1/4. epididymitis after prostate brachytherapy.OBJECTIVES: To analyze the incidence, time-course, and potential predisposing factors for what was clinically diagnosed as postimplant epididymitis. methods: Of 517 patients randomized and treated on two treatment protocols, with a planned total accrual of 1200, 5 patients were identified who developed clinically diagnosed epididymitis after iodine-125 or pallidium-103 prostate brachytherapy. Implants were performed by standard techniques, using a modified peripheral loading pattern. Perioperative antibiotics (cefazolin and ciprofloxacin) were given to 258 patients, according to physician preference. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological association (AUA) and radiation Therapy Oncology Group criteria at 1, 3, 6, 12, and 24 months. patients who did not respond to the mailed questionnaires were interviewed by telephone. Although the patients were not queried specifically regarding epididymitis, its occurrence was noted when discovered in the course of follow-up examinations. RESULTS: Postimplant epididymitis occurred in 5 (1%) of 517 consecutive brachytherapy patients. None of the 5 patients had had a prior history of orchitis, epididymitis, vasectomy, or preimplant catheterization. The symptoms of epididymitis first appeared at 4, 7, 10, 150, and 300 days after implantation. patients with epididymitis had prostate volumes, preimplant AUA scores, and ages typical of other implant patients. No association was apparent between postimplant epididymitis and the degree of implant-related prostate swelling or the number of seeds implanted. Only the preimplant AUA score predicted for epididymitis, but 2 of the 5 patients had low scores. Only 1 (0.4%) of the 258 patients who received perioperative antibiotics developed epididymitis, and 4 (1.5%) of the 259 patients with prophylactic antibiotics developed epididymitis. CONCLUSIONS: epididymitis is an uncommon postimplant complication occurring in 1% of a large patient cohort. That epididymitis patients had greater preimplant AUA scores is consistent with a retrograde infection route, at least in some cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Evaluation of acute scrotum pain with testicular scanning.Emergency room physicians frequently are faced with the evaluation of the patient with acute testicular pain. The rapid differentiation between testicular torsion and acute epididymitis is necessary although frequently difficult due to an atypical presentation. We describe four patients with testicular pain in whom testicular scanning provided useful adjunctive information regarding diagnosis. This technique clearly differentiates acute torsion, acute epididymitis, testicular rupture, and missed torsion with abscess formation, prompting appropriate therapy in each case. Testicular scanning provides a rapid, noninvasive method to assist in the evaluation of testicular pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Intermittent testicular torsion.Testicular torsion is the most common cause of acute scrotal pain in prepubertal and adolescent boys and should be foremost in the minds of primary care physicians evaluating these children. Intermittent testicular torsion is a separate entity that should be considered in all young males with a history of scrotal pain and swelling. Acute and intermittent sharp testicular pain and scrotal swelling, interspersed with long intervals without symptoms, are characteristic. Physical findings may include horizontal or very mobile testes, an anteriorly located epididymis, or bulkiness of the spermatic cord from partial twisting. awareness of this entity and early elective orchiopexy will improve testicular salvage in patients with intermittent testicular torsion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Ultrasound diagnosis of filarial funiculoepididymitis.Genital presentation of filarial disease is not uncommon in endemic areas of the world. Acute, febrile illness involving the epididymis and spermatic cord (funiculoepididymitis) is one of many such presentations. With an internationally mobile society, physicians today, even in nonendemic areas, may encounter patients with filarial infestations. We report the first case of presumptive diagnosis of this disease using scrotal ultrasound.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |