Inflammation of the vas deferens: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

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Содержание

clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Can Urol Assoc J. 2011 Aug; 5(4): E74–E76.

, BSc,^*, MB, BS,^† and , MD, FRCPC^‡

Kathleen Eddy

^*University of British Columbia, Vancouver, BC;

G. Bruce Piercy

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

Richard Eddy

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

^*University of British Columbia, Vancouver, BC;

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

Correspondence: Kathleen Eddy, Medical Student, University of British Columbia, 202-1333 West 11th Ave, Vancouver, BC V6H 1K7; moc.liamtoh@51ydde_eitakCopyright : © 2011 Canadian Urological Association or its licensorsThis article has been cited by other articles in PMC.

Abstract

Vasitis or inflammation of the vas deferens is a rarely described condition categorized by Chan & Schlegel¹ as either generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Clinically, infectious vasitis presents with nonspecific symptoms of localized pain and swelling that can be confused with other, more common conditions such as epididymitis, orchitis, testicular torsion, and inguinal hernia. Ultrasound with duplex Doppler scanning can be used to exclude epididymitis, orchitis, and testicular torsion. On the other hand, while inguinal hernia is difficult to differentiate from vasitis using ultrasound, computed tomography (CT) is diagnostic. We describe 2 cases of vasitis with clinical and ultrasound findings that initially were interpreted as inguinal hernias. In both patients, CT was diagnostic for vasitis showing an edematous spermatic cord and no hernia. Urine cultures in both patients were negative, but the symptoms resolved with antibiotic treatment.

Introduction

Vasitis is rarely reported as an isolated condition. The more commonly described inflammation of the vas deferens, vasitis nodosa, is a benign condition that has been well-characterized (both macroscopically and microscopically) and is usually associated with a history of vasectomy. Clinically, patients present with a nodular mass in the vas deferens and are often asymptomatic and require no specific treatment.¹ If necessary, a biopsy will establish the diagnosis.

Infectious vasitis, while rarely reported in the literature, is thought to be caused by common urinary tract pathogens. Patients present with pain and swelling in the groin and are usually thought to have epididymitis, orchitis, testicular torsion or inguinal hernia. In the few cases of infectious vasitis described, imaging was not used and the patients were treated surgically for suspected inguinal hernias with eventual cord excision and/or drainage when no hernia was found.²^–⁵ The 2 cases presented in this report were differentiated using computed tomography (CT) and were treated non-invasively using antibiotics.

Case 1

A 40-year-old male presented to the emergency room with a 36-hour history of pain in the left groin extending down to the upper scrotum exacerbated with movement and coughing. The patient did not have fever, chills or urinary symptoms. There was no previous history of sexually transmitted infections, but the patient was recently divorced and was sexually active. There was no history of heavy lifting, but he had a long-standing complaint of left lower quadrant pain for which he had been given no specific diagnosis other than irritable bowel. On exam, the left groin was tender and swollen, but both testicles felt normal. Laboratory results were normal except for a slightly elevated white blood count (8.72 neutrophils) and a few cells in the urine (5–10 WBC, 10–40 RBC) but with normal urine cultures.

Ultrasound examination revealed normal and symmetrical testicular and epididymal size and blood flow, excluding orchitis, epididymitis and testicular torsion. An abnormal mass in the left inguinal canal was interpreted as a possible incarcerated inguinal hernia.

The patient was referred to general surgery for a hernia repair and a CT scan was ordered to assess the extent of the possible incarcerated hernia. The CT scan was negative for an inguinal hernia and instead revealed an inflamed spermatic cord consistent with vasitis. The patient was referred back to urology, given antibiotics, and the condition resolved.

Case 2

A 32-year-old male presented to the emergency room with a 12-hour history of pain in the right groin radiating to the upper scrotum. The pain was reportedly similar to that felt prior to the repair of a left inguinal hernia a few years earlier. There were no urinary symptoms, but the patient had a remote history of chlamydia, was sexually active and had a slight fever (38.2°C). On exam, he had tenderness and swelling in the right groin. Laboratory tests were negative with no cells in the urine; urine cultures for chlamydia and gonorrhea were negative.

Ultrasound examination revealed normal and symmetrical testicular and epididymal size and blood flow not consistent with orchitis, epididymitis or testicular torsion. An abnormal mass in the right inguinal canal was interpreted as a possible incarcerated inguinal hernia and a CT was suggested for further evaluation.

The CT scan was negative for inguinal hernia and instead revealed a thickened, edematous spermatic cord consistent with vasitis. The patient was referred to urology and given antibiotics once again with eventual resolution of symptoms.

Discussion

We are only aware of 4 cases of infectious vasitis described in English language medical journals since 1933 and none in the past 20 years when modern medical imaging has been readily available.²^–⁵ Epididymitis, orchitis, testicular torsion and inguinal hernia are the most likely causes of groin pain and inflammation in males and it is not surprising that all previous reported cases of infectious vasitis underwent surgical intervention. An article with more of an imaging focus on this topic has been published.⁶

Epididymitis is the most common cause of intrascrotal inflammation and can occur with or without associated orchitis. Ultrasound of the area showing differential blood flow can confirm if the condition is isolated epididymitis or complicated with associated orchitis. These 2 conditions most frequently affect males between the ages of 18 and 35 years, and can occur with or without infection. Bacterial infection with Chlamydia or gonorrhea is the most likely causative agent and treatment usually consists of antibiotics.⁷

Testicular torsion, while possible at any age, most commonly occurs in males aged 12 to 18 years. The condition presents as acute onset of pain and the affected testicle may be elevated and oriented transversely. The cremasteric reflex is usually abnormal in cases of testicular torsion, and ultrasound will reveal decreased blood flow to the affected testicle.⁸

About 30% of men will experience an inguinal hernia in their lifetime, making inguinal hernia repair one of the most common surgical procedures. Hernias present as masses in the groin, and can become painful when incarcerated or trapped. ⁹ The clinical and ultrasound findings of incarcerated inguinal hernias and vasitis can be very difficult to distinguish: both present clinically with groin masses and pain. In addition, on ultrasound, both conditions appear as masses in the area of the spermatic cord with normal testicular and epididymal size and blood flow. In the cases presented in this report, CT was used to differentiate between incarcerated inguinal hernia and vasitis.

Conclusion

While the clinical and ultrasound features of vasitis and inguinal hernia are similar, computed tomography can readily distinguish between the 2 avoiding unnecessary surgeries.

Axial computed tomography image showing thickened left spermatic cord with surrounding edema as compared to the normal right spermatic cord.

Sagittal computed tomography image showing inflamed left spermatic cord and no hernia.

Coronal computed tomography image showing abnormal left spermatic cord with edema effacing the normal fat in the cord.

Coronal computed tomography image showing normal fat within the left spermatic cord after treatment.

Axial computed tomography image showing inflamed right spermatic cord compared with normal cord on left with preserved fat planes.

Sagittal computed tomography image showing inflamed right spermatic cord and no hernia.

Footnotes

Competing interests: None declared.

This paper has been peer-reviewed.

References

1. Chan PTK, Schlegel PN. Inflammatory conditions of the male excurrent ductal system. Part I and II. J Androl. 2002;23:453–69. [PubMed] [Google Scholar]2. Bissada NK, Redman JF, Finkbeiner AE. Unusual inguinal mass secondary to vasitis. Urology. 1976;8:488–9. [PubMed] [Google Scholar]4. Ryan SP, Harte PJ. Suppurative inflammation of vas deferens: an unusual groin mass. Urology. 1988;31:245–6. [PubMed] [Google Scholar]5. Wolbarst AL. Vas deferens, generally unrecognized clinical entity in urogenital disease. J Urol. 1933;29:405. [Google Scholar]6. Eddy K, Connell D, Goodacre B, et al. Imaging findings prevent unnecessary surgery in vasitis: an under-reported condition mimicking inguinal hernia. Clin Radiol. 2011;66:475–7. [PubMed] [Google Scholar]7. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009;79:583–7. [PubMed] [Google Scholar]8. Edelsberg JS, Surh YS. The acute scrotum. Emerg Med Clin North Am. 1988;6:521–46. [PubMed] [Google Scholar]

clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Can Urol Assoc J. 2011 Aug; 5(4): E74–E76.

, BSc,^*, MB, BS,^† and , MD, FRCPC^‡

Kathleen Eddy

^*University of British Columbia, Vancouver, BC;

G. Bruce Piercy

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

Richard Eddy

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

^*University of British Columbia, Vancouver, BC;

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

Correspondence: Kathleen Eddy, Medical Student, University of British Columbia, 202-1333 West 11th Ave, Vancouver, BC V6H 1K7; moc. liamtoh@51ydde_eitakCopyright : © 2011 Canadian Urological Association or its licensorsThis article has been cited by other articles in PMC.

Abstract

Introduction

Infectious vasitis, while rarely reported in the literature, is thought to be caused by common urinary tract pathogens. Patients present with pain and swelling in the groin and are usually thought to have epididymitis, orchitis, testicular torsion or inguinal hernia. In the few cases of infectious vasitis described, imaging was not used and the patients were treated surgically for suspected inguinal hernias with eventual cord excision and/or drainage when no hernia was found. ²^–⁵ The 2 cases presented in this report were differentiated using computed tomography (CT) and were treated non-invasively using antibiotics.

Case 1

Case 2

A 32-year-old male presented to the emergency room with a 12-hour history of pain in the right groin radiating to the upper scrotum. The pain was reportedly similar to that felt prior to the repair of a left inguinal hernia a few years earlier. There were no urinary symptoms, but the patient had a remote history of chlamydia, was sexually active and had a slight fever (38. 2°C). On exam, he had tenderness and swelling in the right groin. Laboratory tests were negative with no cells in the urine; urine cultures for chlamydia and gonorrhea were negative.

Discussion

About 30% of men will experience an inguinal hernia in their lifetime, making inguinal hernia repair one of the most common surgical procedures. Hernias present as masses in the groin, and can become painful when incarcerated or trapped.⁹ The clinical and ultrasound findings of incarcerated inguinal hernias and vasitis can be very difficult to distinguish: both present clinically with groin masses and pain. In addition, on ultrasound, both conditions appear as masses in the area of the spermatic cord with normal testicular and epididymal size and blood flow. In the cases presented in this report, CT was used to differentiate between incarcerated inguinal hernia and vasitis.

Conclusion

While the clinical and ultrasound features of vasitis and inguinal hernia are similar, computed tomography can readily distinguish between the 2 avoiding unnecessary surgeries.

