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Lacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med 2023; 66:98-104. [PMID: 36738571 DOI: 10.1016/j.ajem.2023.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Testicular torsion is a serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of testicular torsion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Testicular torsion is a urological emergency that occurs with rotation of the testicle along its supporting ligaments leading to obstruction of vascular flow. A key risk factor is the presence of a bell-clapper deformity. The most common population affected includes children in a bimodal distribution with the most cases occurring in the first year of life and between 12 and 18 years, although cases do occur in adults. Acute, severe, unilateral scrotal pain is the most common presenting symptom. Nausea and vomiting are common, but the presence or absence of a cremasteric reflex is not a reliable indicator of disease. The TWIST score may assist with clinical decision making in patients presenting with acute testicular pain but should not be used in isolation. If torsion is suspected or confirmed, consultation with the urology specialist should not be delayed, as outcomes are time sensitive. Ultrasound can be used for diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Treatment includes emergent urology consultation for surgical exploration and detorsion, as well as symptomatic therapy in the ED. Manual detorsion can be attempted in the ED while awaiting transfer or consultation. CONCLUSIONS An understanding of testicular torsion can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Aaron Lacy
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MS, USA.
| | - Amanda Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam, Houston, TX, USA.
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Yan XJ, Wu B, He X, Tian ZK, Peng BG. Testicular pain originating from lumbar disc degeneration: A case report. World J Clin Cases 2023; 11:1794-1798. [PMID: 36969992 PMCID: PMC10037293 DOI: 10.12998/wjcc.v11.i8.1794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/07/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Testicular pain caused by lumbar disease is uncommon in the clinic. Here we reported a case of discogenic low back pain with testicular pain that was successfully cured.
CASE SUMMARY A 23-year-old male patient presented to our department with chronic low back pain. Based on his clinical symptoms, signs and imaging, he was diagnosed with discogenic low back pain. Since conservative treatment for more than half a year did not significantly improve his low back pain, we decided to treat it with intradiscal methylene blue injection. During the course of surgery, we again identified the low back pain as originating from the degenerated lumbar disc by analgesic discography. Interestingly, the patient’s low back pain disappeared along with the testicular pain that had been present for more than 3 mo. After the operation, the patient’s low back pain improved, and the testicular pain did not reappear.
CONCLUSION Intradiscal methylene blue injection is a convenient and effective surgical intervention for the treatment of discogenic low back pain. Lumbar disc degeneration may also be a possible clinical cause of testicular pain. Methylene blue injection in the diseased disc improved the low back pain, and the accompanying testicular pain was successfully managed.
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Affiliation(s)
- Xiu-Jie Yan
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bing Wu
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Xin He
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Zi-Kai Tian
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Spine Surgery, The Third Medical Center, PLA (People’s Liberation Army) General Hospital, Beijing 100039, China
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Ichikawa T, Shimojima Y, Nomura S, Kishida D, Shiozaki M, Tanimura J, Sekijima Y. Testicular vasculitis in eosinophilic granulomatosis with polyangiitis: a case-based review. Clin Rheumatol 2023; 42:293-299. [PMID: 36414864 DOI: 10.1007/s10067-022-06453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
Testicular vasculitis (TV) develops when an organ is involved in systemic vasculitis. A 47-year-old man with eosinophilic granulomatosis with polyangiitis (EGPA) developed TV as the first clinical episode. The patient had bronchial asthma for 8 years and developed left testicular pain before developing arthralgia, abdominal involvement, and sensory polyneuropathy, which led to the diagnosis of EGPA. The induration of the affected testicle persisted even after initiating immunosuppressive therapy with corticosteroids and cyclophosphamide, raising concern for testicular neoplasm, while testicular pain and other symptoms resolved. The patient underwent inguinal orchiectomy, and a histology examination of the resected testicle revealed fibrinoid necrotizing vasculitis. Only three cases of biopsy-proven TV in patients with EGPA have been reported in our review of published English-language articles. Two of the three patients in the reviewed cases developed TV before being diagnosed with EGPA. Moreover, all patients underwent extirpation of the affected testicle, leading to a pathological diagnosis of TV. This report suggests that TV may develop and be the presenting condition in EGPA, although urogenital involvement is rare.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Shun Nomura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Masashi Shiozaki
