoplasias malignas. La ecografía tuvo un VPP para malignidad del 68%. En el grupo C, la orquiepididimitis fue la causa más frecuente de orquiectomía con 30 casos (45,5%). Entre las 20 orquiectomías por sospecha de tumor (30,3%), se encontró malignidad en 6. La ecografía tuvo un VPP para malignidad del 31%. Conclusión En menores de 70 años la indicación principal de orquiectomía fue la sospecha tumoral y en mayores, la orquiepididimitis. Los tumores germinales fueron la histología más frecuente en los menores de 70 años; en los mayores la malignidad fue infrecuente. Con la edad, disminuyó el VPP de la ecografía testicular para neoplasia maligna. En los mayores de 50 años se debería mejorar el proceso diagnóstico antes de indicar orquiectomía por sospecha tumoral (AU)

Objective To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. Methods We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. Results We included 489 orchiectomies, which 364 (74%) belonged to group A (patients between 18-50 years), 59 (12%) to group B (50-70 years) and 66 (14%) to group C (older than 70 years). In group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. Conclusion In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done (AU)

Testicular infarction and spontaneous scrotal rupture secondary to acute epididymo-orchitis.

Epididymo-orchitis is a common cause of acute unilateral testicular pain. Both infectious or non-infectious causes have been proposed and, rarely, testicular abscess formation and even infarction can occur as a severe complication. We present here a case of acute epididymo-orchitis leading to testicular abscess formation, infarction and spontaneous rupture through the scrotal wall despite appropriate antibiotic treatments. Orchidectomy and partial scrotectomy were performed during surgical exploration for management of the non-viable testis and associated scrotal sinus. Clinical vigilance is important to prevent this complication by close clinical follow up with ultrasonography and even early surgical decompression to prevent testicular loss.

Unilateral vasectomy for intractable epididiymo-orchitis in patients with anorectal malformation.

BACKGROUND: Male patients treated for anorectal malformations (ARM) and recto-urethral fistula (RUF) tend to develop recurrent epididymo-orchitis (EO) which occurs approximately in 20% of all them. The optimal management of this condition is unclear because of the extreme its rarity and the unavailability of detailed analysis in literature. To date the majority of this patients benefits from medical treatment and symptoms reduce over time but few data have been published in literature about management of patients with intractable EO. OBJECTIVE: To describe the efficacy of unilateral vasectomy in patients operated on for anorectal malformations with RUF and affected by intractable EO. STUDY DESIGN: We present five patients who met the criteria for intractable EO, and followed at our centre four of whom have undergone unilateral vasectomy. RESULTS: The first episode of EO presented at 42,00 mos ±29.39. Initially, patients were all managed with analgesics and antibiotics. For the failure of therapy, five patients were all offered unilateral vasectomy but only four families accepted procedure. Surgical treatment was performed as a day case without complications. Postoperative follow up was 88,50 mos ±68.36. Prompt and durable resolution of symptoms was observed. DISCUSSION: The long-term effects of recurrent EO in ARM are often underestimated. Prompt and appropriate intervention should prevent this undesirable sequela. Unfortunately, the optimal management of this complication is unclear, partly because of its extreme rarity. The established management needs to follow the route of correcting underlying anomalies and providing long-term analgesic and antibiotics but this may have undesired side effects. We therefore offered families vasectomy for complete symptom resolution and/or drug withdrawal. Vasectomy, as a form of treatment for, can be justified if it can prevent pain, infection and destruction of the testes. Early vasectomy may save enough functional testis tissue. CONCLUSION: To date, the only available treatment to achieve definitive resolution of symptoms in intractable unilateral EO is vasectomy. Long-term effects of such procedure on fertility are unknown. The treatment of recurrent EO in cases without site predilection remains a matter of contention.

Testicular toxoplasmosis in a 26-year-old immunocompetent man.

Testicular toxoplasmosis is a very rare presentation of Toxoplasma gondii A 26-year-old immunocompetent man presented to us with right testicular pain and a right epididymal mass. Ultrasound was concerning for malignancy and a radical orchiectomy was performed. Surgical pathology revealed chronic granulomatous inflammation which stained positive for T. gondii.

[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.