Axial computed tomography image showing thickened left spermatic cord with surrounding edema as compared to the normal right spermatic cord.

Sagittal computed tomography image showing inflamed left spermatic cord and no hernia.

Coronal computed tomography image showing abnormal left spermatic cord with edema effacing the normal fat in the cord.

Coronal computed tomography image showing normal fat within the left spermatic cord after treatment.

Axial computed tomography image showing inflamed right spermatic cord compared with normal cord on left with preserved fat planes.

Sagittal computed tomography image showing inflamed right spermatic cord and no hernia.

Footnotes

Competing interests: None declared.

This paper has been peer-reviewed.

References

clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Can Urol Assoc J. 2011 Aug; 5(4): E74–E76.

, BSc,^*, MB, BS,^† and , MD, FRCPC^‡

Kathleen Eddy

^*University of British Columbia, Vancouver, BC;

G. Bruce Piercy

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

Richard Eddy

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

^*University of British Columbia, Vancouver, BC;

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

Correspondence: Kathleen Eddy, Medical Student, University of British Columbia, 202-1333 West 11th Ave, Vancouver, BC V6H 1K7; moc. liamtoh@51ydde_eitakCopyright : © 2011 Canadian Urological Association or its licensorsThis article has been cited by other articles in PMC.

Abstract

Introduction

Infectious vasitis, while rarely reported in the literature, is thought to be caused by common urinary tract pathogens. Patients present with pain and swelling in the groin and are usually thought to have epididymitis, orchitis, testicular torsion or inguinal hernia. In the few cases of infectious vasitis described, imaging was not used and the patients were treated surgically for suspected inguinal hernias with eventual cord excision and/or drainage when no hernia was found. ²^–⁵ The 2 cases presented in this report were differentiated using computed tomography (CT) and were treated non-invasively using antibiotics.

Case 1

Case 2

A 32-year-old male presented to the emergency room with a 12-hour history of pain in the right groin radiating to the upper scrotum. The pain was reportedly similar to that felt prior to the repair of a left inguinal hernia a few years earlier. There were no urinary symptoms, but the patient had a remote history of chlamydia, was sexually active and had a slight fever (38. 2°C). On exam, he had tenderness and swelling in the right groin. Laboratory tests were negative with no cells in the urine; urine cultures for chlamydia and gonorrhea were negative.

Discussion

About 30% of men will experience an inguinal hernia in their lifetime, making inguinal hernia repair one of the most common surgical procedures. Hernias present as masses in the groin, and can become painful when incarcerated or trapped.⁹ The clinical and ultrasound findings of incarcerated inguinal hernias and vasitis can be very difficult to distinguish: both present clinically with groin masses and pain. In addition, on ultrasound, both conditions appear as masses in the area of the spermatic cord with normal testicular and epididymal size and blood flow. In the cases presented in this report, CT was used to differentiate between incarcerated inguinal hernia and vasitis.

Conclusion

While the clinical and ultrasound features of vasitis and inguinal hernia are similar, computed tomography can readily distinguish between the 2 avoiding unnecessary surgeries.

Axial computed tomography image showing thickened left spermatic cord with surrounding edema as compared to the normal right spermatic cord.

Sagittal computed tomography image showing inflamed left spermatic cord and no hernia.

Coronal computed tomography image showing abnormal left spermatic cord with edema effacing the normal fat in the cord.

Coronal computed tomography image showing normal fat within the left spermatic cord after treatment.

Axial computed tomography image showing inflamed right spermatic cord compared with normal cord on left with preserved fat planes.

Sagittal computed tomography image showing inflamed right spermatic cord and no hernia.

Footnotes

Competing interests: None declared.

This paper has been peer-reviewed.

References

clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Can Urol Assoc J. 2011 Aug; 5(4): E74–E76.

, BSc,^*, MB, BS,^† and , MD, FRCPC^‡

Kathleen Eddy

^*University of British Columbia, Vancouver, BC;

G. Bruce Piercy

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

Richard Eddy

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

^*University of British Columbia, Vancouver, BC;

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

Abstract

Introduction

Case 1

Case 2

Discussion

About 30% of men will experience an inguinal hernia in their lifetime, making inguinal hernia repair one of the most common surgical procedures. Hernias present as masses in the groin, and can become painful when incarcerated or trapped.⁹ The clinical and ultrasound findings of incarcerated inguinal hernias and vasitis can be very difficult to distinguish: both present clinically with groin masses and pain. In addition, on ultrasound, both conditions appear as masses in the area of the spermatic cord with normal testicular and epididymal size and blood flow. In the cases presented in this report, CT was used to differentiate between incarcerated inguinal hernia and vasitis.

Conclusion

While the clinical and ultrasound features of vasitis and inguinal hernia are similar, computed tomography can readily distinguish between the 2 avoiding unnecessary surgeries.

Axial computed tomography image showing thickened left spermatic cord with surrounding edema as compared to the normal right spermatic cord.

Sagittal computed tomography image showing inflamed left spermatic cord and no hernia.

Coronal computed tomography image showing abnormal left spermatic cord with edema effacing the normal fat in the cord.

Coronal computed tomography image showing normal fat within the left spermatic cord after treatment.

Axial computed tomography image showing inflamed right spermatic cord compared with normal cord on left with preserved fat planes.

Sagittal computed tomography image showing inflamed right spermatic cord and no hernia.

Footnotes

Competing interests: None declared.

This paper has been peer-reviewed.

References

clinical and ultrasound confusion with inguinal hernia clarified by computed tomography

Can Urol Assoc J. 2011 Aug; 5(4): E74–E76.

, BSc,^*, MB, BS,^† and , MD, FRCPC^‡

Kathleen Eddy

^*University of British Columbia, Vancouver, BC;

G. Bruce Piercy

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

Richard Eddy

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

^*University of British Columbia, Vancouver, BC;

^†Division of Urology, Vancouver Island Health Authority, Victoria BC;

^‡Medical Imaging, Vancouver Island Health Authority, Victoria BC

Abstract

Introduction

Case 1

Case 2

Discussion

About 30% of men will experience an inguinal hernia in their lifetime, making inguinal hernia repair one of the most common surgical procedures. Hernias present as masses in the groin, and can become painful when incarcerated or trapped.⁹ The clinical and ultrasound findings of incarcerated inguinal hernias and vasitis can be very difficult to distinguish: both present clinically with groin masses and pain. In addition, on ultrasound, both conditions appear as masses in the area of the spermatic cord with normal testicular and epididymal size and blood flow. In the cases presented in this report, CT was used to differentiate between incarcerated inguinal hernia and vasitis.

Conclusion

While the clinical and ultrasound features of vasitis and inguinal hernia are similar, computed tomography can readily distinguish between the 2 avoiding unnecessary surgeries.

Axial computed tomography image showing thickened left spermatic cord with surrounding edema as compared to the normal right spermatic cord.

Sagittal computed tomography image showing inflamed left spermatic cord and no hernia.

Coronal computed tomography image showing abnormal left spermatic cord with edema effacing the normal fat in the cord.

Coronal computed tomography image showing normal fat within the left spermatic cord after treatment.

Axial computed tomography image showing inflamed right spermatic cord compared with normal cord on left with preserved fat planes.

Sagittal computed tomography image showing inflamed right spermatic cord and no hernia.

Footnotes

Competing interests: None declared.

This paper has been peer-reviewed.

References

Causes, Symptoms, and Treatments for Inflammation of the Epididymis

What Is Epididymitis?

Epididymitis is when the epididymis — a long, coiled tube at the back of each of a man’s two testicles — is inflamed.

It’s usually caused by a sexually transmitted infection, but several other types of bacteria can cause epididymitis as well.

What does the epididymis do?

The epididymis carries sperm from the testes, which produce it, to the vas deferens, a tube behind the bladder.

The epididymis lays in coils around the back of a man’s testicle and can be nearly 20 feet long.

It can take nearly 2 weeks for sperm to make it from one end of the epididymis to the other. In that time, the sperm cells mature to the point where they’re able to fertilize a woman’s egg cell.

Epididymitis Symptoms

When a bacterial infection strikes, the epididymis gradually becomes swollen and painful. This usually happens on one testicle, rather than both. It can last up to 6 weeks if untreated.

You might have one or more of these other possible symptoms:

Redness, swelling, or tenderness in the scrotum, the sac that contains the testes
A more frequent or urgent need to pee
A lump on your testicle
Painful urination or ejaculation
Fever
Bloody urine
Discomfort in your lower abdomen
Enlarged lymph nodes in your groin
A lump on your testicle

See your doctor if you have any of these symptoms.

Related conditions

Epididymitis shares many of the symptoms of a more serious problem called testicular torsion (that’s when a testicle gets turned around the cord that connects it to the body).

Testicular torsion symptoms usually develop much faster, however. Torsion is an emergency that may cause you to lose a testicle if you don’t get treatment quickly.

When the swelling and tenderness extends past the epididymis and into the testicle itself, that’s known as epididymo-orchitis.

Epididymitis Causes

The most common causes of epididymitis are a pair of sexually transmitted infections: gonorrhea and chlamydia.

About 600,000 cases of epididymitis are reported in the United States every year, mostly in men between 18 and 35. In men older than 35, epididymitis usually happens because of an infection of the bladder or urinary tract.

Some cases of epididymitis are caused by the E. coli bacteria, or in rare cases, by the same bacteria that causes tuberculosis.

Tell your partners

If your condition is the result of a sexually transmitted disease, you should tell anyone with whom you have had sex in the past 60 days about your diagnosis. If it’s been more than 60 days since you had sex, contact your most recent sex partner.

They should see a doctor and get tested for sexually transmitted diseases as well.

Epididymitis Risk Factors

Your chances of having epididymitis rise if you have:

Sex with someone who has a sexually transmitted infection (STI)
A history of STIs
A history of infections in your prostate or urinary tract
A history of procedures that impact your urinary tract
An uncircumcised penis
An enlarged prostate

Epididymitis in Children

Kids can also get epididymitis. An STI, urinary tract infection, or a physical problem in the urinary and reproductive organs can cause the condition. Symptoms in children are similar to those in adults:

Testicle pain and swelling
Fever
A heavy feeling in your testicles
Leaking fluid from the urethra
Blood in your semen
A lump in your testicles
Pain while peeing or during ejaculation

Epididymitis Diagnosis

When you go to the doctor, they will examine your scrotum for signs of infection and ask you questions about your symptoms. They might also do a rectal exam to check your prostate and check for any tenderness.

