DOCSLIB.ORG

What Can We Do for Chronic Scrotal Content Pain?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health 2017 December 35(3): 146-155 https://doi.org/10.5534/wjmh.17047 Review Article What Can We Do for Chronic Scrotal Content Pain? Wei Phin Tan, Laurence A Levine Department of Urology, Rush University Medical Center, Chicago, IL, USA Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options. Key Words: Chronic pain; Epididymis; Epididymitis; Pelvic pain; Vasovasostomy INTRODUCTION mately 2.5% of all urology visits are associated with scro- tal content pain, resulting in a significant healthcare finan- Chronic scrotal content pain (CSCP) is defined by at cial burden [1,5]. Many patients with this condition end up least 3 months of chronic or intermittent scrotal content seeing physicians across many disciplines, further frustrat- pain with severity that interferes with daily activities, ing them [6,7]. prompting the patient to seek medical treatment [1]. CSCP In recent years, physicians are seeing more patients may originate from the testicle, epididymis, paratesticular with CSCP due to the increased awareness of men’s health structures, and/or the spermatic cord. The etiology of the [8]. It is estimated that around 100,000 men suffer from pain is idiopathic in up to 50% of patients [2]. Easily recog- this problem, and the number will continue to increase nizable and reversible causes include varicocele, epi- [9]. It is estimated that chronic pain affects around 116 mil- didymitis, spermatocele, tumor, infection, and torsion. lion Americans, leading to $635 billion being spent on This syndrome has been referred to by many names, in- medical expenses and lost productivity per year due to this cluding chronic orchialgia, testicular pain syndrome, tes- problem [10]. tialgia, CSCP, post-vasectomy orchialgia, post-vasectomy Multiple algorithms have been proposed, but none pain syndrome (PVPS), congestive epididymitis, and have been validated [2,4]. It is recommended that pharma- chronic testicular pain. Presently, this problem is referred cotherapy options should be exhausted before consider- to as CSCP, as this term appears to best encompass the va- ing surgical treatments, which include epididymectomy, riety of structures that may be involved [3,4]. Approxi- microdenervation of the spermatic cord (MDSC), vasec- Received: Oct 12, 2017; Revised: Oct 22, 2017; Accepted: Nov 12, 2017 Correspondence to: Laurence A Levine Department of Urology, Rush University Medical Center, 1725 W Harrison Street, Suite 352, Chicago 60612, IL, USA. Tel: +1-312-563-5000, E-mail: [email protected] Copyright © 2017 Korean Society for Sexual Medicine and Andrology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Wei Phin Tan and Laurence A Levine: Chronic Scrotal Content Pain 147 tomy reversal, and finally orchiectomy. In this article, we further mediators of WD, such as interleukin 1α [14]. aim to review the workup and treatment options available Any organ that shares the same nerve pathways with the for CSCP. scrotal content (L1∼L2 and S2∼S4) may refer pain to this area. Lower back pain due to irritation of the nerve root of METHODOLOGY T10∼L1 may radiate to the testicle, as they share the same innervation. Pain arising in the ureter due to obstruction, We conducted a computerized bibliographic search of hip pain and intervertebral disc prolapse, or pudendal the PubMed, Medline, Embase, and Cochrane databases neuropathies can all result in CSCP [15]. The pain could al- for all reports pertaining to CSCP using the Medical so be part of chronic prostatitis/chronic pelvic pain syn- Subject Headings keywords “Chronic scrotal content drome, for which up to 50% of men have reported to also pain”, “Testicular pain”, “Orchialgia”, “Testicular Pain have pain in the testes [2]. Ultimately, CSCP can arise from Syndrome”, “microdenervation of the spermatic cord”, any traumatic, infectious, or irritative stimulus to the “Post-vasectomy Pain Syndrome”, and “testialgia” through nerves in the scrotum [16]. 