Tratamiento endoscópico del reflujo uretrodeferencial en niños / Endoscopic treatment of urethrodeferential reflux in children

Introducción: El reflujo uretrodeferencial es una entidad infradiagnosticada, no existiendo consenso en su tratamiento. Nuestro objetivo es mostrar nuestra experiencia en el tratamiento mínimamente invasivo de esta dolencia mediante tratamiento endoscópico. Material y métodos: Presentamos 8 pacientes con orquitis supuradas de repetición por reflujo uretrodeferencial tratados de forma endoscópica en el período de 2008-2013. Todos presentaron orquitis unilaterales. El número mínimo de orquitis por paciente anterior a la intervención fue de 3. El tratamiento endoscópico consistía en una uretroscopia con localización de los orificios eyaculatorios y un estudio de contraste intraoperatorio para demostrar el reflujo uretrodeferencial. Posteriormente se inyectó ácido hialurónico/dextranómero subeyaculatorio en todos los casos. Resultados: El tiempo medio de la cirugía fue de 15 min, siendo un procedimiento ambulante en todos los pacientes. No hubo complicaciones postoperatorias. Los pacientes presentaron buena evolución clínica. Solo un caso requirió el uso de una segunda inyección de ácido hialurónico/dextranómero. El seguimiento de estos pacientes mostró la resolución completa de los cuadros de epididimitis y un buen desarrollo testicular, con un seguimiento mayor de 4 años en todos los casos. Conclusión: Proponemos esta forma de tratamiento como una alternativa poco invasiva, fácilmente reproducible y que ha presentado buenos resultados a largo plazo en nuestra pequeña serie de pacientes

Introduction: Urethrodeferential reflux is an underdiagnosed condition, and there is no consensus on its treatment. Our objective is to show our experience in the minimally invasive treatment of this disease using endoscopy. Material and methods: We present 8 patients with recurrent suppurative orchitis due to urethrodeferential reflux treated endoscopically during the period 2008-2013. All patients presented unilateral orchitis. The minimum number of episodes of orchitis per patient prior to the operation was 3. The endoscopic treatment consists of ureteroscopy, locating the ejaculatory orifices and conducting an intraoperative contrast study to demonstrate the urethrodeferential reflux. Subejaculatory dextranomer/hyaluronic acid was subsequently injected in all the cases. Results: The mean surgical time was 15min, and the procedure was outpatient for all patients. There were no postoperative complications, and the patients had good clinical progression. Only one case required a second injection of dextranomer/hyaluronic acid. The follow-up of these patients showed a complete resolution of the epididymitis and good testicular development, with a follow-up longer than 4 years in all cases. Conclusion: We propose this form of treatment as a minimally invasive, easily reproducible alternative that shows good long-term results in our small series of patients

Orchitis reveals an extragonadal primary mediastinal thymic seminoma: a coincidence or not?

BACKGROUND: Mediastinal thymic seminomas are rare male germ cell tumors with extragonadal origin that appear predominately with a cystic appearance. CASE PRESENTATION: A 22-year-old male was referred to our department for further investigation of a mediastinal mass discovered incidentally during routine chest X-ray. The patient has denied any symptoms including dyspnea, chest pain, cough, fever, dysphagia, hemoptysis, weight loss, and weakness. His past medical history was remarkable for orchitis, for which he had undergone a bilateral testicular biopsy, without the latter however, indicating the presence of a germ cell tumor or a premalignant lesion. Contrast-enhanced chest computed tomography revealed a lobulated and well-marginated cystic lesion in the anterior mediastinum. Differential diagnosis included mostly a multilocular thymic cyst, a lymphoma, a seminoma, or a soft tissue tumor. Resection of the mass revealed a primary thymic seminoma. CONCLUSIONS: A surgical approach for the management of these tumors might be reasonable considering that an extensive sampling is mandatory to gain an appropriate biopsy preoperatively in order to securely confirm or refute the presence of a mediastinal extragonadal tumor. Orchitis might be a sign of a general disorder of the germ cells which might transform in time.