If your doctor suspects epididymitis based on the exam, you might get one or more tests. They include:

Urine sample: You may pee into a cup so a lab can check for signs of an infection.
Blood sample: This can also find abnormalities.
Swab sample: For this test, your doctor inserts a narrow swab into the tip of your penis to get a sample of discharge. This is used to test for chlamydia or gonorrhea.
Ultrasound: You might also be asked to sit for an ultrasound test, which uses sound waves to produce an image of your scrotum and testicles.

Epididymitis Treatment

The most common treatment for epididymitis is antibiotics. If your doctor believes you have epididymitis, they might give you a prescription for antibiotics before any lab test results are even back.

You’ll likely take those medications for a week or two, and you’ll usually start feeling better in a matter of days. Always take your full course of antibiotics as prescribed, even when you feel better.

Even after your antibiotics take effect, some swelling may last for weeks or months, and you may still be sore during that time. You can reduce the pain and swelling by taking over-the-counter pain relievers, applying a cold compress, or elevating your scrotum (you might wear supportive underwear, like a jockstrap).

Epididymitis Complications

If left untreated, epididymitis can become a “chronic” condition, one that lingers and causes recurring problems.

Epididymitis might also cause an infection in the scrotum.

In rare cases, it can damage a man’s ability to make a woman pregnant.

Epididymitis: Symptoms, Causes, Treatments

Overview

Male urinary system

What is epididymitis?

Epididymitis is inflammation (swelling and irritation) of the epididymis, a tube at the back of the testicle that carries sperm. This swelling can cause intense pain in the testicle. It can occur in men of any age, though it happens most often in men between the ages of 14 and 35. There are an estimated 600,000 cases of epididymitis in the United States each year.

Symptoms and Causes

What causes epididymitis?

Most cases of epididymitis are caused by an infection, usually by the bacteria Mycoplasma or Chlamydia. These infections often come by way of sexually transmitted diseases. The bacterium E. coli can also cause the condition. Other infections, including with the mumps virus and, rarely, tuberculosis, can also cause epididymitis.

Sometimes epididymitis occurs when urine flows backward into the epididymis. This can happen as a result of heavy lifting. Other causes of epididymitis include:

Blockage in the urethra (the tube that carries urine from the body)
An enlarged or infected prostate gland (a muscular, walnut-sized gland that surrounds part of the urethra)
Use of a catheter (a tube that drains the bladder)
Traumatic groin injury

What are the symptoms of epididymitis?

Symptoms of epididymitis include:

Pain in the scrotum, sometimes moving to the rest of the groin
Swelling and redness in the testicle
Blood in the semen
Fever and chills
Pain when urinating

Diagnosis and Tests

How is epididymitis diagnosed?

To diagnose epididymitis, the doctor will do a physical exam, and will examine the scrotum to look for a tender area or lump. The doctor may also order a urinalysis (urine test) to look for bacteria in the urine. In some cases, doctors use an imaging test called an ultrasound to examine the scrotum.

Management and Treatment

How is epididymitis treated?

Epididymitis caused by bacteria is treated with antibiotics, most often doxycycline (Oracea®, Monodox®), ciprofloxacin (Cipro®), levofloxacin (Levaquin®), or trimethoprim-sulfamethoxazole (Bactrim®). Antibiotics are usually taken for 1 to 2 weeks.

Men who have epididymitis can also relieve their symptoms by:

Resting
Elevating the scrotum
Applying ice packs to the affected area
Drinking fluids
Taking anti-inflammatory medications for the pain

What are complications of epididymitis?

If epididymitis is not treated, complications can develop, including an abscess (pus-filled sac) in the scrotum. The scrotum’s skin may open because of swelling and infection.

In rare cases, epididymitis can cause fertility problems in men. Early diagnosis and treatment can help prevent these complications.

Prevention

Can epididymitis be prevented?

You can reduce your risk of developing epididymitis by:

Using condoms during sex
Avoiding strenuous lifting or physical activity
Minimizing long periods of sitting

Outlook / Prognosis

What is the outlook for men who have epididymitis?

Epididymitis usually does not cause any long-term problems. Most men who are treated for the condition start to feel better after 3 days, though discomfort and swelling may last weeks or even months after finishing antibiotic treatment.

It is important to finish the entire treatment recommended by your doctor. If symptoms return, follow up with your doctor. Follow-up can rule out other conditions, including a tumor or testicular cancer.

Living With

When should I call my doctor about epididymitis?

Call your doctor if you develop any symptoms of epididymitis. If your doctor confirms that your infection comes from a sexually transmitted disease, be sure to let recent sex partners know so that they can be examined and treated.

Vasit: Funiculitis, Inflammation of the vaginal membrane of the testicle, Funiculitis | doc.ua

Funicular

Funiculitis – inflammation of the spermatic cord, which involves the vas deferens and surrounding tissues. It is a complication after epididymitis or testicular removal. It is characterized by severe pain in the groin area and specifically in the scrotum, compaction and sharp thickening of the spermatic cord. In the chronic form, the pain is more moderate, the thickening of the cord is insignificant.

Treatment of inflammation in the acute period consists in the use of anti-inflammatory drugs and the cessation of sexual intercourse during the period of therapy.

Inflammation of the vaginal membrane of the testicle

The inflammatory process is called periorchitis. It is extremely rare as an independent disease. In fact, it is a reaction to an inflammatory process, trauma or neoplasm of the visceral plate of the vaginal membrane. It proceeds in an acute and chronic form.

Acute inflammation has signs of acute orchitis with accumulations of purulent or serous-fibrinous substance between the plates of the vaginal membrane.With incomplete resorption of the exudate, a chronic form of inflammation develops, in which infiltrates of bone or cartilaginous consistency can be felt in the testicular membranes.

Treatment of acute inflammation of the vaginal membrane of the testicle is aimed at eliminating the process. Purulent inflammation is most often opened and the cavity is drained. Chronic periorchitis is treated by excision of the altered testicular membranes and measures to treat the underlying disease. With timely medical care, the prognosis is favorable.

Deferentite

Inflammation of the vas deferens, which occurs due to infection, most often together with epididymitis (inflammation of the epididymis). If treatment is not provided on time, inflammation affects all components of the spermatic cord and funiculitis is formed. The infection is caused by a specific (tuberculosis) and nonspecific flora (E. coli, streptococcus, staphylococcus). Sometimes inflammation can develop due to testicular injury, complications after surgery on the organs of the scrotum, to which an infectious component will join.

The symptoms of deferentitis are:

Groin pain
swelling and redness;
weakness;

90,023 increase in body temperature;

fatigue.

Symptoms are pronounced in acute form and milder in chronic.

Treatment of inflammation is conservative and consists in antibacterial therapy using anti-inflammatory and analgesic drugs, as well as physiotherapy.

An experienced urologist will be able to diagnose vazit and any of the diseases included in this concept. You can find such a specialist and make an appointment with him using the Doc.ua website.

Inflammation of the epididymis (epididymitis)

Epididymis is located on top of the testicle and is a short tube-like formation.

Epididymitis is an inflammatory process in the epididymis. Spermatozoa formed in the testicle ripen in the epididymis and here they acquire mobility.The inflammatory process in the epididymis is caused by various microorganisms and viruses. Most often, the infection enters the epididymis through the blood from distant foci of infection, or in acute infectious diseases (flu, pneumonia, sinusitis, tonsillitis). Microorganisms can reach the epididymis and along the vas deferens during inflammatory processes in the urethra, bladder. Anomalies in the development of the genitourinary system and trauma to the epididymis contribute to the occurrence of epididymitis.

A special type of epididymitis occurs after sterilization (ligation of the vas deferens).Then the sperm formed does not find a way out and inflammation may occur in the epididymis. The epididymis increases in size and reaches the size of the testicle and more. The vas deferens swells and thickens. Epididymitis can be accompanied by inflammation of the vas deferens (deferentitis) or inflammation of the sheath of the spermatic cord (funiculitis).

Epididymitis can be

– acute

– chronic.

Chronic epididymitis is rare.Usually with specific infections (tuberculosis, syphilis). It is more often bilateral and very often leads to infertility. Chronic epididymitis occurs after male sterilization.

Acute epididymitis begins with an increase in body temperature to 39-40 degrees. The epididymis increases dramatically in size. A sharp pain appears in one half of the scrotum, the scrotum swells, its skin stretches, losing folds. There may be redness of the scrotum. Pain is given to the groin, perineum, sacrum.If untreated, suppuration of the epididymis may occur and the patient’s condition deteriorates sharply. The transition of the infectious process to the testicle is possible – there is an inflammation of the testicle – orchitis. With a prolonged course of the infectious process, the tissues of the epididymis become sclerosed, adhesions form in the lumen of the vas deferens, and the duct can become impassable for spermatozoa. In this case, if the process is bilateral, infertility occurs.

The diagnosis of epididymitis is established on the basis of a characteristic clinical picture: pain, enlargement of the epididymis.Laboratory tests of blood and urine are performed. In case of difficulties in the diagnosis, an ultrasound examination is performed.

Treatment of acute epididymitis

The patient is prescribed bed rest. Prescribe a diet (exclude spicy, fried foods), drink plenty of fluids. The scrotum needs to be elevated for better blood flow and pain relief. To do this, use a jockstrap or simply put a towel. Cold is applied to the scrotum in the first days of the disease.Antibacterial drugs are prescribed. It is difficult to determine which microorganism caused the inflammation, so broad-spectrum antibiotics or a combination of them are prescribed. If an abscess (suppuration) of the appendage occurs, surgical treatment is performed – the abscess cavity is opened, sometimes with a long-term current process and no effect of treatment, the appendage is removed.

Inguinal purulent funiculitis. Review of clinical observations

The term “funiculitis” means inflammation of the membranes, tissue and elements of the spermatic cord (vas deferens, blood and lymphatic vessels, nerves) caused by a banal or specific microflora [1, 2].Currently, this term has become wider and unites many acute and chronic inflammatory diseases of the spermatic cord of various (autoimmune, infectious, pseudotumor and parasitic) nature, differing in clinical manifestations, course and prognosis [3, 4]. Funiculitis is often combined with inflammation of the vas deferens (deferentitis) and can be a complication of it (or vice versa), which confuses the terminology of these diseases [2].

BRIEF REVIEW OF LITERATURE.RELEVANCE

Inguinal purulent funiculitis (PGF) refers to a rare disease that is poorly studied and unfamiliar to a wide range of surgeons, urologists and radiologists. This pathology was first described by N.R. Smith in 1834 as an inguinal phlegmon of unknown etiology [2]. According to K. Eddy et al., In the English-language literature for the period from 1933 to 2011. only 4 cases of PHF are described [5, 6]. In total, the literature reports about 12 cases of PHF in patients of different ages, mainly middle and elderly [2-11].

The etiopathogenesis of PHF remains unexplored. PHF is considered as a phlegmon or abscess of the spermatic cord [2, 7], as a segmental infected dilatation of the inguinal part of the vas deferens [8], as purulent wasitis (resp., Deferentitis) [3-6, 9-11]. It is assumed that PHF is caused by aerobic and anaerobic pyogenic flora, mycobacterium tuberculosis, Pfeifer’s hemophilus influenzae, fungi. In most cases, the causative microflora and the source of infection at the time of the clinical manifestation of PHF cannot be identified, which is considered one of the features of this disease [11].In this regard, it has even been proposed to refer to the disease as idiopathic PHF [2]. It is believed that the path of infection spreading to the membranes of the spermatic cord is hematogenous [2-6].

In PHF, the inguinal section of the spermatic cord is affected [2-11]. PHF occurs in two clinical and pathomorphological forms (in the form of phlegmon and abscess of the spermatic cord), proceeds as an acute surgical disease and can cause diagnostic errors, simulating a strangulated inguinal hernia, abscess of the anterior abdominal wall or acute disease of the scrotal organs [3-6, 10 , eleven].

In the diagnosis of PHF, many authors have noted the high efficiency of computed tomography (CT), which in the presented literary observations made it possible to identify phlegmon or abscess of the spermatic cord before surgery and exclude other acute surgical diseases, in particular, strangulated inguinal hernia [5, 6, 8-14 ].

Treatment of PHF is only surgical (by percutaneous puncture and aspiration of the abscess of the spermatic cord under ultrasound navigation or by open surgery – revision and drainage of the membranes of the spermatic cord – with its phlegmon) [8-10].With timely surgical treatment, the prognosis of the disease is favorable. Death due to sepsis was observed in 3 (25%) of the described cases of PHF [2].

The prognosis for PHF can be different and depends on the clinical and pathomorphological form of the disease, the timeliness of diagnosis and treatment, as well as on the body’s immunoreactivity. In immunocompromised patients, PHF is characterized by a septic course and is fatal [2, 5, 6]. In patients of reproductive age, the course of PHF can be complicated by the excretory form of infertility due to the development of stricture or obliteration of the vas deferens as a result of inflammation [1, 2].

Over a 20-year period (from 1994 to 2014) in the GBUZ “City Clinical Urological Hospital No. 47” and the GBUZ “City Clinical Hospital No. 57” of the Moscow Department of Health, working in emergency urological care, two cases of PHF were observed which caused serious diagnostic difficulties. We present these observations as an illustration.

CLINICAL OBSERVATION No. 1

Patient K., 42 years old in September 2009 was admitted to the clinic for urgent indications with a referral diagnosis: acute left-sided epididymo-orchitis, left hydrocele.Complains of enlargement and soreness of the left groin and left half of the scrotum, hyperthermia up to 38 ° C with chills for 1.5 weeks, weakness, sweating. He fell ill acutely. The disease is associated with hypothermia. In the anamnesis he had repeated urogenital infections (gonorrhea, trichomoniasis), in childhood – orchiectomy on the right for inguinal cryptorchidism, which led to testicular atrophy. Tuberculosis, HIV, hepatitis B and C denies. General condition of moderate severity due to inflammatory intoxication.Body temperature – 37.5 ° C. Correct physique, normal nutrition. The skin is pale with an earthy tinge. No pathological abnormalities were found on the part of internal organs and organ systems. AD – 130/70 mm. rt. Art., pulse – 92 beats / min. On examination, an increase in the left groin area and the left half of the scrotum was noted. The skin of the left groin area is hyperemic, edematous, the local temperature is increased. In the projection of the left inguinal canal, an ovoid-shaped, tight-elastic and sharply painful formation of 7×3 cm, limited by the anatomical boundaries of the inguinal canal, is palpated.The color of the skin of the scrotum and the local temperature are not changed, the folds of the skin of the left half of the scrotum are somewhat smoothed. The left testicle, epididymis and scrotal part of the spermatic cord were not changed on palpation. There is a small accumulation of fluid in the membranes of the left testicle (hydrocele). The right testicle in the scrotum is not detected (removed). There was no pathological discharge from the urethra. With digital rectal examination, the rectum, prostate gland, seminal vesicles and ampullar sections of the vas deferens are not changed.Blood tests revealed moderate anemia (hemoglobin – 108 g / l, erythrocytes – 4.0×106), leukocytosis up to 16×103, shift of the blood formula to the left to young forms, an increase in ESR up to 43 mm / hour. No pathological changes were found in urine tests. X-ray examination of the chest organs did not reveal any focal-infiltrative changes in the lungs; there was a diffuse increase and deformation of the pulmonary pattern (chronic bronchitis of a “smoker”). Ultrasound examination (US) in the projection of the left inguinal canal revealed a liquid heterogeneous formation of a “cigar-shaped” shape of 9.5×3.5×4.2 cm (280 cm3), completely occupying the inguinal canal and bounded by its walls, pushing back the elements of the spermatic cord (Fig.1, 2, 3, 4). Magnetic resonance imaging (MRI) was performed, which confirmed the ultrasound data and additionally revealed a high protein content in the effusion of the left inguinal canal, which indicated its purulent character (Fig. 5, 6). Differential diagnosis was carried out between a festering cyst (as the most likely diagnosis) and hematoma (as the least likely diagnosis) of the spermatic cord. An explorative revision of the inguinal canal confirmed the presence of a purulent cystic formation of the spermatic cord, which was opened, excised and drained.About 250 ml of thick pus was evacuated, the walls of the inguinal canal and the sheath of the spermatic cord were soaked with pus, thickened and compacted. During the operation, it was suggested about the possible suppuration of the congenital funicular. Histopathological examination revealed a picture of diffuse purulent inflammation of the membranes and fiber of the spermatic cord. When sowing the purulent contents, no growth of flora was found. The outcome of the disease is recovery.

Fig. 1.Case No. 1. Patient K., 42 years old. Panoramic longitudinal echogram of the left groin-scrotal region. 1 funiculopiocele occupying the entire inguinal canal, 2 – unchanged testicle and epididymis, 3 – small hydrocele

Fig. 2. The same patient. Targeted ultrasound of the left inguinal and scrotal region. 1 – funicular, 2 – unchanged funicular part of the vas deferens

Fig. 3. The same patient. Transverse echogram of the inguinal canal on the left in the middle third.1 – funiculopiocele, 2 elements of the modified spermatic cord

Fig. 4. The same patient. Dopplerangiogram of the spermatic cord on the left in the middle third of the inguinal canal. 1 – funiculopiocele, 2 – vessels of the spermatic cord

Fig. 5. The same patient. MRI. Frontal cut. A – T1VI, B – T2VI. 1 – funiculopiocele on the left, 2 – hydrocele on the left, 3 – the right testicle in the scrotum is absent (removed)

Fig.6. The same patient. MRI. T2VI. Axial section at the level of the middle third of the inguinal canal on the left. 1 – funiculopiocele, 2 – spermatic cord

CLINICAL OBSERVATION No. 2

Patient S., 63 years old in August 2010 for prostate cancer T1N0M0 underwent radical prostatectomy. The early postoperative period was complicated by a festering pelvic lymphocele with a volume of 650 ml, which was drained openly. Secondary intention wound healing.Was discharged on the 24th day after the operation in a satisfactory condition. 1 month after discharge, he was admitted to the clinic again with complaints of enlargement and soreness of the left groin area and left half of the scrotum, hyperthermia up to 38 ° with chills for 5 days. General condition of moderate severity due to purulent-inflammatory intoxication. In the left groin area, an immobile, tight-elastic and sharply painful formation 10x4x3 cm is palpable, the skin above it is edematous and hyperemic (Fig. 7).Acute epididymo-orchitis and strangulated inguinal hernia were excluded during clinical and echographic examination. The assumption of an inguinal lymphocele was also rejected, since dissection of the inguinal lymph nodes during the previous operation was not performed. Ultrasound examination of the inguinal canal on the left revealed an enclosed accumulation of heterogeneous fluid in the membranes of the spermatic cord (Fig. 8). Preliminary diagnosis: acute inguinal funiculitis with the development of reactive (inflammatory) funiculopiocele. During the revision of the inguinal canal and spermatic cord, about 150 ml of intershell purulent exudate was evacuated, thickening and compaction of the walls of the inguinal canal and the membranes of the spermatic cord were noted.Pathohistological examination of the resected membranes of the spermatic cord revealed signs of acute purulent diffuse inflammation (Fig. 9). When sowing the contents of the membranes of the spermatic cord, no growth of flora was detected. The outcome of the disease is recovery. The patient was discharged on the 20th day after the operation in satisfactory condition with a healed wound. Ultrasound examination 2 weeks after the operation showed the restoration of the structure of the spermatic cord and the walls of the inguinal canal (Fig. 10).

Fig.7. Case No. 2. Patient S., 61 years old. Asymmetric enlargement of the right groin and scrotum (arrow). Hyperemia of the skin of the scrotum and groin on the right. Right-sided inguinal funiculitis

Fig. 8. The same patient. Panoramic longitudinal echogram of the right groin-scrotal region. 1 funiculopiocele simulating an inguinal hernia, 2 – intact testicle and epididymis, 3 – hydrocele, 4 – abdominal cavity

Fig. 9. The same patient.Micropreparation of the membranes of the spermatic cord. Hematoxylin and eosin. Magnification: x 100. Foci of polymorphonuclear leukocytic and eosinophilic infiltration (1) with foci of hemorrhage (2). Acute purulent funiculitis

Fig. 10. The same patient. 14th day after surgery – opening and drainage of the phlegmon of the spermatic cord on the right. Panoramic longitudinal echogram of the right groin-scrotal region. Restoration of the structure of the spermatic cord and inguinal canal. 1 – spermatic cord, 2 – testicle, 3 – hydrocele, 4 – abdominal cavity

DISCUSSION

The clinical manifestations and course of PHF in our observations did not differ from the cases of PHF described in the literature [2-11].PHF clinically simulated various acute diseases of the groin-scrotal region: from acute purulent epididymo-orchitis to suppurative hematoma of the spermatic cord. The final verification of the disease belonged to the intraoperative and pathomorphological research methods.

