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1.
Arch Esp Urol ; 73(2): 126-131, 2020 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32124843

RESUMO

OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.


Assuntos
Cisto Epidérmico , Orquiectomia , Doenças Testiculares , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/terapia , Humanos , Masculino , Estudos Retrospectivos , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia
2.
Curr Urol Rep ; 20(11): 78, 2019 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-31734886

RESUMO

PURPOSE OF REVIEW: Hypogonadism is a common endocrine dysfunction. This review focuses on the most up-to-date guideline for evaluation of pituitary function among men presenting with signs and symptoms of hypogonadism. RECENT FINDINGS: The clinician must differentiate between primary (testicular) and secondary (pituitary-hypothalamic or central) hypogonadisms and be aware of adult-onset hypogonadism. If gonadotropins are low or inappropriately normal, the clinician must consider potential reversible causes in the hypothalamus-pituitary axis. Also, it is critical to understand the pitfalls of testosterone testing. When clinically indicated, evaluation of other pituitary hormone functions as well as pituitary magnetic resonance imaging may be necessary. Furthermore, it is essential to recognize that pituitary incidentalomas are common. Patients with microprolactinoma are more likely to present with symptoms of sexual dysfunction while those with macroprolactinoma are more likely to present with symptoms of mass effect. Some functional pituitary tumors respond to drug therapy while other nonfunctional tumors require surgical intervention. It is important for the clinician to understand the proper work-up of the hypogonadal patient with pituitary dysfunction and when necessary to refer to an endocrinologist or a neurosurgeon.


Assuntos
Hipogonadismo/etiologia , Hipófise/fisiopatologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/terapia , Prolactinoma/complicações , Testosterona/uso terapêutico , Gonadotropinas/sangue , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/fisiopatologia , Neoplasias Hipofisárias/diagnóstico , Guias de Prática Clínica como Assunto , Prolactinoma/diagnóstico , Prolactinoma/tratamento farmacológico , Disfunções Sexuais Fisiológicas/etiologia , Doenças Testiculares/sangue , Doenças Testiculares/complicações , Doenças Testiculares/diagnóstico , Testosterona/sangue
3.
Emerg Med Clin North Am ; 37(4): 593-610, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563197

RESUMO

Scrotal emergencies are rare but potentially life and fertility threatening. This article explains how to diagnose and manage scrotal emergencies such as testicular torsion, Fournier gangrene, and testicular trauma. These diagnoses are often difficult to discern from less-concerning causes. This article helps to elucidate the differences between the dangerous and the less-harmful pathologic conditions.


Assuntos
Escroto , Doença Aguda , Emergências , Humanos , Masculino , Escroto/lesões , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/terapia , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia
4.
Prog Urol ; 29(10): 465-473, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383508

RESUMO

INTRODUCTION: There are no clear recommendations on how patients with testicular microlithiasis should be followed up. The aim of our systematic review is to give clinical guidelines based on the evidence in the literature. METHODS: A web search was conducted during February 2018 based on Pubmed data, Embase and Cochrane database. The eligibility of articles was defined using the PICOS method, in concordance with the PRISMA recommendations. RESULTS: Fifty three articles were selected for our final synthesis. Our review highlighted an association between testicular microlithiasis and the already known risk factors of testicular germ cell tumor. The presence of testicular microlithiasis in patients with such risk factors increases more the risk of cancer. In the absence of risk factors, the risk to develop testicular cancer is similar to the risk in general population. CONCLUSION: In patients at risk to develop testicular cancer, observation versus testicular biopsy is debatable. We recommend an individualized approach based on the age of the patient, the presence of concurrent features of testicular dysgenesis syndrome, the fertility of the couple, the desire of paternity and the ultrasound pattern (bilateral and clustered vs. unilateral and limited).


Assuntos
Cálculos/diagnóstico , Cálculos/terapia , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia , Cálculos/epidemiologia , Árvores de Decisões , Humanos , Guias de Prática Clínica como Assunto , Prevalência , Doenças Testiculares/epidemiologia
5.
New Microbiol ; 42(3): 184-187, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305938

RESUMO

Tuberculosis (TB) of the testicle is a rarely reported and poorly described disease localization. There are no well-defined clinical features suggestive of testicular TB, which makes the diagnosis difficult to establish, especially in low-income settings like Mozambique, where TB is endemic and often associated with HIV-infection; both considered leading causes of death worldwide. We reported the case of a 45-year-old male, HIV positive, naïve to antiretroviral treatment, admitted to the Department of Medicine of the Central Hospital of Beira to investigate chronic enlargement of the testicles.


