Localised intratesticular abscess complicating epididymo-orchitis: the use of scrotal ultrasonography in diagnosis and management

Pediatric intratesticular abscess managed with a testicular sparing approach: A case report

Intratesticular abscess is a rare finding associated with advanced or untreated epididymo-orchitis, often in immunocompromised patients. Implicated pathogens can be spread hematogenously, by urine reflux in dysfunctional voiders, through aberrant mesonephric duct anatomy, or via a patent processus vaginalis in the setting of an intra-abdominal infection. A testicular-sparing surgical approach is often used in prepubertal populations and is associated with positive outcomes. We present the case of a 6-year-old male with a polymicrobial intratesticular abscess that was successfully managed with antibiotics, operative incision and drainage of abscess cavity, and primary wound closure with drain placement.

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Testicular abscesses may occur in healthy patients with advanced epididymo-orchitis.

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Testicular abscesses are often polymicrobial; cover for aerobic and anaerobic organisms.

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Use a testicular-sparing approach in intratesticular abscess in the pediatric population.

The Good, the Bad and the Ugly of Testicular Immune Regulation: A Delicate Balance Between Immune Function and Immune Privilege

The testis is one of several immune privilege sites. These sites are necessary to decrease inflammation and immune responses that could be damaging to the host. For example, inflammation in the brain, eye or placenta could result in loss of cognitive function, vision or rejection of the semi-allogeneic fetus, respectively. In the testis, immune privilege is "good" as it is necessary for protection of the developing auto-immunogenic germ cells. However, there is also a downside or "bad" part of immune privilege, where pathogens and cancers can take advantage of this privilege and persist in the testis as a sanctuary site. Even worse, the "ugly" of privilege is how re-emerging viruses, such as Ebola and Zika viruses, can establish persistence in the testes and be sexually transmitted even months after they have been cleared from the bloodstream. In this review, we will discuss the delicate balance within the testis that provides immune privilege to protect the germ cells while still allowing for immune function to fight off pathogens and tumors.

The 2016 European guideline on the management of epididymo-orchitis

Epididymo-orchitis is a commonly encountered condition with a reported incidence of 2.45 cases per 1000 men in the United Kingdom. This 2016 International Union against Sexually Transmitted Infections guideline provides up-to-date advice on the management of this condition. It describes the aetiology, clinical features and potential complications, as well as presenting diagnostic considerations and clear recommendations for management and follow-up. Early diagnosis and management are essential, as serious complications can include abscess formation, testicular infarction and infertility. Recent epidemiological evidence suggests that selection of fluoroquinolone antibiotics with anti-Chlamydial activity is more appropriate in the management of sexually active men in the over 35 years age group.