15th September 2017. All studies pertaining to CSCP were included in the review. Studies were excluded if they were CLINICAL PRESENTATION AND published in languages other than English. EVALUATION ETIOLOGY/PATHOPHYSIOLOGY The signs and symptoms of CSCP include orchialgia, tender epididymis, tender vas, dyspareunia, pain with The iliohypogastric, ilioinguinal, genitofemoral, and ejaculation, premature ejaculation, pain with straining, pudendal nerves originate from the L1∼L2 and S2∼S4 and pain after prolonged sitting. The key to a successful nerve roots and are responsible for innervation of the evaluation is to establish a good rapport with the patient. testes, epididymis, and scrotum [1,11]. These nerves in- The evaluation of a patient presenting with scrotal content nervate the scrotal content and travel through the sper- pain should include a thorough history and physical ex- matic cord. At least 50% of the nerves innervating those amination with a focused examination of the scrotal structures were identified near the vas deferens and 20% content. The history portion of the clinical visit should in- were identified in the cremasteric fascia [12]. The patho- clude the duration and nature of the pain (sharp, aching, physiology of CSPS is multifactorial and poorly under- burning, pressure, etc.), consistency (intermittent or con- stood. An injury to the testes or other scrotal content struc- stant), severity (on a 0∼10 visual analogue scale), varia- tures is typically the precursor of CSPS. This acute pain tion in intensity, location, radiation, aggravating factors, leads to nerve sensitization, resulting in modulation of the associated symptoms, and previous therapeutic maneu- nerve pathways, causing hypersensitivity around the sper- vers. The patient should be asked whether the pain is asso- matic cord. This hypersensitivity has been proposed to fol- ciated with voiding, bowel movements, sexual or physical low neural injury, with resulting Wallerian degeneration activities, or prolonged sitting. A surgical history pertain- (WD) in these peripheral nerves. WD is characterized as ing to the spine, inguinal, scrotal, pelvic, and retro- an auto-destructive change in both the proximal and distal peritoneal space should also be documented. A thorough nerve axons, which leads to an environment clear of in- psychosocial exam to rule out depression, a history of sex- hibitory debris and supportive of axon regrowth and func- ual abuse, Munchausen syndrome, or other somatoform tional recovery [13]. Following nerve injury, calcium en- disorders should also be included in the evaluation ters the cell, triggering the sealing of the proximal and dis- [17,18]. tal axonal stump by the fusion of axolemmal vesicles A thorough physical examination focusing on the geni- around the injured axon endings. This also activates cal- talia is essential for a patient presenting with scrotal con- cium-dependent protease pathways, such as phospholi- tent pain. The patient should be examined while standing pases and M-calpain. M-calpain triggers the expression of and supine, beginning on the normal/less painful side. A www.wjmh.org 148 World J Mens Health Vol. 35, No. 3, December 2017 focused examination of the testicles, epididymides, and cele, or infection [19,20]. A magnetic resonance imaging vas deferens is recommended, as well as a 360° digital scan of the spine and/or hips is also recommended when rectal exam to evaluate abnormalities of the prostate and there is a history of back or hip pain to rule out nerve hypertonicity or tenderness of the pelvic floor structures. impingement. A spermatic cord block (SCB) should also A neurological examination of the lower limbs should also be performed to determine if the pain is being generated be performed to rule out radicular pain syndromes and from within the scrotum. We recommend that this block neurosensory deficits. Laboratory investigation studies be performed by injecting 20 mL of 0.25% bupiva- should include a urinalysis and urine and semen culture to caine/ropivacaine without epinephrine into the spermatic rule out infection when indicated. Should microscopic cord at the level of the pubic tubercle [17]. If the pain sig- hematuria be identified on the urinalysis, a computed to- nal is conducted via the spermatic cord nerves, the pain mography scan of the abdomen and pelvis is indicated, as should be temporarily relived after performing the cord obstructing stones in the ureter (particularly the intramural block. The differential diagnoses for CSPS include con- portion of the ureter) can result in scrotal content pain. stipation; hydrocele; varicocele; epididymitis; tumor; in- The use of scrotal ultrasound in men with chronic orchi- termittent testicular torsion; inguinal hernia; aortic
Recommended publications
  • Ultrasonography and Elastography Imaging