Assuntos
Infecções por HIV , Doenças Testiculares , Tuberculose , Antirretrovirais , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique , Doenças Testiculares/diagnóstico , Doenças Testiculares/microbiologia , Doenças Testiculares/patologia , Testículo/microbiologia , Testículo/patologia , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/patologia
7.
Ann R Coll Surg Engl ; 101(4): e99-e101, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30907629

RESUMO

Sarcoidosis is a systemic granulomatous disease, with genitourinary tract involvement being very rare (0.2% of all sarcoidosis cases). Genitourinary sarcoidosis may present with a scrotal mass with or without testicular pain, often mimicking epididymo-orchitis or malignancy. Only 8 cases of genitourinary sarcoidosis have been reported in the literature in the last 14 years. We describe the case of a 25-year-old man who was referred with testicular pain. Scrotal ultrasonography demonstrated multiple bilateral hypoechoic testicular lesions that were of similar size and distributed unusually throughout the testicular parenchyma. Computed tomography detected a nodule in the middle lobe of the right lung, multiple small volume nodes in the retrocaval and left para-aortic regions, and enlarged bilateral external iliac and inguinal nodes, similar to those found in metastatic testicular cancer. Following ultrasound guided excision of one of the lesions, histopathological examination confirmed granulomatous inflammation consistent with sarcoidosis.


Assuntos
Sarcoidose/diagnóstico , Doenças Testiculares/diagnóstico , Testículo/patologia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Dor/etiologia , Sarcoidose/cirurgia , Doenças Testiculares/cirurgia , Neoplasias Testiculares/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
Urology ; 128: 84-86, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904639

RESUMO

Paratesticular masses are a relatively common finding in males. The majority are benign, as opposed to testis masses, which tend to be malignant. Fibrous pseudotumors are rare, but are the third most common paratesticular tumor after adenomatoid and lipoma. The exact cause is unclear but likely from a fibroinflammatory reaction. Because of the non-specific findings on physical exam and scrotal ultrasound, patients may undergo scrotal exploration and occasionally orchiectomy, in spite of the benign nature of this lesion. Here we report the rare case of free-floating paratesticular calcifying fibrous pseudotumors in a prepubertal patient.


Assuntos
Calcinose/diagnóstico , Fibrose/diagnóstico , Doenças Testiculares/diagnóstico , Ultrassonografia/métodos , Calcinose/cirurgia , Criança , Fibrose/cirurgia , Humanos , Masculino , Orquiectomia , Escroto , Doenças Testiculares/cirurgia
9.
BMJ Case Rep ; 12(2)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30787023

RESUMO

Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Dor/diagnóstico , Doenças Testiculares/microbiologia , Hidrocele Testicular/microbiologia , Tuberculose Urogenital/tratamento farmacológico , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/microbiologia , Cavidade Abdominal/patologia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Humanos , Linfadenopatia/microbiologia , Linfadenopatia/patologia , Imagem por Ressonância Magnética , Masculino , Orquite/diagnóstico , Orquite/tratamento farmacológico , Dor/etiologia , Doenças Testiculares/diagnóstico , Hidrocele Testicular/genética , Testículo/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/microbiologia
10.
Int J Surg Pathol ; 27(3): 311-314, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30178697

RESUMO

Endometriosis in men is extremely rare with only a few cases reported in the English literature. Different theories have been proposed as to its origin. In this article, we describe the clinicopathologic features of 2 cases of endometriosis occurring in male patients. The patients' ages were 50 and 43 years, and sizes were 2 and 5.2 cm, respectively. No significant chemical or hormonal exposure was identified. Both patients presented with a testicular mass. Grossly, both lesions were cystic and contained hemorrhagic fluid. Microscopic examination revealed cysts and occasional glands lined by low columnar to cuboidal epithelium, surrounded by spindle cell stroma with abundant hemosiderin-laden macrophages reminiscent of endometrium. One case was predominantly intratesticular, with a minute focus of endometrial-type glands and spindled stroma within the tunica vaginalis. Focal chronic inflammation and epithelial denudation were present in both cases. The surrounding testicular and epididymal structures adjacent to the cystic mass were unremarkable. In summary, endometriosis is an extremely rare lesion in men. The presence of these lesions in both cases along the route of the Müllerian duct supports the theory that these lesions arise from embryonic remnants. Awareness of this entity is crucial for general pathologists to avoid wrong diagnosis and unnecessary management.


