DOCSLIB.ORG

Henoch-Schönlein Purpura Presenting with Orchitis: a Case Report and Review of the Literature

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Henoch-Schönlein Purpura Presenting with Orchitis: a Case Report and Review of the Literature CONTINUING MEDICAL EDUCATION Henoch-Schönlein Purpura Presenting With Orchitis: A Case Report and Review of the Literature Patrick Davol, MD; Joseph Mowad, MD; Christen M. Mowad, MD GOAL To understand Henoch-Schönlein purpura (HSP) to better treat patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical presentation of HSP. 2. Explain the presentation and diagnosis of HSP orchitis. 3. Describe the pathogenesis of HSP. CME Test on page 88. This article has been peer reviewed and is accredited by the ACCME to provide continuing approved by Victor B. Hatcher, PhD, Professor of medical education for physicians. Medicine, Albert Einstein College of Medicine. Albert Einstein College of Medicine designates Review date: January 2006. this educational activity for a maximum of 1 This activity has been planned and implemented category 1 credit toward the AMA Physician’s in accordance with the Essential Areas and Policies Recognition Award. Each physician should of the Accreditation Council for Continuing Medical claim only that credit that he/she actually spent Education through the joint sponsorship of Albert in the activity. Einstein College of Medicine and Quadrant This activity has been planned and produced in HealthCom, Inc. Albert Einstein College of Medicine accordance with ACCME Essentials. Drs. Davol, J. Mowad, and C.M. Mowad report no conflict of interest. The authors report no discussion of off-label use. Dr. Hatcher reports no conflict of interest. Henoch-Schönlein purpura (HSP) is the most symptoms, and nephritis are other common find- common cause of nonthrombocytopenic purpura ings typically associated with the cutaneous in children. The clinical picture is classically a findings. We present an unusual case of HSP cutaneous purpuric eruption of the legs and with scrotal swelling and orchitis. buttocks and infrequently the upper torso and Cutis. 2006;77:89-92. extremities. Arthritis, gastrointestinal tract Case Report Accepted for publication April 27, 2005. A 7-year-old boy presented to the Emergency Drs. Davol and J. Mowad are from the Department of Urology, and Department with a 1-day history of bilateral scrotal Dr. C.M. Mowad is from the Division of Dermatology, Geisinger rash, swelling, and pain of insidious onset. The pain Medical Center, Danville, Pennsylvania. Reprints: Christen M. Mowad, MD, Geisinger Medical Center had worsened progressively to the point that ambu- 14-06, 100 N Academy Ave, Danville, PA 17821 lation was difficult. The patient’s only medical his- (e-mail: [email protected]). tory was a circumcision as a newborn. There was no VOLUME 77, FEBRUARY 2006 89 Henoch-Schönlein Purpura history of hematuria, urinary tract infections, or trauma. The family reported the boy had been ill 10 days prior to presentation with intermittent fevers, nausea, emesis, and diarrhea, the latter of which had been bloody on at least one occasion. These symptoms had abated several days prior to his presentation to the Emergency Department. Results of a physical examination revealed an anxious boy in no acute distress. He was afebrile with a blood pressure level and respiratory rate within reference range. The abdomen was soft and without masses, rebound tenderness, or guarding. On the genitalia, there was an extensive beefy-red rash con- fined to the scrotal skin, with several areas of petechia overlying the suprapubic fat pad. Both testis were tender to palpation but were descended bilaterally and positioned normally. No inguinal her- nias were detected. Results of a cutaneous examina- tion revealed a diffuse purpuric rash over the lower extremities (Figure). The rash did not extend to the buttocks or above the waist. There were no bullae or vesicles. On further questioning, the patient and his parents admitted noticing the rash 2 days prior to presentation to the Emergency Department. Results of a urinalysis were within reference range. Results of a complete blood count revealed a hemoglobin level within reference range, but an ele- vated platelet count of 500ϫ103/␮L. The patient was sent for a scrotal ultrasound with Doppler flow studies, the results of which showed blood flow to both testes, edema of the scrotal wall, and hyperemia of the epididymides bilaterally. The diagnosis of Henoch-Schönlein purpura Cutaneous purpuric eruption on the lower extremity. (HSP) orchitis was made, and the patient was dis- charged on a therapeutic regimen of prednisolone 2 mg/kg per day, as well as instructions to elevate and apply ice packs to the scrotum. His pain reported in association with HSP; however, no spe- improved dramatically over the next 24 hours; by cific organism appears to be found causative in HSP.1 48 hours, the swelling and erythema had started to The overall incidence of HSP is estimated to be improve. He was seen in follow-up 2.5 weeks later, 9/100,000 people, and males are affected more often at which time the results of a repeat Doppler