- Department of Urology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Jun Tanimura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
- Department of Neurology, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, 390-8510, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Jin HL, Ma Q, Zhu J, Zang YC, Zhou YB, Xue BX, Yang DR, Sun CY, Gao J, Xu LJ, Zhang B. A case report of acute testicular pain secondary to segmental testicular infarction. BMC Urol 2022; 22:52. [PMID: 35382805 PMCID: PMC8985257 DOI: 10.1186/s12894-022-01006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Segmental testicular infarction is a rare condition that often occurs in the upper pole of the left testicle and usually presents with acute onset of scrotal pain. Contrast-enhanced ultrasound and MR are essential for diagnosing and differentiating segmental testicular infarction in clinical practice, and conservative treatment can only be adopted after a definitive diagnosis. In the present case, after conservative treatment, the infarct volume was reduced, the blood flow around the infarct was increased, and blood flow signals appeared in the infarct. We performed a correlation analysis to investigate the causes of these changes. CASE PRESENTATION A 33-year-old male, without any specific disease history, was admitted to the hospital with a 5-day history of left testicular pain, and the imaging showed focal necrosis of the left testicle with hemorrhage. He was diagnosed with segmental testicular infarction after differentiating and excluding it from malignant tumors. Conservative medical treatment was given, and the symptoms of testicular pain were relieved after treatment. After discharge, regular reexamination at follow-ups showed that the infarct's size was reduced, the blood flow around the infarct was increased, and blood flow signals appeared in the infarct. CONCLUSION Conservative treatment has become the standard treatment currently adopted after confirming the diagnosis of segmental testicular infarction through contrast-enhanced ultrasound and MR. The blood flow changes in and around the focus of testicular infarction can be related to various factors. At present, relevant conclusions of the underlying mechanisms were mainly deduced from infarction studies of other related organs such as the heart and brain; thus, the specific pathological mechanism needs further experimental verification.
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Affiliation(s)
- Hong-Liang Jin
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Qi Ma
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Ya-Chen Zang
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Yi-Bin Zhou
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Bo-Xin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Dong-Rong Yang
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Chuan-Yang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Jie Gao
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China
| | - Li-Jun Xu
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China.
| | - Bo Zhang
- Department of Urology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Rd, Suzhou, 215004, China.
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Sako K, Kenzaka T, Kumabe A. Epstein-Barr virus-associated infectious mononucleosis with acute epididymitis: a case report. BMC Infect Dis 2022; 22:147. [PMID: 35144561 PMCID: PMC8832690 DOI: 10.1186/s12879-022-07116-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Infectious mononucleosis due to the Epstein–Barr virus is an infectious disease that causes the appearance of atypical lymphocytes in the peripheral blood; it mainly presents with fever, tonsillar pharyngitis, and lymphadenopathy. In addition to hepatitis, splenomegaly, and rashes, it can involve different organs. Here, a case of epididymitis as a rare complication in a patient with Epstein–Barr virus-associated infectious mononucleosis was reported. Case presentation A healthy 23-year-old man visited an outpatient clinic with fever and pharyngitis. Tonsillar pharyngitis, lymphadenopathy, atypical lymphocytes in the peripheral blood, liver dysfunction, and splenomegaly were observed. The patient was diagnosed with infectious mononucleosis based on clinical signs. The next day, the patient developed left testicular pain and was immediately transferred to the emergency outpatient ward. Pain, redness, and swelling were observed in the left scrotum. Ultrasonography revealed swelling of the epididymis and increased blood flow, and the patient was hospitalized with a diagnosis of left epididymitis. The patient’s symptoms improved with symptomatic treatment and was discharged on day 16 after admission. Changes in antibody titers established a definitive diagnosis of infectious mononucleosis caused by the Epstein–Barr virus. Based on the disease course, the patient was also diagnosed with infectious mononucleosis associated with unilateral epididymitis. Conclusions This is the first case report of Epstein–Barr virus-associated infectious mononucleosis complicated with acute epididymitis. Infectious mononucleosis can cause numerous organ-related complications; thus, physicians and healthcare workers should remain cognizant of Epstein–Barr virus-associated complications throughout the body and not just in the primary organs affected by infectious mononucleosis.