Evaluación ecográfica de la orquiepididimitis complicada / Ultrasound findings in complicated orchiepididymitis

Para describir los hallazgos ecográficos de la orquiepididimitis aguda complicada diseñamos un estudio descriptivo retrospectivo de casos entre 2006-2013. Registramos 75 casos de orquiepididimitis aguda severa, presentando complicaciones 15 pacientes (20%). La media de edad fue 54 años (rango 15-84). Las principales manifestaciones clínicas fueron dolor escrotal y edema testicular, encontrando: orquiepididimitis crónica, absceso escrotal, absceso intratesticular, piocele, isquemia testicular y atrofia testicular en el contexto de una orquitis crónica. Fue preciso realizar cirugía en 9 casos. La ecografía identifica lesiones específicas cuyo manejo precoz permite el tratamiento conservador y un seguimiento del proceso sin recurrir a exploraciones quirúrgicas innecesarias. Se revisan los datos clínicos y su correlación con los patrones ecográficos encontrados en nuestro estudio. La orquiepididimitis es un problema habitual que puede derivar en complicaciones de variada gravedad. El conocimiento de los signos ecográficos nos permitirá establecer un diagnostico precoz y fiable, eligiendo el tratamiento adecuado (AU)

A retrospective descriptive study was conducted on patients diagnosed between 2006 and 2013, in order to describe the ultrasound findings in complicated acute orchiepididymitis (orchitis). There have been 75 cases of severe acute orchitis, with 15 (20%) of them having complications. The mean age was 54 years (range 15-84), and the main clinical manifestations were scrotal pain and testicular swelling. Other findings included, chronic orchitis, scrotal abscess, intra-testicular abscess, pyocele, testicular ischaemia, and testicular atrophy. Surgery was performed in 9 cases. Ultrasound can reliably identify specific lesions, for which early treatment that includes conservative management and monitoring of the process without resorting to unnecessary surgical exploration. Clinical data and its correlation with the main ultrasound patterns found in the study were reviewed. The diagnosis of orchitis is a common problem that can lead to complications of varying severity. Knowledge of the ultrasound signs of these conditions will allow us to establish a reliable early diagnosis and the choice of appropriate conservative or surgical treatment (AU)

Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer: A case report.

INTRODUCTION: Emphysematous epididymo-orchitis is a rare cause of acute scrotum pain characterized by gas formation within the tissue. Diabetes mellitus and recto-seminal fistula secondary to sigmoid diverticulitis are generally accepted as being responsible for this disease. However, prostate invasion secondary to rectal cancer may be considered to be a newly identified pathogenetic mechanism. Herein, we report this rare case and illustrate the pathogenesis. CASE PRESENTATION: A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. Emphysematous epididymo-orchitis was diagnosed by scrotal sonography initially; however, advanced rectal cancer with prostate invasion was diagnosed by CT after a recurrent episode. An exploratory laparotomy with abdominoperineal resection and radical prostectomy were performed after neoadjuvant chemoradiotherapy. Histopathologic analysis confirmed the previous diagnosis. Emphysematous epididymo-orchitis caused by advanced rectal cancer is very rare, and our case is the first to be reported according to a literature search. Neoadjuvant chemoradiotherapy plus extended surgery can achieve a good oncological outcome. CONCLUSION: This case indicated that the very rare presentation as emphysematous epididymo-orchitis caused by locally advanced colorectal cancer.

[A Case of Granulomatous Orchitis].

A 54-year-old man presented with slight pain and swelling of the right scrotum. On performing scrotal ultrasonography, the right testis showed swelling and diffused hypoechogenicity compared with the left normal testis. T2-weighted magnetic resonance imaging (MRI) revealed swelling and low intensity areas in the right testis. Diffusion-weighted MRI revealed increased diffusion in the right testis. A testicular tumor was suspected and right high orchitectomy was performed. Histopathological diagnosis was granulomatous orchitis. To our knowledge, this is the 22nd case in Japan.

Syphilitic orchitis mimicking a testicular tumor in a clinically occult HIV-infected young man: a case report with emphasis on a challenging pathological diagnosis.

BACKGROUND: Syphilitic orchitis is a rare manifestation of gumma in tertiary syphilis, microscopically typically characterized by multiple discrete granulomas with central necrosis and peripheral fibrosis. We report a case of syphilitic orchitis mimicking a testicular tumor with atypical histological features. CASE PRESENTATION: A 33-year-old clinically occult HIV-infected man had a testicular tumor. A radical orchiectomy was performed, and a histological examination showed an acute and chronic interstitial inflammatory lesion as well as spindle cell proliferation, without typical gumma formation, necessitating the differential diagnosis having to be made from a panel of etiological factors. Syphilitic orchitis was confirmed by both an immunohistochemical study and PCR testing for the Treponema pallidum DNA polymerase I gene using paraffin-embedded tissues. However, serology tests, including both the Venereal Disease Research Laboratory (VDRL) test and Treponema pallidum partical agglutination (TTPA), demonstrated false-negative results. CONCLUSION: Syphilitic orchitis may present atypical and unusual histological features, and should be included in the differential diagnoses of nonspecific interstitial inflammatory lesions of the testes by pathologists, especially in immunocompromised patients.