ultra- than females.1,2 HSP has been reported in patients sound of the testes showed no abnormalities. Results aged 6 months to 86 years, but most cases occur in of an examination revealed his scrotal rash and children (mean age, 6 years). Two thirds of affected tenderness had resolved completely, as did his lower children are younger than 8 years.1 There appears to extremity rash. be some seasonal variation, with more cases occur- ring in fall through spring and fewer cases reported Comment in summer.1,3 HSP, a vasculitic syndrome of the small blood vessels, The most common clinical presentation of HSP is the most common cause of nonthrombocytopenic is the cutaneous purpuric eruption that typically purpura in children. The etiology of HSP remains affects the legs and buttocks and, less frequently, the unknown; however, its occurrence has been reported upper extremities. Bullae and vesicles are seen less following upper respiratory tract infections. Elevated commonly. This eruption is the initial presenting levels of antistreptolysin O antibodies have been finding in more than half of patients with HSP.4 The associated anecdotally with HSP in a minority of second most common clinical symptom found in cases. Several other infectious processes have been HSP is arthritis, which can occur in 60% to 82% of 90 CUTIS® Henoch-Schönlein Purpura patients.3,4 Involvement of the gastrointestinal tract acute scrotal pain and HSP and found that most had with bleeding and abdominal pain occurs in 50% to epididymal enlargement, scrotal skin thickening, 75% of patients and can be life threatening if the hydrocele, and normal-appearing testes with blood gastrointestinal bleeding is severe.3,5 Intussusception flow that was either within reference range or is an uncommon manifestation of HSP.3,5 Renal increased. In addition, other authors have described involvement occurs in 20% to 50% of patients with gray-scale ultrasonographic findings of hypo- HSP. Nephritis is the only manifestation that can echogenicity and hypovascularity of the testicular result in a chronic disease, with 1% to 5% of pa- parenchyma, which may represent areas of necrotic tients developing end-stage renal disease. Uncom- foci.12,13 In these reports, patients found to have mon manifestations of HSP include scrotal disease, intact testicular blood flow did well with observa- pulmonary disease, carditis, and central nervous tion and, in some instances, with a therapeutic regi- system involvement.5 men of oral or intravenous steroids.11-13 Scrotal involvement is an uncommon manifes- Other uncommon genitourinary findings of HSP tation of HSP but has been reported to occur in include priapism, purpura of the penile shaft, hem- 3% to 38% of cases. It may include scrotal rash, orrhagic cystitis, renal colic, ureteral calcifications, swelling, and either bilateral or unilateral pain. bladder hematomas, and stenotic ureteritis.14-17 Allen and colleagues6 were the first to describe HSP typically is acute and self-limited, running scrotal involvement in HSP in a 1960 review that its course in about 4 weeks; however, 30% to 40% of focused on renal complications of the disease. In patients can experience recurrences.5 Short-term the case series of 131 patients, 5 boys had scrotal morbidity depends on the presence and severity of involvement: 2 with “swelling and hemorrhage of gastrointestinal tract involvement, and long-term the testes” and 3 with “marked scrotal hematomas.” prognosis primarily is dependent on the extent of Clark and Kramer7 reviewed the Mayo Clinic expe- renal involvement.5 Supportive therapy is all that rience in a 1986 report; in a series of 87 males diag- typically is necessary, though systemic steroids often nosed with HSP, scrotal involvement was seen are used to treat the associated arthritis, skin find- in 3.4%. Interestingly, orchitis has been the present- ings, and orchitis, when present. However, studies ing symptom of HSP in only a handful of reported have shown that these symptoms typically resolve cases.7 More commonly, the development of scrotal with or without the use of corticosteroids; addition- signs and symptoms parallels the development of ally, the use of corticosteroids does not have a sig- the classic purpuric rash. nificant effect on the duration of the disease or the The clinical presentation of HSP orchitis may frequency of recurrences.3,5,18,19 The use of high-dose mimic testicular torsion, which can often be a diffi- steroids in severe nephritis and gastrointestinal tract cult distinction to make based on clinical examina- hemorrhage is more established.3,5,18,19 tion findings alone. Several reports have described The pathogenesis of HSP results from a leukocy- patients diagnosed with HSP who also presented toclastic vasculitis due to immunoglobulin A (IgA) with signs of testicular torsion and were explored deposition in vessel walls. IgA also has been found surgically. In almost all cases, the patients were to be elevated in the serum of patients with HSP; found not to have torsion but rather to have vas- additionally, IgA circulating immune complexes culitic changes in the spermatic cord, testes, and have been found.