The etiopathogenesis of PHF in the two presented cases remains not entirely clear. In the 1st case, given the history of genital anomalies (cryptorchidism), repeated urogenital infections and the results of exploratory revision of the inguinal canal, suppuration of the congenital funicular can be assumed as a pathomorphological substrate of PHF against the background of latent infectious deferentitis.It is known that congenital incomplete obliteration of the vaginal process of the peritoneum (processus vaginalis peritoneae Halleri) occurs in about 20% of children and can cause the development of a funiculocele complicated by suppuration [12].

In the second case, the onset of PHF was more likely to be preceded by pelvic purulent cellulitis and pelvic pyolymphocele, which arose as a complication of radical prostatectomy. It is known that complications of radical prostatectomy are common: in every 4th – 5th patient [13].Among them, purulent-inflammatory diseases of the kidneys, urinary tract, scrotum and pelvic tissue rank first, accounting for 40-60% of all postoperative complications [13, 14]. In this case, the most probable way of spreading a purulent infection from the bed of the removed prostate gland to the membranes of the spermatic cord is well studied: along the fascial sheath of the vas deferens to the membranes of the spermatic cord along the continuation – per continuitatem with the formation of funicolopyelocele [15].

In our observations, high diagnostic efficiency of high-resolution ultrasound (6-16 MHz) and MRI was noted.Ultrasound played the main role, it made it possible to assess the nature of the volumetric lesion of the spermatic cord and to carry out differential diagnostics with acute surgical diseases of the groin-scrotal region. MRI, in our opinion, is somewhat more accurate than ultrasound in assessing the prevalence of damage to the spermatic cord, as well as when clarifying the nature of effusion (pus, blood, lymph).

The treatment of PHF was surgical: revision of the inguinal canal, excision and drainage of the funiculopiocele. Surgical intervention was performed according to urgent indications for diagnostic and therapeutic purposes and in compliance with the principles of purulent surgery; as a result of the treatment, both patients recovered.

PGF is proposed to be differentiated, first of all, with strangulated inguinal hernia and acute diseases of the scrotal organs (acute epididymitis and volvulus), as well as with hematoma, venous thrombosis and spermatic cord tumor, osteomyelitis of the pubic bones and symphysis [2-11]. In the differential diagnosis of PHF and acute diseases of the scrotal organs, the method of choice is gray-scale ultrasound, supplemented by Doppler ultrasound; while when distinguishing between PHF and restrained inguinal hernia, the priority belongs to computed tomography (CT) [5, 6, 8].For the diagnosis of a tumor or hematoma of the spermatic cord, the use of MRI and high-resolution ultrasound is effective, for osteomyelitis of the pelvic bones – the use of pelvic radiography and CT [2, 5, 6]. In our observations, the use of complex radiation examination, including high-resolution ultrasound (6-16 MHz) and MRI of the groin-scrotal region, allowed us to speak about the nature of the spermatic cord disease and choose the necessary treatment tactics.

CONCLUSION

Inguinal purulent funiculitis is an extremely rare disease with an unknown etiopathogenesis.One of the probable mechanisms for the development of PHF is suppuration of a congenital funiculocele or the development of an acquired funiculopiocele against a background of urogenital infection or pelvic purulent cellulitis. A causative infection, presumably from the urethra, prostate, seminal vesicles and pelvic tissue, spreads to the membranes of the spermatic cord along the lumen of the vas deferens (canalicular way) or along its fascial sheath and then from the vas deferens to the spermatic cord – by continuation (per continuitatem) …PHF proceeds as an acute surgical or urological disease and causes serious diagnostic difficulties. In the diagnosis of PHF, the use of high-resolution ultrasound and MRI of the inguinal canal and organs of the scrotum is effective. The final verification of the diagnosis is carried out by intraoperative and pathomorphological methods. PHF must be differentiated using radiation methods with acute diseases of the inguinal-scrotal region, and above all, with strangulated inguinal hernia, acute epididymitis and volvulus.Treatment of PHF should be surgical (revision of the inguinal canal, opening and drainage of the membranes of the spermatic cord). With timely diagnosis and treatment, the prognosis of PHF is favorable.

REFERENCES

1. Tiktinsky O. L., Mikhailichenko V. V. Andrology (manual). SPb., 1999. P. 62 – 80.

2. Wilensky AO, Samuels SS. Acute deferentitis and funiculitis // Ann Surg. 1923. Vol. 78, N 6.P. 785 – 794.

3. Bissada NK, Redman JF.Unusual masses in the spermatic cord: report of six cases and review of the literature. // South Med J. 1976. Vol. 69. P. 1410-1412.

4. Chan PTK, Schglegel PN. Inflammatory conditions of the male excurrent ductal system. Review. Parts II. // J Androl. 2002. Vol. 23, No. 4. P. 461 – 469.

5. Eddy K, Pierce B, Eddy R. Vasitis: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography. // Can Urol Assoc J. 2011. Vol. 5, No. 4. P. E74 – E76.

6.Eddy K, Connell D, Gooodacre B, Eddy R. Imaging findings prevent unnecessary surgery in vasitis: an under-reported condition mimicking inguinal hernia. // Clin Radiol. 2011. Vol. 66, No. 5. P. 475-477. 7. Maitra AK. Odd inguinal swelling. // Lancet. 1970. Vol. 1.P. 45.

8. Gomez Herrera JJ., Zabia Galindez E, Carrera Terron R, Borruel Nacenta S. Dilatacion unilateral completa de conducto deferente como causa de massa inguinal. // Radiologia. 2013. Vol. 55, N 6.P. 533 – 536.

9.Bissada NK, Redman JF, Finkbeiner AE. Unusual inguinal mass secondary to vasitis. // Urology. 1976. Vol. 8. P. 488-499. 10. Ryan S. P, Harte PJ. Suppurative inflammation of vas deferens: an unusual groin mass. // Urology. 1988. Vol. 31. P. 245 – 246.

11. Wolbarst AL. The vas deferens, generally unrecognized clinical entity in urogenital disease. // J Urol. 1933. Vol. 29. P. 405 – 412.

12. Garriga V, Serrano A, Marin A, Medrano S, Roson N, Pruna X. US of the tunica vaginalis testis: anatomic relationships and pathologic conditions.// RadioGraphics. 2009. Vol. 29. P. 2017 – 2032.

13.. Froehner M, Novotny V, Koch R, Leike S, Twelker L, Wirth MP.Perioperative complications after radical prostatectomy: open versus robot-assisted laparoscopic approach. // Urol. Int. 2013. Vol. 90, N 3.P. 312 – 315.

14. Salomon L, Levrel O, Anastasiadis AG, Saint F, de La Taille A, Cicco A, Vordos D, Hoznek A, Chopin D, Abbou CC.Outcome and complications of radical prostatectomy in patients with PSA 10 ng / ml: comparison between the retropubic, perineal and laparoscopic approach.// Prostate Cancer Prostatic Dis. 2002. Vol. 5, N 4.P. 285 – 290.

15. Kovanov V.V., Anikina T.I. Surgical anatomy of human fascia and cellular tissue. Moscow: Medgiz, 1961, pp. 169 – 185.

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90,000 Inflammation of the organs of the scrotum. Causes, effects, diagnostics, treatment

EPIDYDYMITIS, ORCHITIS, ORCHOEPIDYDYMITIS and DEFERENTITIS or INFLAMMATION OF THE ORGANS OF THE SCREW in questions and answers

What is it, how does it manifest itself and why does it happen?

Epididymitis is an inflammation of the epididymis. Orchitis – inflammation of the testicle itself, and orchiepididymitis – simultaneous inflammation of the testicle and its epididymis. The testicle, epididymis and spermatic cord are also called the organs of the scrotum. In practice, epididymitis is most often observed, less often orchiepididymitis, and even less often isolated orchitis. Also, isolated inflammation of the vas deferens, which is part of the spermatic cord, is quite rare – deferentitis . These inflammatory processes can be acute, chronic and recurrent.

Acute epididymitis, orchiepididymitis or orchitis is a sudden onset of inflammation, accompanied by an increase and hardening of the testicle and / or its epididymis, sharp and intense pain and a rise in body temperature. With proper treatment, these diseases disappear within 2 weeks.

Chronic inflammation of the testicle and / or its epididymis is characterized by a long (from several months to several years) course and resistance to treatment.The chronic course is most often characterized by tuberculous epididymitis. Recurrent inflammation of the scrotal organs is associated with inadequate treatment or repeated infection in the epididymis and testis. Chronic and recurrent epididymitis, orchiepididymitis and orchitis are manifested by less pronounced enlargement and more local compaction of the scrotal organs, pain is less intense and paroxysmal, body temperature is usually normal.

The causes of these inflammatory processes are most often infections that enter the epididymis through the vas deferens from the urethra (urethra).Moreover, in young men younger than 35 years old, these are most often sexually transmitted infections. In particular, chlamydia is the cause of acute epididymitis in young men with a frequency of more than 50%. At an older age (after 50 years), the leading cause of inflammation of the scrotum is intestinal microorganisms that cause urinary tract infections (cystitis, pyelonephritis). These include Escherichia coli, Klebsiella, enterococci, Pseudomonas, Proteus, etc. Less often, the cause of epididymitis and orchitis, as well as deferentitis, can be a tuberculosis or viral infection.So in boys under 15 years old, orchitis can often become a complication of viral mumps (mumps) or rubella. The development of epididymitis, orchitis and orchiepididymitis is largely promoted by sudden hypothermia, which leads to a deterioration in the blood supply to the scrotum. Inflammation of the scrotal organs can also be caused by injuries and operations on the testicle, its epididymis and the spermatic cord. In this regard, antibiotics and anti-inflammatory drugs are often prescribed after scrotal injuries and operations on its organs.

What is the danger of inflammation of the organs of the scrotum? Do I need to see a doctor urgently?

Inflammation of the testicle and / or its epididymis is dangerous, first of all, by the development of male infertility. If they are not treated promptly, they can lead to disruption of sperm formation, their normal development and transport from the testicle to the posterior urethra, where sperm is finally formed. If there is bilateral inflammation of the scrotal organs, the risk of infertility is much higher. In such cases, problems associated with insufficient production of the male sex hormone – testosterone (decreased libido, weakened erection, decreased performance, decreased muscle mass, etc.) may develop.).