    Ultrasonography and Elastography Imaging

    Jemds.com Case Report Post Traumatic Hematocele - Ultrasonography and Elastography Imaging Shivesh Pandey1, Suresh Vasant Phatak2, Gopidi Sai Nidhi Reddy3, Apoorvi Bharat Shah4 1, 2, 3, 4 Department of Radio diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra India. INTRODUCTION Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Corresponding Author: Elastography is the new recent advance in the field of ultrasound. USG and Dr. Suresh Vasant Phatak, elastography findings of the acute hematocele is described in this aricle. Department of Radiodiagnosis, Jawaharlal Testicular trauma is the third most common cause of acute scrotal pain,1 and Nehru Medical College, Sawangi (Meghe), high-frequency ultrasonography (USG) with a linear array transducer is the first Wardha, Maharashtra – 442001, India. E-mail: [email protected] preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the DOI: 10.14260/jemds/2021/340 scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, How to Cite This Article: spontaneous resolution occurs with the support of conservative therapy,3 even if Pandey S, Phatak SV, Reddy GSN, et al. Post treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed traumatic hematocele - usg and broad hematoceles and testicular hematomas over time.4 elastography imaging. J Evolution Med A testis with its coverings, epididymis, and spermatic cord are all contained in Dent Sci 2021;10(21):1636-1638, DOI: 10.14260/jemds/2021/340 each hemiscrotum.
  • Spring 06 2 27.Qxp

    Spring 06 2 27.Qxp

    University of California, Irvine School of Medicine Spring 2006 UCI Medical Center Department of Urology 101 THE CITY DRIVE SOUTH ORANGE, CA 92868-5395 N E W S L E T T E R Re-United: The facts about vasectomy reversal "When a man consents to undergo a vasectomy, he is usually instructed that the procedure should be considered Aaron Spitz, MD to be permanent and irreversible.... Nonetheless, even the Assistant Clinical Professor Male Reproductive Medicine most insightful, thoughtful decision can ultimately prove and Surgery wrong. When that decision is a vasectomy, a man may still change his mind." re you considering a vasec- tomy. Therefore, before undergoing a tomy reversal? Thousands vasectomy, a man should be as sure as A of men undergo vasectomy possible that he is finished having chil- each year as a permanent means of dren. Nonetheless, even the most birth control, yet for some of these men insightful, thoughtful decision can ulti- life brings unexpected turns, which mately prove wrong. When that deci- leads them to change their mind. For sion is a vasectomy, a man may still Epididymo-vasostomy some, there is a strong desire to have change his mind. sperm travel from the testicle to the another child a few years later. For urethra. It feels like a piece of under- others, there may be a tragic loss of a What is a vasectomy? cooked spaghetti in each side of the child. For many men, a new marriage To understand the vasectomy reversal, scrotum. The sperm are produced in brings a new opportunity for creating a it is important to understand the vasec- the testicle, and then they exit out the family.
  • Non-Certified Epididymitis DST.Pdf

    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
  • Vasectomy Reversal (VR)

    Vasectomy Reversal (VR)

    Vasectomy Reversal (VR) ! Need to know Please read this before your Vasectomy Reversal Preparing for the VR • Do not eat or drink after midnight if your operation is in the morning and not after 7.00am if it is in the afternoon. • Please shave the hair at the front and sides of the scrotum from the base of the penis down. You do not need to shave the pubic hair • Take supportive underpants (not your best) or a jockstrap into the hospital with you and to theatre to wear after the operation. • Arrange a week off work. • Avoid intercourse for two weeks after the operation and heavy lifting for four weeks. REF 0000.0 – 12/15 What to expect during the VR • An infection of the scrotum rarely occurs but if it does, • An incision is placed on each side of the scrotum that will present a few days after the surgery and is apparent are a little larger than those used for the vasectomy. because the pain becomes worse rather than better and the scrotum becomes red. • The vas is a very small muscular tube with a 2mm outer diameter and an inner diameter through which If you experience any of the above complications or sperm flow (the lumen), of less than 1/2mm. Since the have any other problem occur after your VR, please structure is so small, the stitches must be placed very call the Clinic or your Surgeon if outside clinic exactly so that there is minimal scarring. Too much hours. scarring can cause the lumen of the vas to close and the procedure to fail.
  • Urologic Malignancies