Load more

Recommended publications
  • A Clinical Case of Fournier's Gangrene: Imaging Ultrasound
    J Ultrasound (2014) 17:303–306 DOI 10.1007/s40477-014-0106-5 CASE REPORT A clinical case of Fournier’s gangrene: imaging ultrasound Marco Di Serafino • Chiara Gullotto • Chiara Gregorini • Claudia Nocentini Received: 24 February 2014 / Accepted: 17 March 2014 / Published online: 1 July 2014 Ó Societa` Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2014 Abstract Fournier’s gangrene is a rapidly progressing Introduction necrotizing fasciitis involving the perineal, perianal, or genital regions and constitutes a true surgical emergency Fournier’s gangrene is an acute, rapidly progressive, and with a potentially high mortality rate. Although the diagnosis potentially fatal, infective necrotizing fasciitis affecting the of Fournier’s gangrene is often made clinically, emergency external genitalia, perineal or perianal regions, which ultrasonography and computed tomography lead to an early commonly affects men, but can also occur in women and diagnosis with accurate assessment of disease extent. The children [1]. Although originally thought to be an idio- Authors report their experience in ultrasound diagnosis of pathic process, Fournier’s gangrene has been shown to one case of Fournier’s gangrene of testis illustrating the main have a predilection for patients with state diabetes mellitus sonographic signs and imaging diagnostic protocol. as well as long-term alcohol misuse. However, it can also affect patients with non-obvious immune compromise. Keywords Fournier’s gangrene Á Sonography Comorbid systemic disorders are being identified more and more in patients with Fournier’s gangrene. Diabetes mel- Riassunto La gangrena di Fournier e` una fascite necro- litus is reported to be present in 20–70 % of patients with tizzante a rapida progressione che coinvolge il perineo, le Fournier’s Gangrene [2] and chronic alcoholism in regioni perianale e genitali e costituisce una vera emer- 25–50 % patients [3].
    [Show full text]
  • Urologic Disorders
    Urologic Disorders Abdulaziz Althunayan Consultant Urologist Assistant professor of Surgery Urologic Disorders Urinary tract infections Urolithiasis Benign Prostatic Hyperplasia and voiding dysfunction Urinary tract infections Urethritis Acute Pyelonephritis Epididymitis/orchitis Chronic Pyelonephritis Prostatitis Renal Abscess cystitis URETHRITIS S&S – urethral discharge – burning on urination – Asymptomatic Gonococcal vs. Nongonococcal DX: – incubation period(3-10 days vs. 1-5 wks) – Urethral swab – Serum: Chlamydia-specific ribosomal RNA URETHRITIS Epididymitis Acute : pain, swelling, of the epididymis <6wk chronic :long-standing pain in the epididymis and testicle, usu. no swelling. DX – Epididymitis vs. Torsion – U/S – Testicular scan – Younger : N. gonorrhoeae or C. trachomatis – Older : E. coli Epididymitis Prostatitis Syndrome that presents with inflammation± infection of the prostate gland including: – Dysuria, frequency – dysfunctional voiding – Perineal pain – Painful ejaculation Prostatitis Prostatitis Acute Bacterial Prostatitis : – Rare – Acute pain – Storage and voiding urinary symptoms – Fever, chills, malaise, N/V – Perineal and suprapubic pain – Tender swollen hot prostate. – Rx : Abx and urinary drainage cystitis S&S: – dysuria, frequency, urgency, voiding of small urine volumes, – Suprapubic /lower abdominal pain – ± Hematuria – DX: dip-stick urinalysis Urine culture Pyelonephritis Inflammation of the kidney and renal pelvis S&S : – Chills – Fever – Costovertebral angle tenderness (flank Pain) – GI:abdo pain, N/V, and