The second very important point dictating the necessity of urgent medical attention is the danger of a testicular tumor, which can begin to manifest itself in the same way as orchiepididymitis. As you know, testicular tumors in more than 90% under 45 years of age, we recommend testing for sexually transmitted infections, at this age can develop and malignant and can cause death of a young person, if he does not consult a doctor in a timely manner. At the same time, if a testicular tumor is detected in time and correctly treated, it is curable in almost 100% of cases.In the presence of painful enlargement, and especially testicular compaction, it is important to exclude its infarction, or necrosis associated with the cessation of the normal blood supply to the organ. Testicular infarction – an irreversible disease leading to organ necrosis and requiring the removal of the testicle. It usually occurs as a result of torsion of the spermatic cord and clamping of the testicular artery. Torsion of the spermatic cord develops most often against the background of significant hypothermia or injury, when a spasm of the muscle that lifts the testicle (musculus cremaster) occurs.Thus, if the symptoms described above appear (enlargement and induration of the testicle and / or its epididymis, pain in the scrotum, increased body temperature), you should urgently consult a urologist and undergo proper diagnosis and treatment.

How is the diagnosis of inflammatory diseases of the scrotum organs carried out?

The diagnosis of diseases of the testicle, its epididymis and the spermatic cord is based on a physical examination (primarily palpation or feeling). The leading auxiliary methods are diaphanoscopy and ultrasound examination (US) of the scrotum.All these methods are absolutely painless, and their correct use and proper interpretation make it possible to make an accurate diagnosis in the vast majority of cases. In recent years, ultrasound of the scrotum, as a much more informative and accurate method, has practically replaced diaphanoscopy.

To establish the causes of epididymitis, orchitis and orchiepididymitis, a general analysis and urine culture for microflora are required, sometimes semen (ejaculate) is analyzed for the presence of various infections in it.Tests are performed for the presence of sexually transmitted diseases. If suspected, an examination is carried out for the presence of Mycobacterium tuberculosis in the urine and / or ejaculate. If a testicular tumor is suspected, blood tests are performed for the appropriate tumor markers. Only a properly constructed complex of diagnostic measures allows you to establish an accurate diagnosis and carry out the most effective treatment. Be sure to contact your urologist!

What is the treatment of inflammatory diseases of the scrotum organs?

Treatment of epididymitis, orchitis, orchiepididymitis and deferentitis is carried out primarily with antibiotics, since their main cause is various infections.The choice of an antibiotic in an acute inflammatory process is carried out empirically, taking into account the known age characteristics of causative infections. Upon receipt of the results of microbiological studies and analysis of the sensitivity of the isolated microflora to antibiotics, it is possible to adjust antibiotic therapy, change its duration, dosages of drugs, and sometimes the drugs themselves and their combinations.

Along with antibiotics, non-steroidal anti-inflammatory drugs (indomethacin, diclofenac, celebrex, etc.) are prescribed.) in order to reduce inflammatory edema, pain and the fastest reverse development of inflammatory changes. In case of severe pain, blockade of the spermatic cord with a local anesthetic (lidocaine, prilocaine, marcaine) is used, which significantly reduces pain. All patients are advised to wear tight panties (swimming trunks) that tighten the scrotum during treatment. This promotes better blood and lymph flow in the scrotum, accelerates the reverse development of inflammation.

In the presence of abscesses or abscesses of the testicle and its epididymis, as well as in chronic recurrent epididymitis that is difficult to treat, in the case of testicular tuberculosis, surgical treatment is used.It can consist in opening and draining abscesses, partial or complete removal of the testicle and / or its epididymis. The use of various methods of physiotherapy for inflammatory diseases of the scrotal organs has not proven its effectiveness in correctly conducted scientific studies and is not included in the international standards for the treatment of epididymitis, orchitis and orchiepididymitis. In this regard, we do not use physiotherapeutic methods of treating these diseases in our practice.

What is the prevention of inflammatory diseases of the scrotal organs and their complications?

For the prevention of the diseases described above and their complications, it is necessary, first of all, to avoid infection with sexually transmitted infections and treat them in a timely manner, not to be exposed to sudden hypothermia, to protect the scrotum from injury.You should give preference to tight-fitting panties, dress warmly enough in winter. If you have the signs of epididymitis, orchitis and orchiepididymitis described above, you should immediately consult a urologist!

Hello. Six months ago, there was a pulling pain in the scrotum. An ultrasound scan revealed a varicocele on the left, the veins dilated to 3.9mm and a fluid formation of the epididymis on the right 4.2mm.The pain does not go away what should I do thanks in advance

See other questions or ask your own on the topic: Pain in the scrotum

A method for the diagnosis of acute pelvic deferentitis (ampulitis) in adults

The invention relates to medicine, namely to urology and andrology, and can be used in the diagnosis of acute pelvic deferentitis (ampulitis) – inflammation of the ampulla of the vas deferens, occurring against the background of acute prostatitis or acute vesiculitis in adults before the development of its clinical picture.

The vas deferens (hereinafter SVP) (ductus deferens, vas deferens) is an integral part of the testicular vas deferens and provides the transport of semen from the epididymis to the urethra. Anatomically, the SVP is a paired tubular formation 40-50 cm long with an outer diameter of 3.0-3.5 mm and a lumen of 0.5-0.7 mm. Its boundaries are the tail of the epididymis and the base of the prostate gland.

Based on the topographic features of the vas deferens, 4 parts are distinguished in it.The initial, shortest section, located behind the testicle, medial to its epididymis, is called the testicular part. The next part, rising vertically upwards, passes as part of the spermatic cord, medially from its vessels, and reaches the superficial inguinal ring – this is the cord part. Further, the vas deferens enters the inguinal canal, where its groin is located. Coming out of the inguinal canal through the deep inguinal ring, the vas deferens is directed along the lateral wall of the small pelvis downward and posteriorly until it merges with the excretory duct of the seminal vesicle.This section of the vas deferens is called the pelvic part. In the pelvic cavity, the duct is located under the peritoneum (retroperitoneally). On its way, it bends around the trunk of the lower epigastric artery from the lateral side, crosses with the external iliac artery and vein, penetrates between the bladder and rectum, crosses the ureter, reaches the bottom of the bladder and approaches the base of the prostate gland, next to the same duct of the opposite side … This end section of the vas deferens is dilated, spindle-shaped and forms the ampulla of the vas deferens.The length of the ampoule is 3-4 cm, its largest transverse size reaches 1 cm. In the lower part, the ampoule gradually narrows and, entering the thickness of the prostate gland, connects with the excretory duct of the seminal vesicle.

Among SVP diseases, acute nonspecific deferentitis occurs most often [7]. Deferentitis, known in the English-language literature as vasitis, refers to diseases that are poorly studied and unfamiliar to a wide range of doctors. There are few publications on acute nonspecific deferentitis and are presented in the scientific literature, mainly by foreign sources [6, 7, 11].In many domestic and foreign manuals on urology, andrology and radiology, deferentitis, as a separate nosological form, is not considered, and often is not even mentioned.

Timely diagnosis of acute nonspecific deferentitis is one of the pressing medical and social problems for a number of reasons. First, the course of a timely unrecognized deferentitis in bilateral lesions of SVP can be complicated by infertility due to the development of SVP obliteration in the outcome of the disease [3, 4].As you know, according to the WHO, the frequency of infertile married couples is 15-25%, while the male factor accounts for 30-50% of all cases of infertility [4]. One of the causes of male infertility is a violation of the patency of the SVP of a congenital and acquired nature. The incidence of SVP obstruction in men with infertility is 15-25% and 1% in the general male population [1, 3, 4, 5]. The anatomical features of SVP (large length reaching 50 cm; narrow lumen of 0.2-0.5 mm) predispose to the fact that various inflammatory, traumatic and tumor diseases of SVP and surrounding tissues and organs are accompanied by impaired patency of SVP of a functional or organic nature …As a result, any diseases of SVP can lead to obstructive azoospermia (aspermia), which underlies the excretory form of male infertility. At the same time, inflammatory diseases of the male genital organs, including SVP diseases, play a major role in the development of its obstruction. Their frequency among the causes of excretory infertility in Europe and the United States is 10-15%, in Asia, Africa and South America it reaches 70% [5]. Even with unilateral inflammatory lesion of SVP, the development of a secretory-excretory form of infertility is possible in 15-76% of cases due to autoimmune processes [4].

Secondly, in addition to the obliteration of SVP, the course of acute deferentitis can lead to the formation of an SVP abscess, which, in turn, may be complicated by sepsis and require surgical intervention.

Thirdly, in time undetected indolent deferentitis can cause chronic inflammatory processes of the scrotum and small pelvis [8].

Acute deferentitis occurs in men of reproductive age with infectious inflammatory diseases of the urethra, prostate, seminal vesicles and epididymis [1, 3, 4].Among the causative factors of acute deferentitis, sexually transmitted infections (trichomoniasis, chlamydia, gonorrhea) are most common. According to the modern point of view, urogenital infection in urethritis often spreads to the prostate gland and seminal vesicles through their excretory ducts, and through the SVP – to the epididymis and the testicle, involving SVPs in the inflammatory process, while the SVP ampoule is affected by one of the first [1, 3, 4]. The clinical feature of deferentitis is the absence of a specific clinical picture of the disease [3, 4].The clinical manifestations of acute deferentitis depend only on the level of SVP lesions. When the scrotal part of the SVP is involved in the inflammatory process, acute deferentitis proceeds under the mask of acute epididymitis or acute epididymo-orchitis, with the defeat of the inguinal part of the SVP – under the mask of a strangulated inguinal hernia [6, 7]. When the pelvic SVP is affected, pelvic deferentitis (ampulitis) often occurs as acute prostatitis, acute vesiculitis, less often – it simulates any acute disease of the rectum or peri-rectal tissue (proctitis, paraproctitis, complicated by infringement or inflammation of internal hemorrhoids) [6, 7, 8] …The clinical manifestations of these competing diseases (acute epididymitis, acute epididymo-orchitis, acute prostatitis and acute vesiculitis) are usually the first reason for a patient with deferentitis to see a doctor.

Timely diagnosis of acute deferentitis, regardless of the level of SVP lesions, is difficult due to the nonspecificity of its clinical and laboratory picture. On physical examination, against the background of edematous-inflammatory changes in the scrotum and its organs, the prostate gland or seminal vesicles, acute deferentitis is usually not recognized.

When analyzing the prior art, we identified a source of information from which a method for diagnosing acute deferentitis of the inguinal and scrotal localizations is known, based on a retrospective analysis of 12 observations (Yang DM, Kim NS, Lee HL, Lim JW, Kim GY Sonographic findings of acute vasitis // J Ultrasound Med. 2010. Vol. 29, No. 12. P. 1711-15.). The age of patients with acute deferentitis ranged from 24 to 71 years. Acute deferentitis was combined with acute epididymitis in 11 of 12 patients.One patient had isolated acute deferentitis in the inguinal segment of the SVP. In 10 cases, acute deferentitis was localized in the epididymis of the SVP, in one – in the inguinal segment, and in one more – in the inguinal and epididymal segments. In 11 cases, acute deferentitis was clinically manifested as acute epididymitis, in one case – inguinal pain. In 11 cases, ultrasound showed a thickening of the adnexal part of the SVP over 6 mm in diameter, loss of structural differentiation of the SVP wall, hypervascularization of the SVP wall during Doppler sonography.In one case of acute deferentitis of the inguinal section of the SVP, the latter had a normal diameter, but pronounced hypervascularization on Doppler imaging. It should be noted that the authors in their work did not investigate the pelvic section of the SVP (ampoule) [11].