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Affiliation(s)
- Kentaro Sako
- Department of General Medicine, Toyooka Public Hospital, 1094, Tobera, Hyogo, 668-8501, Toyooka, Japan
| | - Tsuneaki Kenzaka
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, 652-0032, Kobe, Hyogo, Japan.
| | - Ayako Kumabe
- Department of General Medicine, Toyooka Public Hospital, 1094, Tobera, Hyogo, 668-8501, Toyooka, Japan.,Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, 652-0032, Kobe, Hyogo, Japan
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Casajuana E, Clarà A, Grochowicz L, Vivas I, Mateos E, Calsina L. Testicular pain as a warning symptom of a symptomatic abdominal aortic aneurysm: case report and review of the literature. Ann Vasc Surg 2021; 80:395.e1-395.e5. [PMID: 34808265 DOI: 10.1016/j.avsg.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/12/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Isolated testicular pain is an unusual clinical presentation of symptomatic abdominal aortic aneurysms (AAA). We present two patients hemodynamically stable with an isolated acute testicular pain related to an AAA and a review of the published literature up to present. CASE REPORT Two adult-old males with an acute isolated testicular pain presented to the emergency department. Although both cases had their symptoms for more than 24 hours and were hemodynamically stable, the misdiagnosis of a urological condition in one case and a delay of the intervention in the second resulted in a sudden drop of vital signs and the need of an urgent open surgery. DISCUSSION A bibliographic review of the 15 published cases is presented. Most cases occurred without a previous diagnosis of AAA. Aneurysms were characteristically very large (mean 10 cm). The initial diagnosis was frequently wrong, attributing the pain mostly to genito-urinary conditions. The testicular pain presented days and even weeks before rupture, which may offer a convenient window of hemodynamic stability for repair. CONCLUSIONS Acute testicular pain in adult-old patients with aneurysm risk factors and specially with a first urological evaluation discarding a genitourinary disorder should alert clinicians to consider the diagnosis of a symptomatic abdominal aortic aneurysm. The early and accurate recognition of these cases may increase the survival.
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Affiliation(s)
- Eduard Casajuana
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Albert Clarà
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; CIBER Cardiovascular, Hospital del Mar, Barcelona.
| | - Lukasz Grochowicz
- Department of Vascular and Endovascular Surgery, Clínica Universidad de Navarra, Navarra, Spain
| | - Isabel Vivas
- Department of Radiodiagnosis and Imaging, Clínica Universidad de Navarra, Navarra, Spain
| | - Eduardo Mateos
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Laura Calsina
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain
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Al-Gadheeb A, El-Tholoth HS, Albalawi A, Althobity A, AlNumi M, Alafraa T, Jad A. Microscopic subinguinal varicocelectomy for testicular pain: a retrospective study on outcomes and predictors of pain relief. Basic Clin Androl 2021; 31:1. [PMID: 33413080 PMCID: PMC7788765 DOI: 10.1186/s12610-020-00119-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 2–10% of patients with varicocele complain of pain. Varicocelectomy for testicular pain is a surgical choice when conservative therapy fails to relieve the pain. Different variables have been reported as prognostic factors for pain relief following varicocele ligation. Moreover, the success rate of varicocelectomy for testicular pain has varied among studies. This retrospective study aimed to investigate the predictors and success rate of microscopic subinguinal varicocelectomy performed for the treatment of painful varicocele. Results Among the 132 patients, 83.3% reported pain relief. A significant association was identified between varicocelectomy for unilateral testicular pain and pain resolution (P < 0.0001); no other factors were predictors of pain relief. Conclusions Microscopic subinguinal varicocelectomy for testicular pain is an effective surgical alternative. Varicocelectomy for unilateral testicular pain may predict postoperative pain relief in appropriately selected patients.