    [Show full text]
  • Non-Certified Epididymitis DST.Pdf
    Clinical Prevention Services Provincial STI Services 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel : 604.707.5600 Fax: 604.707.5604 www.bccdc.ca BCCDC Non-certified Practice Decision Support Tool Epididymitis EPIDIDYMITIS Testicular torsion is a surgical emergency and requires immediate consultation. It can mimic epididymitis and must be considered in all people presenting with sudden onset, severe testicular pain. Males less than 20 years are more likely to be diagnosed with testicular torsion, but it can occur at any age. Viability of the testis can be compromised as soon as 6-12 hours after the onset of sudden and severe testicular pain. SCOPE RNs must consult with or refer all suspect cases of epididymitis to a physician (MD) or nurse practitioner (NP) for clinical evaluation and a client-specific order for empiric treatment. ETIOLOGY Epididymitis is inflammation of the epididymis, with bacterial and non-bacterial causes: Bacterial: Chlamydia trachomatis (CT) Neisseria gonorrhoeae (GC) coliforms (e.g., E.coli) Non-bacterial: urologic conditions trauma (e.g., surgery) autoimmune conditions, mumps and cancer (not as common) EPIDEMIOLOGY Risk Factors STI-related: condomless insertive anal sex recent CT/GC infection or UTI BCCDC Clinical Prevention Services Reproductive Health Decision Support Tool – Non-certified Practice 1 Epididymitis 2020 BCCDC Non-certified Practice Decision Support Tool Epididymitis Other considerations: recent urinary tract instrumentation or surgery obstructive anatomic abnormalities (e.g., benign prostatic
    [Show full text]
  • Brucellar Epididymo-Orchitis Van Tıp Dergisi: 17 (4):131-135, 2010
    Brucellar epididymo-orchitis Van Tıp Dergisi: 17 (4):131-135, 2010 Brucellar Epididymo-orchitis: Report of Fifteen Cases Mustafa Güneş*, İlhan Geçit**, Salim Bilici*** , Cengiz Demir****, Ahmet Özkal*****, Kadir Ceylan**, Mustafa Kasım Karahocagil***** Abstract Aim: To discuss brucellar epididymo-orchitis cases in our clinic in terms of clinical and laboratory findings, treatment, and prognosis. Materials and methods: Our diagnostic criteria for the patients having epididymo-orchitis clinical findings are Standard Tube Agglutination (STA) or STA with Coombs test ≥1/160 titer or increase of STA titers four times and more in their serum samples in two weeks. Results: Ten of our cases (66%) had herb cheese eating history and five of them (33%) were dealing with animal husbandry. The most frequently observed symptom in our cases was testicular pain, and the most frequent clinical and laboratory finding was scrotal swelling and the alteration of the C-reactive protein (CRP). The diagnosis was made with STA test in 14 cases (93%), STA with Coombs test in one case (7%). Epididymo-orchitis was diagnosed on the right side in nine cases, on the left in five cases and bilateral in one case on physical examination. The patients were treated with rifampicin+doxycycline. Orchiectomy was done in one case who applied late to our clinic. Conclusion: Brucellar epididymo-orchitis should be thought first in patients applied with orchitis in brucellosis endemic regions, and should not be ignored in nonendemic regions also. It was shown that with early and appropriate medical treatment cases could be cured without surgery. Key words: Brucella spp., epididymo-orchitis, orchiectomy.