Assuntos
Cistos/patologia , Endometriose/patologia , Doenças Raras/patologia , Doenças Testiculares/patologia , Testículo/patologia , Adulto , Cistos/diagnóstico , Diagnóstico Diferencial , Endometriose/diagnóstico , Endometriose/cirurgia , Epididimo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Paramesonéfricos/patologia , Orquiectomia , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Doenças Testiculares/diagnóstico , Doenças Testiculares/cirurgia
11.
Clin Genet ; 95(1): 172-176, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30294972

RESUMO

Molecular diagnosis is rarely established in 46,XX testicular (T) disorder of sex development (DSD) individuals with atypical genitalia. The Wilms' tumour factor-1 (WT1) gene is involved in early gonadal development in both sexes. Classically, WT1 deleterious variants are associated with 46,XY disorders of sex development (DSD) because of gonadal dysgenesis. We report a novel frameshift WT1 variant identified in an SRY-negative 46,XX testicular DSD girl born with atypical genitalia. Target massively parallel sequencing involving DSD-related genes identified a novel heterozygous WT1 c.1453_1456del; p.Arg485Glyfs*14 variant located in the fourth zinc finger of the protein which is absent in the population databases. Segregation analysis and microsatellite analysis confirmed the de novo status of the variant that is predicted to be deleterious by in silico tools and to increase WT1 target activation in crystallographic model. This novel and predicted activating frameshift WT1 variant leading to the 46,XX testicular DSD phenotype includes the fourth zinc-finger DNA-binding domain defects in the genetic aetiology of 46,XX DSD.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Patologia Molecular , Doenças Testiculares/diagnóstico , Proteínas WT1/genética , Transtornos 46, XX do Desenvolvimento Sexual/genética , Transtornos 46, XX do Desenvolvimento Sexual/patologia , Criança , Proteínas de Ligação a DNA/genética , Feminino , Heterozigoto , Humanos , Lactente , Masculino , Mutação , Fenótipo , Desenvolvimento Sexual/genética , Doenças Testiculares/genética , Doenças Testiculares/patologia , Testículo/patologia
12.
Arch Esp Urol ; 71(10): 840-849, 2018 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-30560797

RESUMO

Testicular microlithiasis (TM) is an uncommonurologic condition incidentally diagnosed byscrotal ultrasound. It has been associated with differentdiseases, such as Klinefelter`s syndrome, testicular atrophy,cryptorchidism, testicular torsion, and infertility.However, it can also present in healthy males that haveno associated risk factors. Currently, TM is most oftendetected thanks to the superior resolution of today's ultrasoundequipment, compared with former models. In the1990s, TM was considered a benign condition with noimportant clinical relevance, but later reports associatedit with the development of testicular neoplasias andinfertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging,with some even promoting the use of testicular biopsy.The aim of this article is to clearly and specifically presentcurrent information about testicular microlithiasis, toestablish both diagnostic and follow-up indications.


Assuntos
Cálculos , Litíase , Doenças Testiculares , Neoplasias Testiculares , Cálculos/complicações , Cálculos/diagnóstico , Cálculos/terapia , Humanos , Masculino , Doenças Testiculares/complicações , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia , Neoplasias Testiculares/etiologia , Ultrassonografia
13.
Arch. esp. urol. (Ed. impr.) ; 71(10): 840-849, dic. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-178765

RESUMO

La microlitiasis testicular (MT) es un padecimiento urológico poco frecuente que se diagnostica de forma incidental mediante ltrasonografía escrotal. Ha sido asociado a diversas enfermedades como síndrome de Klinefelter, atrofia testicular, criptorquidia, torsión testicular e infertilidad. Sin embargo, también se puede encontrar en varones sanos sin factores de riesgo asociados. La microlitiasis testicular es detectada con mayor frecuencia en la actualidad, debido a la resolución superior de los equipos de ultrasonido actuales en comparación a los anteriores. En la década de los noventa la MT fue considerada una condición benigna sin gran relevancia clínica. Sin embargo, reportes posteriores asociaron este padecimiento al desarrollo de neoplasias testiculares e infertilidad. Por tal motivo muchos autores recomendaban la vigilancia periódica con marcadores tumorales y ultrasonido, e incluso algunos preconizaban el uso de la biopsia testicular. El objetivo del presente articulo de revisión es exponer de manera clara y especifica la evidencia actual de la microlitiasis testicular para así establecer las pautas tanto diagnósticas como de seguimiento


