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Inflammation and Infection
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Judith Hall, Christopher K. Harding
Complications of epididymo-orchitis:Abscess formation, Fournier’s GangreneTesticular infarctionChronic testicular painSubfertility (up to one in three cases)
Testicular torsion
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Specific details to elicit are: How old is the patient?When did the pain start? Timing of onset is crucial, as salvageability is 90%–100% within 6 hours.Enquire about any associated symptoms – nausea and vomiting are common (60%–70% of patients).Enquire about any voiding symptoms such as frequency, urgency and dysuria.Is there a history of trauma?Take a full sexual history in a sexually active male.A previous history of similar testicular pain, which resolved spontaneously, may imply intermittent torsion.Any prior genitourinary surgeries or urological abnormalities, including cryptorchidism (where one or both testes are undescended).
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Acute testicular pain due to testicular torsion is a urological emergency requiring urgent surgery to preserve viable testes. It arises due to anatomical variants in the testicle with a large mesorchium which allow testicular rotation in the tunica vaginalis. Initial venous congestion evolves into arterial compression with rapid onset of testicular ischaemia and necrosis. Delays in scrotal exploration and untwisting lead to testicular death with associated atrophy. Subfertility is a serious complication of testicular torsion. Testicular torsion in young boys may be mistaken for an acute abdomen due to presence of nausea, vomiting and abdominal pain. Emergency scrotal exploration may reveal non-viable testes. In all cases, it is important to fix the contralateral testis to ensure it does not happen on that side in the future. Other causes of testicular pain include epididymo-orchitis, torsion of testicular appendages or acute inguinal lymphadenopathy.
Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele
Published in Systems Biology in Reproductive Medicine, 2020
Yu Yang, Xiaoqiang Wu, Qu Leng, Wei Su, Shuo Wang, Rongwei Xing, Xumin Zhou, Daojun Lv, Bingkun Li, Xiangming Mao
Understanding the nerve distribution patterns in the spermatic cord is important for the microsurgery involving nerves. This study was based on cross sections rather than spermatic cord biopsies, which was likely to be more accurate. Following its first use by Choa to treat chronic orchalgia in 1992, microsurgical varicocelectomy has been proved to be effective by several subsequent studies (Choa and Swami 1992; Levine et al. 1996). This operation aims to ligate all the nerves in the spermatic cord. Yet, current anatomical studies on the location of nerves in the spermatic cord have not revealed their precise distribution to facilitate the microsurgical varicocelectomy. Therefore, one of our goals was to examine the microanatomy of the spermatic cord nerves. We found that many nerves were distributed in all tissues except tabular structures and their distribution or location in the spermatic cord was not constant. This microanatomic finding is of interest to microsurgical varicocelectomy. Studies on the use of varicocelectomy to treat chronic orchalgia reported that 9.2% of the patients had only partial pain relief and 8% still felt pain after surgery (Biggers and Soderdahl 1981; Yeniyol et al. 2003). We postulate that the unsuccessful pain relief might have been caused by incomplete ligation of nerve fiber bundles. Consequently, we suggest that skeletonized ligation should be performed during varicocelectomy to relieve refractory chronic testicular pain. A study on clinical use in microsurgical spermatic cord denervation procedure will be performed in future.
Managing recurrent urinary tract infections in kidney transplant patients
Published in Expert Review of Anti-infective Therapy, 2018
Marta Bodro, Laura Linares, Diana Chiang, Asuncion Moreno, Carlos Cervera
Recurrent UTI episodes can present as different clinical pictures, including cystitis, acute prostatitis, orchiepididymitis, AGP and less frequently, acute pyelonephritis of the native kidney. Patients with cystitis present dysuria, frequency or urinary urgency in absence of pyelonephritis criteria. It is not uncommon the occurrence of recurrent cystitis in KTR without urological abnormalities and excellent graft function. Prostatitis is characterized by discomfort to the lower urogenital and perineal and fever and chills, accompanied by urinary symptoms such as dysuria, frequency and perineal pain. Orchiepididymitis present with perineal or pelvic pain, low back pain, testicular pain and inflammation of testis and epididymis. Fever, costovertebral pain (if native kidney involved), renal allograft tenderness (if transplanted kidney involved), chills and criteria for cystitis are symptoms of pyelonephritis.
Association of five-factor score with the mortality in Japanese patients with polyarteritis nodosa
Published in Modern Rheumatology, 2018
Yoshiyuki Abe, Kurisu Tada, Ken Yamaji, Yoshinari Takasaki, Naoto Tamura
The median follow-up period was 70.5 months (range: 11–207 months). Table 1 shows the characteristics at diagnosis, treatment details at first admission, outcomes, and clinical features according to the MHLW criteria of the 18 patients with PAN. The median age of onset was 57.0 years (IQR: 51.8–68.3). ANCA was measured only 14 patients at diagnosis. C-ANCA and P-ANCA were measured before 2012, and MPO-ANCA and PR3-ANCA were measured after 2013. All 14 patients were negative. Hepatitis B surface antigen was negative in all 18 cases at diagnosis. Biopsies were performed in 13 cases, including nine cases of skin biopsy, three cases of gastrocnemius muscle biopsy, and one case of partial colectomy. All 13 cases were proved necrotizing angiitis characterized by fibrinoid necrosis in medium-sized arteries. One patient complained testicular pain at diagnosis. The median of the original 1996 FFS was 0.0 (IQR: 0.0–1.0), and the median of the revised 2009 FFS was 1.0 (IQR: 0.0–1.0). Supplemental Table 1 shows the details of the 2009 FFS of all 18 patients. Two patients were complicated with gastrointestinal perforation at the time of PAN onset and underwent emergency surgery. All patients received daily oral or intravenous prednisolone with or without 500 or 1000 mg of daily intravenous methylprednisolone pulse therapy for three consecutive days. Nine patients (50%) were treated with an immunosuppressant, i.e. cyclophosphamide, azathioprine, or cyclosporine A during induction of remission therapy because seven patients showed refractory cases for remission induction and two patients were provided severe cases with gastrointestinal perforation.