    [Show full text]
  • Redalyc.HEMATOCELE CRÓNICO CALCIFICADO. a PROPOSITO DE UN CASO
    Archivos Españoles de Urología ISSN: 0004-0614 [email protected] Editorial Iniestares S.A. España Jiménez Yáñez, Rosa; Gallego Sánchez, Juan Antonio; Gónzalez Villanueva, Luis; Torralbo, Gloria; Ardoy Ibáñez, Francisco; Pérez, Miguel HEMATOCELE CRÓNICO CALCIFICADO. A PROPOSITO DE UN CASO. Archivos Españoles de Urología, vol. 60, núm. 3, 2007, pp. 303-306 Editorial Iniestares S.A. Madrid, España Disponible en: http://www.redalyc.org/articulo.oa?id=181013938015 Cómo citar el artículo Número completo Sistema de Información Científica Más información del artículo Red de Revistas Científicas de América Latina, el Caribe, España y Portugal Página de la revista en redalyc.org Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto 303 HEMATOCELE CRÓNICO CALCIFICADO. A PROPOSITO DE UN CASO. en la que se realizan varias biopsias de la albugínea en 8. KIHL, B.; BRATT, C.G.; KNUTSSON, U. y cols.: la zona distal del cuerpo cavernoso con una aguja de “Priapism: evaluation of treatment with special re- biopsia tipo Trucut. Una modificación quirúrgica a cielo ferent to saphenocavernous shunting in 26 patients”. abierto más agresiva de este tipo de derivación es la Scand. J. Urol. Nephrol., 14: 1, 1980. intervención que propone El-Ghorab. En ella se realiza *9. MONCADA, J.: “Potency disturbances following una comunicación caverno-esponjosa distal mediante saphenocavernous bypass in priapism (Grayhack una incisión transversal en la cara dorsal del glande a procedure)”. Urologie, 18: 199, 1979. 0.5-1cm del surco balanoprepucial. Se retira una por- 10. WILSON, S.K.; DELK, J.R.; MULCAHY, J.J. y ción de albugínea en la parte distal de cada cuerpo cols.: “Upsizing of inflatable penile implant cylin- cavernoso.
    [Show full text]
  • The Management of Acute Testicular Pain in Children and Adolescents
    BMJ 2015;350:h1563 doi: 10.1136/bmj.h1563 (Published 2 April 2015) Page 1 of 8 Clinical Review CLINICAL REVIEW The management of acute testicular pain in children and adolescents 1 2 1 Matthew T Jefferies specialist registrar in urology , Adam C Cox specialist registrar in urology , 1 3 Ameet Gupta specialist registrar in urology , Andrew Proctor general practitioner 1Department of Urology, University Hospital of Wales, Cardiff, UK; 2Institute of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK; 3Roath House Surgery, Cardiff, UK Sudden onset testicular pain with or without swelling, often aspect of the testes to the tunica vaginalis. Consequently the referred to as the “acute scrotum,” is a common presentation in testis is free to swing and rotate within the tunica vaginalis of children and adolescents, and such patients are seen by the scrotum. This defect is referred to as the “bell-clapper urologists, paediatricians, general practitioners, emergency deformity,” occurring in 12% of all males; of those, 40% of doctors, and general surgeons. Of the many causes of acute cases are bilateral 7 (figure⇓). This type of abnormality mainly scrotum, testicular torsion is a medical emergency; it is the one occurs in adolescents. In contrast, extravaginal torsion occurs diagnosis that must be made accurately and rapidly to prevent more often in neonates (figure), occurring in utero or around loss of testicular function. the time of birth before the testis is fixed in the scrotum by the This review aims to cover the salient points in the history and gubernaculum. Consequently, both the spermatic cord and the clinical examination of acute scrotum to facilitate accurate tunica vaginalis undergo torsion together, typically in or just diagnosis and prompt treatment of the most common below the inguinal canal.
    [Show full text]
  • EAU Guidelines on Male Infertility$ W
    European Urology European Urology 42 (2002) 313±322 EAU Guidelines on Male Infertility$ W. Weidnera,*, G.M. Colpib, T.B. Hargreavec, G.K. Pappd, J.M. Pomerole, The EAU Working Group on Male Infertility aKlinik und Poliklinik fuÈr Urologie und Kinderurologie, Giessen, Germany bOspedale San Paolo, Polo Universitario, Milan, Italy cWestern General Hospital, Edinburgh, Scotland, UK dSemmelweis University Budapest, Budapest, Hungary eFundacio Puigvert, Barcelona, Spain Accepted 3 July 2002 Keywords: Male infertility; Azoospermia; Oligozoospermia; Vasectomy; Refertilisation; Varicocele; Hypogo- nadism; Urogenital infections; Genetic disorders 1. Andrological investigations and 2.1. Treatment spermatology A wide variety of empiric drug approaches have been tried (Table 1). Assisted reproductive techniques, Ejaculate analysis and the assessment of andrological such as intrauterine insemination, in vitro fertilisation status have been standardised by the World Health (IVF) and intracytoplasmic sperm injection (ICSI) are Organisation (WHO). Advanced diagnostic spermato- also used. However, the effect of any infertility treat- logical tests (computer-assisted sperm analysis (CASA), ment must be weighed against the likelihood of spon- acrosome reaction tests, zona-free hamster egg penetra- taneous conception. In untreated infertile couples, the tion tests, sperm-zona pellucida bindings tests) may be prediction scores for live births are 62% to 76%. necessary in certain diagnostic situations [1,2]. Furthermore, the scienti®c evidence for empirical approaches is low. Criteria for the analysis of all therapeutic trials have been re-evaluated. There is 2. Idiopathic oligoasthenoteratozoospermia consensus that only randomised controlled trials, with `pregnancy' as the outcome parameter, can accepted Most men presenting with infertility are found to for ef®cacy analysis. have idiopathic oligoasthenoteratozoospermia (OAT).