Testicular microlithiasis (TM) is an uncommon urologic condition incidentally diagnosed by scrotal ultrasound. It has been associated with different diseases, such as Klinefelter's syndrome, testicular atrophy, cryptorchidism, testicular torsion, and infertility. However, it can also present in healthy males that have no associated risk factors. Currently, TM is most often detected thanks to the superior resolution of today’s ultrasound equipment, compared with former models. In the 1990s, TM was considered a benign condition with no important clinical relevance, but later reports associated it with the development of testicular neoplasias and infertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging, with some even promoting the use of testicular biopsy. The aim of this article is to clearly and specifically present current information about testicular microlithiasis, toestablish both diagnostic and follow-up indications


Assuntos
Humanos , Cálculos/complicações , Cálculos/diagnóstico , Litíase , Doenças Testiculares/complicações , Doenças Testiculares/diagnóstico , Neoplasias Testiculares/etiologia , Cálculos/terapia , Doenças Testiculares/terapia , Ultrassonografia
14.
Ugeskr Laeger ; 180(40)2018 Oct 01.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30274580

RESUMO

Scrotal diseases can be categorised in different ways: Are the patients young or old, or is the condition acute or chronic? Few organs are as easily accessible as scrotum. Nevertheless, it can be difficult to make a correct diagnosis especially in chronic patients. This review divides scrotal diseases in two groups: acute and non-acute diseases. Relevant diseases are described with symptoms, clinical findings and treatment.


Assuntos
Doenças dos Genitais Masculinos , Doenças Testiculares , Doença Aguda , Algoritmos , Dor Crônica , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Escroto/anatomia & histologia , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia , Testículo/anatomia & histologia
15.
Nurs Res ; 67(5): 349-358, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30059354

RESUMO

BACKGROUND: The incidence of benign and malignant testicular disorders is on the rise. Three literature reviews and one qualitative study found that men's awareness of testicular disorders was lacking, and their intentions to seek help for symptoms of testicular disease were low. OBJECTIVES: The aim of the study was to enhance men's awareness of testicular disorders, help-seeking intentions for testicular symptoms, and intention and behavior to feel their testes. METHODS: Men aged 18-50 years were recruited from a university and asked to engage in a three-level, educational, virtual reality experience. The Medical Research Council framework guided the development and pilot testing of the intervention. Knowledge, awareness, perceived risk, implementation intentions, help-seeking intentions, and behaviors were measured at pretest (T0), immediately posttest (T1), and 1 month posttest (T2). RESULTS: Data were available from 49 participants. In comparison to T0, a significant increase in knowledge (mean difference [MD] = 3.5, 95% CI [2.8, 4.26]); testicular awareness (MD = 0.2, 95% CI [0.01, 0.41]); implementation intentions (MD = 0.6, 95% CI [0.33, 0.90]); and help-seeking intentions for testicular swelling (MD = 0.3, 95% CI [0.12, 0.51]), lumpiness (MD = 0.3, 95% CI [0.08, 0.46]), and pain (MD = 0.6, 95% CI [0.25, 1.01]) was noted at T1. This increase was maintained at T2. Participants who expressed an intention to feel their testes at T0 were more likely to report performing this behavior at T2. DISCUSSION: The intervention succeeded in promoting knowledge, testicular awareness, implementation intentions, help-seeking intentions, and behaviors. A randomized controlled trial of the Enhancing Men's Awareness of Testicular Disorders intervention with a larger sample size is warranted.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Doenças Testiculares , Realidade Virtual , Adolescente , Adulto , Comportamentos Relacionados com a Saúde , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Doenças Testiculares/diagnóstico , Doenças Testiculares/etiologia , Doenças Testiculares/terapia , Adulto Jovem
16.
Pediatr Med Chir ; 40(1)2018 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-29871476

RESUMO

Epididymal cysts (ECs) are relatively common in adults, rare in children. Normally their treatment is conservative. They may be situated anywhere in the organ, frequently in the region of the head. Torsion of these cysts is extremely rare in both children and adults, causing acute scrotal swelling. The diagnosis is intraoperative. A 16-year-old boy was referred to our Divisional Clinic by the treating physician for scrotal swelling appeared 4 months earlier. Absence of a history of minor scrotal trauma. Ultrasonography showed a 40×50 mm fluid-filled right para-testicular mass. We performed surgery finding a large black cyst connected to the head of the epididymis with 720°-degrees rotation. Histology revealed an acquired EC. The particularity of our case is due to the absence of symptoms in association with a big EC twisted of 720° degrees. This is the only case reported in literature. All patients with EC torsion reported presented symptoms related to acute scrotum.