The case of the shrinking testis.

We report the case of a man with idiopathic lymphocytic orchitis (LO) manifested by undifferentiated testicular pain and atrophy. Conventional investigation results were unremarkable. Oral ciprofloxacin only improved the pain temporarily. Scrotal exploration surgery was performed to exclude acute testicular torsion and a biopsy was taken during surgery for histological examination. Histology revealed severe LO with reduced spermatogenesis. A trial of oral steroids was initially effective but the effect was temporary. Due to chronic pain, he eventually underwent unilateral orchidectomy. Histology confirmed the initial diagnosis of LO. He was pain-free postoperatively. Idiopathic LO is a rarely reported cause of testicular atrophy.

Adult-onset lymphoplasmacytic orchitis in a Labrador retriever stud dog.

A formerly fertile 5-year-old 45-kg Labrador retriever was evaluated for azoospermia noted during routine semen collection for an artificial insemination. Over the past 3 years, the dog had sired 4 litters of anticipated size for the breed out of 5 breedings, the most recent a litter of 10 conceived and whelped 2 months previously. Physical examination findings were normal with the exception of bilaterally small and soft testes. An open excisional wedge biopsy of the right testis was performed under general anesthesia. Histopathology findings supported an immunologic, autoimmune pathogenesis that had resulted in infertility over the previous 4 months.

Epidydimo-orchitis and anorectal malformations: when and in whom?

PURPOSE: Epididymo-orchitis (EO) is infrequently reported in anorectal malformation (ARM) cases. Therefore, it is difficult to assess its risk factors. METHODS: A total of 110 male patients who were operated on for ARM at the same Institution over a period of 13 years were contacted. Association was assessed between EO and the following: spinal dysraphism (SD), symptomatic VUR (VUR), and bowel management (BM) requiring enemas. The data were analyzed with the Chi-square test. RESULTS: A total of 89 patients were contacted. Ten cases of EO were found, and all occurred in patients with recto-urethral (RU) fistula after reconstruction. The patients' age at first episode ranged between 4 and 11 years. RU fistula patients experiencing EO (Group A, 10 patients) were compared with those without EO (Group B, 33 patients). VUR occurred in 9/10 cases in Group A and in 13/33 cases in group B (Chi-square 7.8658, p = 0.005038). SD was present in 4/10 cases in group A and in 13/33 cases in Group B (Chi-square 0.0434, p = 0.83491). A total of 8/10 cases in Group A and 12/33 cases in Group B were on BM (Chi-square 5.87, p = 0.0015). CONCLUSIONS: EO occurs in approximately in 20 % of male cases with ARM, and recto-urinary communication and should be considered the primary diagnosis in the presence of testicular pain. This could avoid unnecessary surgical exploration, and the family should be counseled about this subject.

Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

Neurovascular sparing vas clipping: last option for recurrent epididymo-orchitis in urethrovasal reflux due to urethral injury.

Acute scrotum is a critical clinical entity in children. This report presents a 12-year-old boy presented with recurrent epididymo-orchitis (EO) with a history of pelvic trauma and urethral disruption 10 years ago. Antegrade and retrograde studies confirmed urethrovasal reflux. The patient did not respond to prophylactic antibiotics, clean intermittent catheterization and endoscopic injection of bulking agent at the junction of the ejaculatory duct and posterior urethra. As the last option, neurovascular sparing vas clipping was performed and the patient made a full recovery. This is the first report of this technique in the treatment for recurrent EO caused by traumatic injury.

Testicular inflammation as a new manifestation of IgG4-associated disease.

IgG4-related disease has properties of a systemic disorder but simultaneously is associated with a growing list of organ-specific manifestations including autoimmune pancreatitis, IgG4-associated cholangitis, IgG4-related kidney disease, and IgG4-associated prostatitis. In this study, we present, to the best of our knowledge, the first case of a patient with multiorgan IgG4-related disease who lost his testes because of IgG4-related testicular inflammation. We postulate that IgG4-related disease in the urogenital tract is not restricted to IgG4-related kidney disease and prostatitis, but that this rare disorder may also affect the testis.