    [Show full text]
  • Epididymo-Orchitis-Leaflet Epididymo-Orchitis
    Page 1 of 4 View this article online at: patient.info/health/epididymo-orchitis-leaflet Epididymo-orchitis Epididymo-orchitis is an inflammation of the epididymis and/or testicle (testis). It is usually due to infection, most commonly from a urine infection or a sexually transmitted infection. A course of antibiotic medicine will usually clear the infection. Full recovery is usual. Complications are uncommon. What is epididymo-orchitis? Epididymitis means inflammation of the epididymis (the structure next to the testicle (testis) that is involved in making sperm). Orchitis means inflammation of a testicle. As the epididymis and testis lie next to each other, it is often difficult to tell if the epididymis, the testis, or both are inflamed. Therefore, the term epididymo-orchitis is often used. What causes epididymo-orchitis? Most cases are due to an infection. Causes of infection include the following: A complication from a urine infection Germs (bacteria) such as E. coli that cause urine infections can sometimes track down the vas deferens to cause an epididymo-orchitis. This can happen at any age and is the most common cause of epididymo-orchitis in men aged over 35 years. This is because partial blockage of urine flow becomes more common with increasing age, due an enlarged prostate or narrowing of the urethra (urethral stricture). The urethra is the tube that urine flows out of from the bladder. Partial blockage of urine makes you more prone to develop urine infections. A complication of a urine infection is also the usual cause of epididymo-orchitis in young boys. Page 2 of 4 Sexually transmitted infection A sexually transmitted infection is the most common cause of epididymo-orchitis in young men (but can occur in any sexually active man).
    [Show full text]
  • American Urological Association Guideline on the Management of Priapism
    0022-5347/03/1704-1318/0 Vol. 170, 1318–1324, October 2003 ® THE JOURNAL OF UROLOGY Printed in U.S.A. Copyright © 2003 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000087608.07371.ca AMERICAN UROLOGICAL ASSOCIATION GUIDELINE ON THE MANAGEMENT OF PRIAPISM DROGO K. MONTAGUE (CO-CHAIR),* JONATHAN JAROW (CO-CHAIR),† GREGORY A. BRODERICK,‡ ROGER R. DMOCHOWSKI,§ JEREMY P. W. HEATON,࿣ TOM F. LUE,¶ AJAY NEHRA,** IRA D. SHARLIP,†† AND MEMBERS OF THE ERECTILE DYSFUNCTION GUIDELINE UPDATE PANEL‡‡ INTRODUCTION priapism would eventually resolve on its own albeit with Priapism, a relatively uncommon disorder, is a medical possible permanent damage to the penis. The literature re- emergency. Although not all forms of priapism require im- viewed for this guideline straddles both empirical and mediate intervention, ischemic priapism is associated with pathophysiology-based eras, and some of the reported posi- progressive fibrosis of the cavernosal tissues and erectile tive responses to treatment may reflect the natural course of dysfunction.1, 2 Thus, all patients with priapism should be priapism rather than a true treatment success. In addition, evaluated immediately in order to intervene as early as pos- the literature is bereft of followup data on patients with sible in those patients with ischemic priapism. The goal of priapism. the management of all patients with priapism is to achieve This document derives from a comprehensive review of the detumescence and preserve erectile function. Unfortunately, medical literature related to the management of priapism. As some of the treatments aimed at correcting priapism have noted, deficiencies in this literature made it impossible to the potential complication of erectile dysfunction.