Assuntos
Torção do Cordão Espermático/diagnóstico , Espermatocele/diagnóstico , Doenças Testiculares/diagnóstico , Adolescente , Humanos , Masculino , Escroto/diagnóstico por imagem , Escroto/patologia , Torção do Cordão Espermático/patologia , Torção do Cordão Espermático/cirurgia , Espermatocele/patologia , Espermatocele/cirurgia , Doenças Testiculares/patologia , Doenças Testiculares/cirurgia , Ultrassonografia
17.
J Med Case Rep ; 12(1): 172, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29921313

RESUMO

BACKGROUND: Splenogonadal fusion is a rare and benign condition. Diagnosis is challenging for clinicians. Despite its indolence, diagnosis is often confirmed after orchidectomy. Surgery is mandatory, particularly to rule out the extremely rare association with malignancy. CASE PRESENTATION: We report a case of splenogonadal fusion in a 38-year-old North African man presenting a palpable scrotal mass. We describe clinical aspects, pathogenic hypothesis, radiological features, as well as surgical management principles. CONCLUSIONS: Splenogonadal fusion is rarely suspected and diagnosed preoperatively. A diagnosis is made once an ectopic testicular mass is associated with cryptorchidism and suggestive radiological signs. A better knowledge of the clinical and radiological features of splenogonadal fusion provides an opportunity for conservative surgery.


Assuntos
Coristoma/diagnóstico , Baço , Doenças Testiculares/diagnóstico , Testículo/cirurgia , Adulto , Coristoma/congênito , Coristoma/cirurgia , Edema/etiologia , Humanos , Masculino , Orquiectomia , Escroto , Doenças Testiculares/congênito , Doenças Testiculares/cirurgia
18.
Urology ; 119: 39-43, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29898380

RESUMO

OBJECTIVE: To prospectively validate the chronic orchialgia symptom index (COSI), a newly created instrument with 12 questions in 3 domains (pain, sexual symptoms and quality of life). METHODS: The COSI was given to 170 men with chronic orchialgia at 2 institutions. Seventy-eight men repeated the COSI before therapy and 42 repeated it after surgical therapy. Data was analyzed for test/retest internal reliability, internal consistency, floor and ceiling effects, construct validity, responsiveness and linear regression of all questions including age, duration, and prior surgeries. RESULTS: The 170 men had a mean age of 44.3 (range 18-82) and median symptom duration of 24 months (3-420). About 22.4% had prior vasectomy, 12.4% had hernia repair, and 12.9% had other prior surgery. Mean total COSI was 20.0±7.7 (range 1-37) with subscores of pain 9.1±3.5 (0-17), sexual symptoms 1.82±1.5 (0-5) and quality of life 9.0±4.0 (0-15). Test/retest reliability was high with mean retest total score of 21.2±7.9 and intraclass correlation coefficient of 0.82. Internal consistency by Cronbach's alpha was 0.86. There were no floor or ceiling effects for total score. Construct validity showed all items contributed to a good fit model (P = .001). Patient age, duration, and prior surgeries did not influence COSI. Finally, the COSI was responsive to improvement after therapy (mean after treatment 13.5±9.8, P = .00001). CONCLUSION: COSI is a valid and clinically relevant symptom index to assess severity of orchialgia symptoms and response to therapy in this challenging patient population.


Assuntos
Dor Crônica/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Escroto , Avaliação de Sintomas , Doenças Testiculares/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Genitais Masculinos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Doenças Testiculares/complicações , Adulto Jovem
19.
Pediatr Surg Int ; 34(5): 553-560, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29594470

RESUMO

PURPOSE: We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children. METHODS: We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including > 3 million children. We abstracted data on male children < 12 years who underwent inguinal hernia repair (2005-2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis. RESULTS: 8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1-5). Median follow-up was 3.57 years (IQR 1.69-6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children [Formula: see text] 5 years, with 72% in children < 2 years. Median time to atrophy was 2.4 years (IQR 0.64-3), with 30% occurring within 1 year and 75% within 3 years. CONCLUSION: Testicular atrophy is a rare complication following inguinal hernia repair, with children < 2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later. LEVEL OF EVIDENCE: Prognosis Study, Level II.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Doenças Testiculares/etiologia , Atrofia/diagnóstico , Atrofia/epidemiologia , Atrofia/etiologia , Criança , Pré-Escolar , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Prognóstico , Doenças Testiculares/diagnóstico , Doenças Testiculares/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
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