    Urologic Malignancies

    Scope • Anatomy •Urologic Malignancies • Trauma • Emergencies • Infections • Lower Urinary Tract Obstruction • Upper Urinary Tract Obstruction • Pediatric Urology • Key Points Emmanuel L. Barcenas Urologist/Urologic Surgeon Urology Specialty Group and Associates • Doctor of Medicine, SWU • Diplomate, Philippine Board of Surgery and the Philippine Board of Urology • Fellow, Philippine Urological Association • Fellow, Philippine College of Surgeons • Member, Philippine Endourological Society • Member, Phillippine Society of Urooncologists Urologic Malignancies Urologic Malignancies •Bladder Cancer •Testicular Cancer •Kidney Cancer •Prostate Cancer Urothelial Tumors of the UB •Transitional cell epithelium lines the urinary tract from the renal pelvis, ureter, urinary bladder, and the proximal two-thirds of the urethra •Tobacco use is the most frequent risk factor (50% in men and 40% in women), followed by occupational exposure to various carcinogenic materials such as automobile exhaust or industrial solvents. Detection of Urothelial Cancer •Painless gross hematuria occurs in 85% of patients & requires a complete evaluation that includes cystoscopy, urine cytology, CT scan, & a PSA. •Recurrent or significant hematuria (>3 RBC’s/HPF on 3 urinalysis, a single urinalysis with >100 RBCs, or gross Hematuria) is associated with significant renal or urologic lesion in 9.1% Detection of Urothelial Cancer • Patients with microscopic hematuria require a full evaluation, but low-risk patients do not require repeat evaluations. • High-risk individuals primarily are those with a smoking history & should be evaluated every 6 months. • The level of suspicion for urogenital neoplasms in patients with isolated painless hematuria and nondysmorphic RBCs increases with age. • White light cystoscopy with random bladder biopsies is the gold standard for tumor detection History & Staging •Low-grade papillary lesions are likely to recur in up to 60% of patients but invade in less than 10% of cases.
  • Surgical Management of Male Infertility

    Surgical Management of Male Infertility

    6 Surgical Management of Male Infertility Sandro C Esteves, Alaa Hamada, Ashok Agarwal (Sandro C Esteves) tertiary center for male reproduction, CHAPTER CONTENTS potentially surgical correctable conditions were identi- fied in 34.4% of the male partners. Azoospermia is iden- ♦ Surgical Treatment to Improve Sperm Production tified in about one-third of the individuals. Despite the ♦ Reconstructive Surgeries of Ductal System feasibility of reconstructive surgery in only about 30% of ♦ Ejaculatory Duct the azoospermic subgroup, most of the remaining would ♦ Sperm Retrieval Techniques be candidates for sperm retrieval techniques, if enrolled ♦ Preoperative Planning in assisted reproduction programs. These figures are ♦ Operative Procedure clearly shown in Table 1. ♦ Postoperative Care and Results Two major advances have recently occurred in the surgical management of male infertility. The first was the implementation of microsurgery which increased success rates for reconstruction of the reproductive tract. The second was the development of intracytoplasmic INTRODUCTION sperm injection (ICSI) and the demonstration that sper- matozoa retrieved from either the epididymis or the testis nfertility is a common problem in the urologic prac- were capable of fertilization and pregnancy.2,3 Thereafter, Itice. Approximately, 8% of men in reproductive age several sperm retrieval methods have been developed may ask for medical consultation for fertility problems. to collect epididymal and testicular sperm for ICSI in Of these, 1–10% carries conditions that compromise the azoospermic men. Microsurgery was incorporated to this reproductive potential.1 The essential roles of the urolo- armamentarium, either for collection of sperm from the gist in this context are to diagnose, to counsel, to provide epididymis in men with obstructive azoospermia or from medical or surgical treatment whenever possible or to the testicle in those with nonobstructive azoospermia correctly refer the male patient for assisted conception.
  • The History of Microsurgery in Urological Practice

