Acute epididymo-orchitis: relevance of local classification and partner's follow-up

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Abstract

Introduction

Acute epididymo-orchitis (AEO) is a male urological emergency without an approved clinical classification. We aimed to determine the clinical value of proposed in 2012 local AEO classification system and summarize results of partner's follow-up.

Material and methods

A total of 293 patients with AEO were enrolled into our study. Based on the investigated AEO classification, they were divided into four groups: 118 patients (40.3%) with Stage I AEO; 97 patients (33.1%) with Stage II AEO; 42 patients (14.3%) with Stage IIIA AEO; 36 patients (12.3%) with Stage IIIB AEO.

If after 72 hours of conservative treatment there was no clinical improvement, AEO patients underwent surgery. We analyzed the clinical value of the investigated classification system and results of partner's follow-up.

Results

Only 3 (2.5%) patients with Stage I AEO required surgery. In patients with Stage II AEO, conservative treatment was effective in 79 (81.4%) cases. A total of 27 (64.3%) patients with Stage IIIA and 36 (100%) patients with stage IIIB AEO underwent surgery. Sexually transmitted infections (STIs) were detected in 176 (60.1%) cases among 293 patients with AEO and bacterial infection in 117 (39.9%) cases. We registered a statistically lower incidence rate of trichomoniasis in AEO patients compared to their sole female partners (13.8% vs. 23.3%, p <0.05). Distribution of other STIs in AEO patients and their sole partners was similar.

Conclusions

The investigated classification system enables the determination of a treatment strategy in patients with AEO. Partner's follow-up allows for the clarification of the etiology of disease, complete evaluation of STIs and prevents reinfection in couples.

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Most cited references 25

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Infectious, inflammatory and ‘autoimmune’ male factor infertility: how do rodent models inform clinical practice?

Monika Fijak, Adrian Pilatz, Mark P Hedger … (2018)

Abstract BACKGROUND Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans. OBJECTIVE AND RATIONALE This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions. SEARCH METHODS An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: ‘infection’ and/or ‘inflammation’ and ‘testis’ and/or ‘epididymis’, ‘infection’ and/or ‘inflammation’ and ‘male genital tract’, ‘male infertility’, ‘orchitis’, ‘epididymitis’, ‘experimental autoimmune’ and ‘orchitis’ or ‘epididymitis’ or ‘epididymo-orchitis’, antisperm antibodies’, ‘vasectomy’. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team. OUTCOMES There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection have been instructive in a better understanding of the mechanisms of disease initiation and progression. In this regard, rodent models of acute bacterial epididymitis best reflect the clinical situation in terms of mimicking the infection pathway, pathogens selected and the damage, such as fibrotic transformation, observed. Similarly, animal models of acute testicular and epididymal inflammation using lipopolysaccharides show impairment of reproduction, endocrine function and histological tissue architecture, also seen in men. Autoimmune responses can be studied in models of experimental autoimmune orchitis (EAO) and vasectomy. In particular, the early stages of EAO development showing inflammatory responses in the form of peritubular lymphocytic infiltrates, thickening of the lamina propria of affected tubules, production of autoantibodies against testicular antigens or secretion of pro-inflammatory mediators, replicate observations in testicular sperm extraction samples of patients with ‘mixed atrophy’ of spermatogenesis. Vasectomy, in the form of sperm antibodies and chronic inflammation, can also be studied in animal models, providing valuable insights into the human response. WIDER IMPLICATIONS This is the first comprehensive review of rodent models of both infectious and autoimmune disease of testis/epididymis, and their clinical implications, i.e. their importance in understanding male infertility related to infectious and non-infectious/autoimmune disease of the reproductive organs.

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Epididymitis and orchitis: an overview.

T Lishnak, Thomas Trojian, D Heiman (2009)

Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. In other age groups, coliform bacteria are the primary pathogens. Men with epididymitis and orchitis typically present with a gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever. This presentation helps differentiate epididymitis and orchitis from testicular torsion, which is a surgical emergency. Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. Initial outpatient therapy is empirical and targets the most common pathogens. When C. trachomatis and N. gonorrhoeae are suspected, ceftriaxone and doxycycline are recommended. When coliform bacteria are suspected, ofloxacin or levofloxacin is recommended.

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Epididymitis: revelations at the convergence of clinical and basic sciences

Vera Michel, Adrian Pilatz, Mark P Hedger … (2015)

Acute epididymitis represents a common medical condition in the urological outpatient clinic. Mostly, epididymitis is caused by bacterial ascent through the urogenital tract, with pathogens originating either from sexually transmitted diseases or urinary tract infections. Although conservative antimicrobial therapy is possible in the majority of patients and is usually sufficient to eradicate the pathogen, studies have shown persistent oligozoospermia and azoospermia in up to 40% of these patients. Animal models of epididymitis are created to delineate the underlying reasons for this observation and the additional impairment of sperm function that is often associated with the disease. Accumulated data provide evidence of a differential expression of immune cells, immunoregulatory genes and pathogen-sensing molecules along the length of the epididymal duct. The evidence suggests that a tolerogenic environment exists in the caput epididymidis, but that inflammatory responses are most intense toward the cauda epididymidis. This is consistent with the need to provide protection for the neo-antigens of spermatozoa emerging from the testis, without compromising the ability to respond to ascending infections. However, severe inflammatory responses, particularly in the cauda, may lead to collateral damage to the structure and function of the epididymis. Convergence of the clinical observations with appropriate animal studies should lead to better understanding of the immunological environment throughout the epididymis, the parameters underlying susceptibility to epididymitis, and to therapeutic approaches that can mitigate epididymal damage and subsequent fertility problems.

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Author and article information

Journal

Journal ID (nlm-ta): Cent European J Urol

Journal ID (iso-abbrev): Cent European J Urol

Journal ID (publisher-id): CEJU

Title: Central European Journal of Urology

Publisher: Polish Urological Association

ISSN (Print): 2080-4806

ISSN (Electronic): 2080-4873

Publication date (Electronic): 22 August 2019

Publication date (Print): 2019

Volume: 72

Issue: 3

Pages: 324-329

Affiliations

[1 ]St. Paraskeva Medical Centre, Lviv, Ukraine

[2 ]2 ^nd Lviv Municipal Polyclinic, Lviv, Ukraine

[3 ]Department of Urology, O.O. Bogomolets National Medical University, Kyiv, Ukraine

[4 ]Department of Gynecology, O.O. Bogomolets National Medical University, Kyiv, Ukraine

Author notes

Corresponding author Oleg Banyra, 2 ^nd Lviv Municipal Polyclinic, 23A Lysenko str., Apt. 3, 79008 Lviv, Ukraine. phone: +380 950 366 366. banyra@ 123456onet.eu

Article

Publisher ID: 1973

DOI: 10.5173/ceju.2019.1973

PMC ID: 6830488

PubMed ID: 31720038

SO-VID: e0b8c6cf-084e-47f9-b541-d2c4528a13a7

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

History

Date received : 26 June 2019

Date revision received : 24 July 2019

Date accepted : 21 August 2019

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Acute epididymo-orchitis: relevance of local classification and partner's follow-up

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Abstract

Introduction

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Research from Ukraine

Most cited references 25

Infectious, inflammatory and ‘autoimmune’ male factor infertility: how do rodent models inform clinical practice?

Epididymitis and orchitis: an overview.

Epididymitis: revelations at the convergence of clinical and basic sciences

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Cited by 8

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