The diagnosis of acute pelvic deferentitis (ampulitis) remains unexplored. There is no literature specially devoted to the diagnosis of acute pelvic deferentitis in domestic and foreign information databases. Proposed by D.M. Yang et al.(2010) ultrasound criteria for acute deferentitis of the inguinal and scrotal parts of the SVP are generally correct, but for the diagnosis of acute pelvic deferentitis (acute ampulitis), taking into account the anatomical features of the pelvic region and the ampulla of the SVP, the ultrasound method of their examination (endorectal), require clarification and addition … In addition, using the ultrasound criteria for acute deferentitis mentioned above, which are not adapted to the pelvic SVP, the diagnosis of acute pelvic deferentitis (ampulitis) may be erroneous.In addition, acute ampulitis is usually combined with acute prostatitis or acute vesiculitis. This greatly complicates its diagnosis, and therefore leads to complications and ineffective treatment of the disease.

Advantages of the proposed method

1. The proposed method allows you to shorten the examination of patients with acute ampulitis, as it allows you to abandon a whole series of studies.

2. The proposed method allows you to abandon traumatic and radiation-related research methods.

3. The method allows an accurate differential diagnosis of acute ampulitis, since it is difficult to diagnose acute ampulitis clinically, since the clinical picture is more often dominated by symptoms of acute prostatitis or acute vesiculitis.

TECHNICAL RESULT is to ensure early and highly accurate detection of acute pelvic deferentitis occurring against the background of acute prostatitis or acute vesiculitis in adults before the development of the clinical picture, by taking into account a set of certain ultrasound criteria reflecting the pathogenetic links of acute pelvic deferentitis, its specificity, based on analysis of which it is possible to judge the developing disorders in the structure of the pelvic vas deferens (ampulla), and, accordingly, indicating the development of acute pelvic deferentitis.

Many methods of SVP examination are known:

1. Physical or digital rectal examination of SVP in acute pelvic deferentitis is usually uninformative because of edematous-inflammatory changes in the prostate and seminal vesicles, which complicate the palpation of SVP. The laboratory picture of blood and urine in acute pelvic deferentitis is nonspecific and indicates the presence of inflammation, which may be caused by acute prostatitis, acute vesiculitis, or acute epididymitis [1, 3, 4].

2. Traditional X-ray examination of SVP – deferentography due to its invasiveness in acute pelvic deferentitis is contraindicated. In addition, it is not very informative and is associated with the introduction of X-ray contrast agents, which can cause allergic reactions, hepatic renal failure, sclerosis and SVP obliteration [2].

3. Computed tomography for visualization of SVP is sharply limited due to the high radiation load on the reproductive organs [6, 7].

4. Traditional magnetic resonance imaging due to low spatial resolution for the diagnosis of acute pelvic deferentitis is unacceptable [6, 7]. Endorectal magnetic resonance imaging is used to diagnose diseases of the pelvic SVP (mainly developmental anomalies and cysts), the possibilities of which in the diagnosis of acute pelvic deferentitis (ampulitis) have not yet been studied [8].

5. Endoscopic visualization of the SVP lumen (vasoscopy) using fiber optics is a new diagnostic trend in andrology.It is an invasive, inaccessible and expensive test, the diagnostic capabilities of which have not yet been studied. Currently, for technical reasons, the use of vasoscopy is still limited only to the inguinal section of the SVP [10].

6. Ultrasound examination is an informative and safe method for examining SVP [9]. The use of high-resolution ultrasound examination (at an operating frequency of the transducer over 7 MHz) makes it possible to study the layer-by-layer structure of the SVP wall, which favorably distinguishes ultrasound examination from the methods described above.The topic of ultrasound diagnostics of acute pelvic deferentitis (ampulitis) remains unreported in the literature. The aforementioned post by Yang D.M. et al. (2010) is based on the analysis of the echographic picture of inguinal and scrotal acute deferentitis in 12 patients with acute epididymitis and does not at all reflect issues related to ultrasound diagnostics of acute pelvic deferentitis [11].

The method is carried out as follows.

Ultrasound examination of the pelvic SVP is performed in the decubital position of the patient – lying on the left side with the knees brought to the abdomen (as in transrectal ultrasound examination of the prostate and seminal vesicles).Rectum preparation in patients prior to transrectal ultrasound is usually not performed, except in patients with constipation. In such cases, the preparation of the rectum is carried out according to the generally accepted method using laxatives or cleansing enemas.

Ultrasound examination of the pelvic SVP is performed using an endorectal biplane transducer 5-10 MHz.

Examination of the pelvic SVP is carried out at the level of the base of the prostate gland and above using longitudinal and transverse projections.Ultrasound examination of the pelvic SVP in a longitudinal projection is carried out when the scanning plane is oriented along the ejaculatory ducts, usually at an angle of 30-45 degrees to the midline. In this projection, the SVP is studied during the measurement of the anteroposterior size of the SVP ampoule. During ultrasound examination of the pelvic SVP in a transverse projection, the lateomedial size of the SVP ampoule is measured.

In the presence of inflammatory infiltration in the wall of the SVP ampoule, increased vascularization is manifested by visualization of vascular branches, the number of which may vary depending on the form of inflammation.The degree of vascularization was determined according to the following method: the number of color signals representing the vascular branches within the wall of the SVP ampoule was read. Color signals in the amount from 1 to 3 are classified as single, from 4 or more – as multiple. In areas where destructive changes in the wall occur, the vascular pattern is not determined, but in these cases, vascular branches are visualized in the areas adjacent to the destruction focus in the projection of the SVP ampoule wall. When the surrounding tissues are involved in the inflammatory process, an increase in the vascular pattern can be traced in their projection.

Doppler imaging uses hardware and scan mode settings to maximize the sensitivity of the device to low-speed streams. Sensitivity (“Gain”) within 70-80% before the appearance of flash artifacts, low wall filter (50 Hz), speed scale graduation from 0.3 cm / s and higher, or pulse repetition rate – 540 Hz.

The study is carried out in gray-scale imaging modes in combination with power Doppler sonography, while the contours are examined, the anteroposterior and lateomedial dimensions, layer-by-layer structure, echogenicity and the degree of vascularization of the SVP ampoule wall are determined.With an increase in the anteroposterior size of the SVP ampoule more than 5 mm, the lateomedial size of more than 8 mm, blurred contours and the presence of a violation of the layer-by-layer differentiation of the SVP ampoule wall, a decrease in its echogenicity, and also, if the degree of vascularization of the SVP ampoule wall is more than 1 color signal, acute pelvic deferentitis is diagnosed.

According to the claimed method, 86 patients aged 18-85 with acute prostatitis, acute vesiculitis and acute epididymitis lasting 2.5 days (0.5-7.5) were examined.Acute pelvic deferentitis (ampulitis) was detected in 54 (62.8%). As a result of the late diagnosis of acute pelvic deferentitis in 6 (11%) patients, ultrasound examination revealed small abscesses of the epididymis of the SVP measuring 3.2 (2.6-7.3) mm in diameter, which were then confirmed during surgery. The informative value of the complex of ultrasound criteria that combines the measurement of the anteroposterior size and the lateomedial size of the SVP ampoule, the study of the contours, layer-by-layer structure, echogenicity and the degree of vascularization of the SVP ampoule wall for the diagnosis of acute ampulitis was: sensitivity – 100%, specificity – 96.3%, accuracy – 98.2%.The complex treatment of acute pelvic deferentitis, including, in addition to conservative measures, and surgical intervention, made it possible to achieve regression of clinical symptoms and laboratory parameters in all patients. Against the background of the ongoing treatment with dynamic ultrasound examination, the normalization of the ultrasound picture of the SVP was noted.

The method is illustrated by the following clinical examples.

Example 1. Patient Sh., 35 years old, came to the urology clinic with complaints of acute pain in the left testicle, edema and redness of the left half of the scrotum, fever up to 37.7 ° C.I got sick for the first time. The onset of the disease is associated with hypothermia. On physical examination of the scrotal organs, an enlarged and painful appendage of the left testicle is palpated, the SVP is not palpable. In rectal digital examination, the prostate gland is of normal size, painless with a preserved and pronounced interlobar groove. Diagnosed with acute epididymitis on the left. Ultrasound examination of the scrotal organs revealed an increase of up to 10 mm in the tail of the epididymis of the left testicle (normally no more than 4 mm), a decrease in its echogenicity and hypervascularization.Additionally, an increase in the anteroposterior size of the SVP ampoule up to 8 mm, the lateomedial size – up to 10 mm, indistinct external contours, impaired layer-by-layer differentiation, decreased echogenicity and hypervascularization of the SVP wall (the degree of vascularization of the SVP ampoule wall ranged from 5 to 8 color signals) were found. In other departments, the SVP was not changed. Echographic conclusion: ultrasound picture of acute epididymitis and acute ampulitis on the left. She was prescribed local therapy (wearing a suspensor, cold compresses on the scrotum), antibacterial, anti-inflammatory and immunostimulating treatment.Complete cure achieved. With dynamic ultrasound examination after 12 days, the size, echostructure and vascularization of the epididymis and SVP are normal. In this case, the use of the ultrasound research method helped to establish the diagnosis of acute pelvic deferentitis (ampulitis) and additionally evaluate the effectiveness of the therapy.