    The History of Microsurgery in Urological Practice

    Chen-1 The History of Microsurgery in Urological Practice Mang L. Chen1, Gregory M. Buncke2 and Paul J. Turek3 1G.U. Recon, San Francisco, CA, 94114 2The Buncke Clinic, San Francisco, CA 94114 3The Turek Clinic, Beverly Hills, CA 90210 Correspondence to: Mang Chen, MD G.U. Recon 45 Castro St, Suite 111 San Francisco, CA 94114 Tel: 415-481-3980 Email: [email protected] Chen-2 Abstract Operative microscopy spans all surgical disciplines, allowing human dexterity to perform beyond direct visual limitations. Microsurgery started in otolaryngology, became popular in reconstructive microsurgery, and was then adopted in urology. Starting with reproductive tract reconstruction of the vas and epididymis, microsurgery in urology now extends to varicocele repair, sperm retrieval, penile transplantation and free flap phalloplasty. By examining the peer reviewed and lay literature this review discusses the history of microsurgery and its subsequent development as a subspecialty in urology. Keywords: urology, microsurgery, phalloplasty, vasovasostomy, varicocelectomy Chen-3 I. Introduction Microsurgery has been instrumental to surgical advances in many medical fields. Otolaryngology, ophthalmology, gynecology, hand and plastic surgery have all embraced the operating microscope to minimize surgical trauma and scar and to increase patency rates of vessels, nerves and tubes. Urologic adoption of microsurgery began with vasectomy reversals, testis transplants, varicocelectomies and sperm retrieval and has now progressed to free flap phalloplasties and penile transplantation. In this review, we describe the origins of microsurgery, highlight the careers of prominent microsurgeons, and discuss current use applications in urology. II. Birth of Microsurgery 1) Technology The birth of microsurgery followed from an interesting marriage of technology and clinical need.
  • Fournier's Gangrene: Challenges and Pitfalls for Genital Reconstruction from a Tertiary Hospital in South Africa

    Fournier's Gangrene: Challenges and Pitfalls for Genital Reconstruction from a Tertiary Hospital in South Africa

    Plastic Surgery: Fournier’s gangrene: challenges and pitfalls for genital reconstruction Fournier’s gangrene: challenges and pitfalls for genital reconstruction from a tertiary hospital in South Africa G Steyn1, M G C Giaquinto-Cilliers2, H Reiner1, R Patel1, T Potgieter1 1MBChB (South Africa), Medical Officers 2MD (Brazil), Specialist Plastic Surgeon (South Africa), Head of Unit, Affiliated Lecturer of the Univer-sity of the Free State (Plastic and Reconstructive Surgery Department) Correspondence to: [email protected] Keywords: necrotising infection; necrotising fasciitis; Fournier’s gangrene; genital reconstruction; scrotal reconstruction Abstract Background: Fournier’s gangrene (FG) is an acute urological emergency described as a necrotising soft-tissue infection of the genitalia and perineum with associated polymicrobial infection, organ failure and death. The use of broad-spectrum antibiotics and immediate surgical debridementare the mainstays of treatment. The extensive debridement of all the necrotic tissue, the associated wound care and the recon- struction of the defect remain a big challenge. The prevalence in low-income countries such as South Africa seems to be higher when compared to international statistics despite the lack of published data. Patients and methods: A descriptive retrospective study was performed for the period of January 2006 up to December 2015 at Kimberley Hospital Complex, a facility which provides tertiary services to the Northern Cape Province (NCP) in South Africa. A search for all patients who underwent reconstructive procedures following the successful management of FG was performed using the Department of Plastic and Reconstructive Surgery’s database. Challenges and pitfalls for the performance of the reconstruction were analysed. Results: Sixty-four male patients underwent genital reconstruction after FG debridement.
  • Parviz K. Kavoussi, M.D., F.A.C.S. Reproductive Urologist