    [Show full text]
  • Risk Factors for Squamous Cell Carcinoma of the Penis— Population-Based Case-Control Study in Denmark
    2683 Risk Factors for Squamous Cell Carcinoma of the Penis— Population-Based Case-Control Study in Denmark Birgitte Schu¨tt Madsen,1 Adriaan J.C. van den Brule,2 Helle Lone Jensen,3 Jan Wohlfahrt,1 and Morten Frisch1 1Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark; 2Department of Pathology, VU Medical Center, Amsterdam and Laboratory for Pathology and Medical Microbiology, PAMM Laboratories, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands;and 3Department of Pathology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Denmark Abstract Few etiologic studies of squamous cell carcinoma female sex partners, number of female sex partners (SCC) of the penis have been carried out in populations before age 20, age at first intercourse, penile-oral sex, a where childhood circumcision is rare. A total of 71 history of anogenital warts, and never having used patients with invasive (n = 53) or in situ (n = 18) penile condoms. Histories of phimosis and priapism at least 5 SCC, 86 prostate cancer controls, and 103 population years before diagnosis were also significant risk controls were interviewed in a population-based case- factors, whereas alcohol abstinence was associated control study in Denmark. For 37 penile SCC patients, with reduced risk. Our study confirms sexually tissue samples were PCR examined for human papil- transmitted HPV16 infection and phimosis as major lomavirus (HPV) DNA. Overall, 65% of PCR-examined risk factors for penile SCC and suggests that penile- penile SCCs were high-risk HPV-positive, most of oral sex may be an important means of viral transmis- which (22 of 24; 92%) were due to HPV16.
    [Show full text]
  • Male Factor Infertility
    2 Male Factor Infertility SECTION CONTENTS 3 Evaluation and Diagnosis of Male Infertility 4 Hormonal Management of Male Infertility 5 Immunology of Male Infertility 6 Surgical Management of Male Infertility 7 Genetics and Male Infertility 3 Evaluation and Diagnosis of Male Infertility Sandro C Esteves, Alaa Hamada, Ashok Agarwal to the andrological armamentarium. Today, it is possible CHAPTER CONTENTS to correctly classify some cases which were previously ♦ Definition and Epidemiology of Male Infertility believed to be idiopathic. The initial evaluation of com- ♦ Pathophysiology, Etiology and Classification of Male mon infertility complaint comprises the meticulous his- Infertility tory taking, as well as conducting a thorough physical ♦ Probabilities of Conception for Fertile and Infertile examination along with proper laboratory and imaging Couples studies as needed. ♦ Goals and the Proper Timing for Fertility Evaluation ♦ Approaching the Subfertile Male DEFINITION AND EPIDEMIOLOGY OF MALE INFERTILITY The infertility is defined as failure of the couples to INTRODUCTION conceive after 12 months of unprotected regular inter- course.2 Infertility is broadly classified into primary t is well known that the motivation to have children infertility, when the male partner has no previous history Iand the formation of a new family unit are essential of fertility, and secondary infertility, when there was components of the individual instinct for existence and previous man’s history of successful impregnation of well-being. Fertility problems may represent a stressful a woman. Subfertility refers to a reduced but not unat- situation to the individual’s life with important nega- tainable potential to achieve pregnancy, while sterility tive psychological consequences.1 The experienced cli- is denoted by permanent inability to induce or achieve nician should realize and comprehend the burdensome pregnancy.3 Fecundity, on the other hand, indicates the bearings and frustrated mood of the infertile individual.
    [Show full text]
  • A Retrospective Case Series of Fournier's Gangrene: Necrotic
    A retrospective case series of Fournier’s gangrene: necrotic fasciitis in perineum and crissum Nan Zhang Jilin University Second Hospital Xin Yu Jilin University First Hospital Kai Zhang Jilin University Second Hospital Tongjun Liu ( [email protected] ) Jilin University Second Hospital https://orcid.org/0000-0003-0887-7723 Research article Keywords: Fournier’s gangrene, necrotizing fasciitis, infection Posted Date: July 23rd, 2020 DOI: https://doi.org/10.21203/rs.3.rs-41628/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on October 30th, 2020. See the published version at https://doi.org/10.1186/s12893-020-00916-3. Page 1/8 Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented. Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of LRINEC score of 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. NPWT was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination.
    [Show full text]