Example 2. Patient A., 43 years old, came to the urology clinic with complaints of pulling pains in the perineum, rectum and above the bosom, frequent painful urination, fever up to 37.4 ° C.History: for 5 years suffering from chronic prostatitis, periodically receiving antibacterial, physiotherapeutic treatment. The disease is associated with hypothermia. Digital rectal examination revealed an enlargement of the prostate gland by 1.5 times, its contours are even, the consistency is soft-elastic, pasty, moderately painless. The seminal vesicles and pelvic parts of the SVP are not changed on palpation. The organs of the scrotum were unremarkable on physical examination. Clinical diagnosis: chronic prostatitis in the acute stage.For the purpose of diagnostics, a study of the urethral secretion was carried out, in which the number of leukocytes was increased – up to 30 in the field of view (normally no more than 3-5 in the field of view). Transrectal ultrasound examination of the pelvic organs revealed an enlargement of the prostate gland up to 29 cm ³ (normally no more than 25 cm ³), heterogeneous structure, diffuse enhancement of the parenchymal vascular pattern of the gland. The ampulla of the right SVP is enlarged (anteroposterior size – 8 mm, lateomedial size – 12 mm), has indistinct contours, a wall of reduced echogenicity with lost layer-by-layer differentiation, the degree of vascularization is 5 color signals).There is also an expansion of the right seminal vesicle up to 17 mm (normally up to 15 mm), a thickening of its wall up to 3 mm (normally up to 2 mm), a violation of its layer-by-layer differentiation and a decrease in echogenicity, an increase in the vascular pattern of the wall (vascular density – 6 , normal – 0-1). For the rest of the SVP, as well as the testes and epididymis are not changed. Echographic conclusion: ultrasound signs of acute pelvic deferentitis (ampulitis) and acute vesiculitis on the right, chronic prostatitis (exacerbation).Complex (antibacterial, anti-inflammatory, immunostimulating) therapy was carried out, which resulted in recovery. In this case, ultrasound examination additionally revealed acute deferentitis with lesions of the pelvic SVP (ampulitis) and acute vesiculitis on the right.

The use of the claimed method provides high accuracy in the diagnosis of acute ampulitis while reducing invasiveness, the absence of radiation exposure and the need to use contrast agents.

USED LITERATURE

1. Urology: National leadership / Ed. ON. Lopatkina. M .: GEOTAR – Media, 2009.S. 484-560.

2. Pytel A.Ya., Pytel Yu.A. X-ray diagnostics of urological diseases. M: Medicine; 1966.S. 405-413.

3. Guidance on urology / Ed. ON. Lopatkina. M .: Medicine, 1998. Vol. 2.S. 440-480.

4. Tiktinsky O. L., Mikhailichenko V. V. Andrology (manual). SPb., 1999.S. 62-80

5. Coccuza M., Alvarenga C, Pegani R. The epidemiology and of azoospermia. Clinics (San Paulo) 2013; 68 (Suppl. 1): 15-26.

6. Eddy K., Pierce B., Eddy R. Vasitis: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography. Can Urol. Assoc J 2011; 5 (4): E74-6.

7. Eddy K., Connell D., Goodacre B., Eddy R. Imaging findings prevent unnecessary surgery in vasitis: an under-reported condition mimicking inguinal hernia. Clin Radiol 2011; 66 (5): 475-77.

8.Kim B., Kawashima A., Ryu J. A., Takahashi N., Hartman R. P., King B. F. Jr. Imaging of the seminal vesicle and vas deferens. Radiographics 2009; 29 (4): 1105-21.

9. Middleton W.D., Dahiya N., Naughton C.K., Teefey S.A., Siegel C.A. High-resolution sonography of the normal extrapelvicvas deferens. J Ultrasound Med 2009; 28 (7): 839-46.

10. Wang X. Newly developed techniques in andrology: endoscopy of the vas deference and a new imaging technique for in situ localization of vital spermatozoa.Asian J Androl 2013; 15: 721-22.

11. Yang D.M., Kim H.C., Lee H.L., Lim J.W., Kim G.Y. Sonographic findings of acute vasitis. J Ultrasound Med 2010; 29 (12): 1711-1715.

A method for the diagnosis of acute pelvic deferentitis occurring against the background of acute prostatitis or acute vesiculitis in adults before the development of the clinical picture of acute pelvic deferentitis, characterized by the fact that ultrasound examination of the ampulla of the vas deferens is carried out with an endorectal ultrasound transducer in gray-scale imaging modes in combination with power Doppler ultrasonography examine the contours, determine the anteroposterior and lateomedial dimensions, layer-by-layer structure, echogenicity and degree of vascularization of the ampulla wall of the vas deferens, and with an increase in the anteroposterior size of the ampulla of the vas deferens more than 5 mm, lateomedial size more than 8 mm, indistinctness of the contours and the presence of a violation of the layer-by-layer differentiation of the ampulla of the vas deferens , a decrease in its echogenicity, and also, if the degree of vascularization of the wall of the ampulla of the vas deferens is more than 1 color signal, acute pelvic deferentitis is diagnosed.

Deferentitis

Deferentitis – inflammation of the vas deferens. The vas deferens is involved in the process of inflammation of the epididymis, seminal vesicle or posterior urethra. Deferentitis often occurs during rough instrumental manipulations in urological practice (catheterization, bougienage, genitography, urethrocystography, prostate biopsy, etc.)NS.). Deferentitis can develop with trauma, prolonged sexual abstinence against the background of chronic prostatitis, after repeated violent intercourse. With bilateral deferentitis, infertility is often observed. In the clinical picture of deferentitis, acute and chronic course are distinguished. If the membranes of the spermatic cord, which includes the vas deferens, are involved in the inflammatory process, deferentitis develops. Medication and physiotherapy treatment. Sanatorium treatment is recommended in many sanatoriums in Russia, which have sulphide mineral waters for treatment (for example, Sochi’s health resorts use unique Matsesta waters, which are the standard for the preparation of artificial sulphide waters).On the territory of Siberia, the only resort that treats chronic prostatitis and other andrological diseases. This is the sanatorium “Usolye” in Usolye-Sibirskoye, Irkutsk region, founded in 1848 and having unique sources of curative and medicinal sapropel mud and mud-peat therapeutic mud of Lake Dlinnoye, which has absorbing and anti-inflammatory effects.

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Orchit

Orchitis is an inflammation of the testicle. Orchitis differ in their origin, clinical course and routes of infection, because most often orchitis occurs as a result of infection of the testicular tissue. In this case, specific orchitis is distinguished, caused by sexually transmitted diseases (STIs), tuberculosis, brucellosis, actinomycosis, and nonspecific, caused by various bacteria, viruses, protozoa.Most often, orchitis develops as a result of an existing infection of the lower urinary tract and pelvic organs – urethritis, prostatitis, vesiculitis, cystitis, but it can also be a complication of infectious diseases of other localization of influenza, tonsillitis, mumps, pneumonia, rheumatic arthritis, brucellosis, typhoid. However, orchitis can result from iatrogenic manipulations, as well as testicular injury. In newborns, orchitis is most often caused by infection in the testicle from infected umbilical vessels.In older children, inflammation of the testicular tissue in most cases is a consequence of a complication of mumps, less often with a long stay in the urethra of a catheter, after a testicular injury, with the spread of infection by hematogenous pathways. Orchitis is often associated with epididymitis (inflammation of the epididymis). As a rule, orchitis is a secondary disease due to the spread of infection from other organs by hematogenous, lymphogenous or contact routes. Gonorrheal, Trichomonas, chlamydia, mycoplasma orchitis are acquired sexually.Of great importance in the development of orchitis is a decrease in the body’s immune status against the background of long-term chronic diseases and intoxication.

Symptoms and clinical course.
According to the clinical course, acute and chronic orchitis are distinguished. In acute orchitis, patients complain of severe, sudden pain in the testicle and the corresponding half of the scrotum, chills, fever up to 38-39 ° C, testicular enlargement. Usually, after 2-4 weeks, the orchitis phenomena subside, however, in some cases, a suppurative process occurs in the testicle.In this case, the condition of the patients noticeably worsens due to intoxication, the pain in the testicle increases, the body temperature becomes persistently elevated, swelling and hyperemia of the skin of the scrotum appear, which is soldered to the underlying tissues. Subsequently, the formation of an abscess or testicular atrophy often occurs. With mumps, orchitis develops on the 3-12th day from the onset of the disease or in the first week after the child recovers. In 30% of patients, a bilateral process is observed. Often, mumps orchitis ends with testicular atrophy.Chronic orchitis is much less common. The pain syndrome with them is not pronounced, and in primary chronic forms, the testicle is painful only on palpation, increased in size, sometimes compacted. It is clinically very important to differentiate chronic orchitis from testicular malignant tumors. With an inflammatory process in one testicle, the fertility and sexual function of a man is not impaired, with damage to both testicles, infertility very often develops and sexual function may be impaired. A special place in the development of infertility is occupied by mumps orchitis, which in 70% of cases causes atrophy of the seminal epithelium of the testicular tubules.

Diagnostics.
In the recognition of orchitis, in addition to indications of testicular injury and the above-mentioned infectious diseases, objective research data are essential. The skin of the scrotum in orchitis is tense, but not swollen, as in acute epididymitis (inflammation of the epididymis). The epididymis is not enlarged. The spermatic cord is swollen, thickened, but unlike acute epididymitis, the vas deferens is palpable clearly, no infiltrative changes are found in it. Occurring periorchitis (inflammation of the tissues surrounding the testicle) and reactive dropsy of the testicle can make it difficult to diagnose the disease.The diagnosis of testicular abscess is facilitated by its puncture with obtaining pus and ultrasound scanning, which reveals the rarefaction of testicular tissue with liquid contents. In chronic orchitis, especially in cases of suspected malignant changes in the testicle, such research methods as echoscopy and testicular biopsy are also practiced.

Differential diagnostics.
In some situations, nonspecific orchitis should be differentiated from tuberculosis and testicular tumor. Testicular tuberculosis often begins with and is accompanied by tuberculosis of the epididymis.A testicular tumor, in contrast to orchitis, begins with a gradual increase in the testicle without pain and temperature reaction; palpation of the testicle affected by the tumor is painless. In difficult cases of differential diagnosis, ultrasound and testicular biopsy are critical.

Treatment.
In acute orchitis, inpatient treatment is recommended, which includes novocaine blockade, suspensor, bed rest and antibiotic therapy. Spicy foods are excluded from the diet.It is advisable to use antibiotics of a wide spectrum of action. The occurrence of a testicular abscess is an indication for opening the abscess. In elderly people with purulent orchitis, it is advisable to perform orchiectomy. With mumps orchitis in children, glucocorticoid therapy, acetylsalicylic acid is added to the general anti-inflammatory therapy. It should be remembered that a qualified specialist must be sure to diagnose and treat orchitis. Independent and improper treatment can lead to serious consequences such as infertility, impotence and malignant testicular diseases.In chronic orchitis, great attention should be paid to the activation of the body’s immune defenses and the elimination of the primary etiological factor that led to the development of the disease.

Forecast.
As a rule, with nonspecific orchitis, the prognosis is favorable. In rare cases, widespread septic thrombosis in the testicular parenchyma leads to a heart attack or gangrene of the organ.