    Parviz K. Kavoussi, M.D., F.A.C.S. Reproductive Urologist

    PARVIZ K. KAVOUSSI, M.D., F.A.C.S. REPRODUCTIVE UROLOGIST www.AustinFertility.com www.AustinVasecomyCenter.com www.WestlakeIVF.com www.AustinMensHealth.com WESTLAKE LOCATION: 300 BEARDSLEY LANE Building B, SUITE 200 AUSTIN, TX 78746 SOUTH AUSTIN LOCATION: 4303 JAMES CASEY, SUITE B AUSTIN, TEXAS 78745 ROUND ROCK LOCATION: 7700 CAT HOLLOW DRIVE, SUITE 106 ROUND ROCK, TEXAS 78681 Phone: (512) 444-1414 EXT 2 Fax: (512) 441-1202 POSTDOCTORAL TRAINING THE UNIVERSITY OF VIRGINIA HEALTH SCIENCES CENTER. Charlottesville, Virginia. Fellowship- Reproductive Urology/Andrology – Male Infertility, Sexual Medicine, and Microsurgery (Vasectomy Reversals/Sperm Retrievals). National Institute of Health funded fellow. July 2008-June 2010. BAYLOR SCOTT & WHITE MEMORIAL HOSPITAL AND HEALTH SCIENCES CENTER. Temple, Texas. Residency- Urology- July 2004-June 2008. General Surgery July 2002-June 2004 EDUCATION THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. Galveston, Texas. Doctor of Medicine. August 1998-May 2002. BAYLOR UNIVERSITY. Waco, Texas. Bachelor of Arts, degree in Biology. August 1994-May 1998. BOARD CERTIFICATION The American Board of Urology ACADEMIC APPOINTMENTS • Adjunct Assistant Professor. Department of Urology. University of Texas Health Sciences Center at San Antonio. September 2015-present. • Adjunct Assistant Professor. Department of Psychology, Division of Neuroendocrinology and Motivation. University of Texas at Austin. March 2013- present. SPECIALTY CREDENTIALS RAMSES. Credentialed in Robot Assisted Microsurgery in Urology/Robot Assisted Vasectomy Reversals by RAMSES (Robot Assisted Microsurgical and Endoscopic Society). Winter Haven Hospital & University of Florida. April 2011. LABORATORY EXPERIENCE • Basic science laboratory research in the Department of Urology at University of Virginia funded via NIH training grant. July 2008-June 2010. • Non-human primate surgery at the Michael E.
  • Epididymo- Orchitis

    Epididymo- Orchitis

    What about my partner? If you have been diagnosed with an STI, it is important that all of the people you have recently been in sexual contact with are given the option to be tested and treated. Your doctor or nurse will discuss this with you. When can I have sex again? You will have to wait until you have finished the antibiotics and have had a check-up by your A guide to doctor before having sex again, even sex with a condom or oral sex. Epididymo- If you were diagnosed with an STI, it is really orchitis important that you don’t have sex with your partner before they are tested and treated as you could become infected again. What happens if my epididymo-orchitis is left untreated? If you do not get treatment, the testicular pain and swelling will last much longer. Untreated infection is more likely to lead to complications such as long term testicular pain or an abscess. In rare cases, untreated infection can lead to shrinkage of the testicle and loss of fertility. You can order more copies of this leaflet free of charge from www.healthpromotion.ie October 2017 What is epididymo-orchitis? How do I get epididymo-orchitis? How can I be tested for epididymo-orchitis? Epidiymo-orchitis is a condition that affects men In most men under the age of 35, epididymo- Epididymo-orchitis is diagnosed based on your and is characterised by pain and swelling inside orchitis is caused by a sexually transmitted symptoms and what the doctor or nurse finds the scrotum (ball bag).
  • Sexually Transmitted Infections and Increased Risk of Co-Infection with Human Immunodeficiency Virus

    Sexually Transmitted Infections and Increased Risk of Co-Infection with Human Immunodeficiency Virus

    REVIEW ARTICLE Sexually Transmitted Infections and Increased Risk of Co-infection with Human Immunodeficiency Virus Margaret R.H. Nusbaum, DO, MPH; Robin R. Wallace, MD; Lisa M. Slatt, MEd; Elin C. Kondrad, MD The incidence of trichomoniasis (Trichomonas vaginalis) Clinical Presentation in the United States is estimated at 5 million cases annu- Urethritis, Epididymitis, and Proctitis ally; chlamydia (Chlamydia trachomatis) at 3 million; gon- In men, STIs usually remain confined to the urethra. Symptoms orrhea (Neisseria gonorrhoeae), 650,000; and syphilis (Tre- of urethritis include urethral discharge, dysuria, or urethral ponema pallidum), 70,000. However, most sexually itching. The discharge of nongonococcal urethritis (NGU) is transmitted infections (STIs) are asymptomatic—con- often slight, and may not be apparent without massaging the tributing to underdiagnosis estimated at 50% or more. urethra. Discharge of NGU is usually minimal and gray, white, Diagnosis of an STI signals sexual health risk because an or mucoid rather than yellow. Discharge that is yellow and pre- STI facilitates the transmission and acquisition of other sent in greater volume most often signals infection with N STIs, including human immunodeficiency virus (HIV). gonorrhoeae. In fact, comorbid STIs increase patients’ susceptibility of Epididymitis presents as acute unilateral testicular pain acquiring and transmitting HIV by two- to fivefold. Sev- and swelling. Clinical findings include tenderness of the epi- eral studies have shown that aggressive STI prevention, didymis and ductus deferens, erythema and edema of the testing, and treatment reduces the transmission of HIV. overlying scrotal skin, urethral discharge, and dysuria. Swelling The authors discuss common clinical presentations, and tenderness may be localized or may extend to the entire screening, diagnosis, and treatment for trichomoniasis, epididymis and surrounding areas, making the epididymis less chlamydia, gonorrhea, syphilis, and herpes simplex virus.
  • Guidelines on Testicular Cancer

    Guidelines on Testicular Cancer

    GUIDELINES ON TESTICULAR CANCER (Limited text update March 2015) P. Albers (Chair), W. Albrecht, F. Algaba, C. Bokemeyer, G. Cohn-Cedermark, K. Fizazi, A. Horwich, M.P. Laguna, N. Nicolai, J. Oldenburg Eur Urol 2011 Aug;60(2):304-19 Introduction Compared with other types of cancer, testicular cancer is relatively rare accounting for approximately 1-1.5% of all cancers in men. Nowadays, testicular tumours show excellent cure rates, mainly due to early diagnosis and their extreme chemo- and radiosensitivity. Staging and Classification Staging For an accurate staging the following steps are necessary: Postorchiectomy half-life kinetics of serum tumour markers. The persistence of elevated serum tumour markers after orchiectomy may indicate the presence of disease, while their normalisation does not necessarily mean absence of tumour. Tumour markers should be assessed until they are normal, as long as they follow their half-life kinetics and no metastases are revealed. A chest CT scan should be routinely performed in patients diagnosed with non-seminomatous germ cell tumours (NSGCT), because in up to 10% of cases, small subpleural nodes may be present that are not visible radiologically. 110 Testicular Cancer Recommended tests for staging at diagnosis Test Recommendation GR Serum tumour markers Alpha-fetoprotein A hCG LDH Abdominopelvic CT All patients A Chest CT All patients A Testis ultrasound (bilateral) All patients A Bone scan or MRI columna In case of symptoms Brain scan (CT/MRI) In case of symptoms and patients with meta- static disease with mul- tiple lung metastases and/or high beta-hCG values. Further investigations Fertility investigations: B Total testosterone LH FSH Semen analysis Sperm banking should be offered.