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Affiliation(s)
- Abdullah Al-Gadheeb
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Albalawi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Mussa AlNumi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Tala Alafraa
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amr Jad
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Zeitouni L, Khan A, Almasri L, Gulati M, Reekhaye A, Hammadeh MY. Long term follow up of ultrasound diagnosed bilateral testicular sarcoidosis: Case report and literature review. Urol Case Rep 2020; 33:101427. [PMID: 33102123 PMCID: PMC7574344 DOI: 10.1016/j.eucr.2020.101427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
Testicular sarcoidosis is a rare condition characterised by non-caseating granulomas located within the testicles. This case study reports a 44-year-old man who presented initially in 2011 with testicular pain and bilateral testicular sarcoidosis was confirmed on scrotal US. In 2019 he presented with erectile dysfunction. Scrotal ultrasound scan (US) showed bilateral testicular sarcoidosis that has not changed in size and nature when compared with US in 2011.
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Affiliation(s)
| | - Ayesha Khan
- GKT School of Medical Education, King's College London, UK
| | - Lynn Almasri
- GKT School of Medical Education, King's College London, UK
| | - Manpreet Gulati
- Radiology Department, Lewisham and Greenwich NHS Trust, London, UK
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Abstract
PURPOSE OF REVIEW This paper reviews the pathophysiology, current literature, techniques for full microsurgical denervation (MDSC) and targeted microsurgical denervation (TMDSC) of the spermatic cord, and outcomes for these treatment options for patients with chronic scrotal content pain (CSCP) or orchialgia. RECENT FINDINGS Significant reduction in pain (77-100%) is reported across various studies for CSCP patients with minimal patient morbidity. The testicular atrophy/loss risk is less than 1%. Testosterone levels do not appear to be affected by TMDSC/MDSC. The outcomes between TMDSC and MDSC are comparable (not statistically significantly different). However, TMDSC is significantly more efficient and a lot less tedious to perform. TMSCD had a shorter microsurgical operative time (21 min vs 53 min, P = 0.0001) than MDSC. Targeted or full microsurgical denervation of the spermatic cord is a safe and effective treatment option that is well published across several studies. The targeted MDSC approach is a more efficient and potentially less risky approach with similar outcomes to full MDSC.
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Affiliation(s)
- Sijo Joseph Parekattil
- Avant Concierge Urology & University of Central Florida, 15548 W. Colonial Drive, Winter Garden, FL, 34787, USA.
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Sanagawa M, Kenzaka T, Kato S, Yamaoka I, Fujimoto S. Campylobacter jejuni enterocolitis presenting with testicular pain: A case report. World J Clin Cases 2020; 8:3280-3283. [PMID: 32874982 PMCID: PMC7441251 DOI: 10.12998/wjcc.v8.i15.3280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/23/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Common symptoms of Campylobacter colitis include abdominal pain, vomiting, diarrhea, and fever, among others. However, Campylobacter colitis also has a high incidence of extraintestinal symptoms.
CASE SUMMARY We report the case of a 51-year-old man who presented with bilateral testicular pain. A scrotal examination failed to reveal any physical findings, but the patient exhibited mild tenderness in the right lower abdomen. Computed tomography revealed ileocecal wall thickening. Post-admission, the patient developed diarrhea, and a stool culture was submitted; Campylobacter jejuni infection was confirmed. Testicular pain is known to be caused by appendicitis. Consequently, we suggest that Campylobacter colitis, which causes ileocecal inflammation, caused the testicular pain in this case.
CONCLUSION In patients with testicular pain and no other objective findings, diseases such as Campylobacter colitis should be considered.
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Affiliation(s)
- Masahiro Sanagawa
- Department of Internal Medicine, Miyazaki Seikyo Hospital, Miyazaki 880-0824, Japan
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Hyogo 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Hyogo 652-0032, Japan
| | - Sayaka Kato
- Department of Internal Medicine, Miyazaki Seikyo Hospital, Miyazaki 880-0824, Japan
| | - Ichiko Yamaoka
- Department of General Surgery, Miyazaki Seikyo Hospital, Miyazaki 880-0824, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
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Mascitti H, Calin R, Dinh A, Makhloufi S, Davido B. Testicular pain associated with clear fluid meningitis: How many cases of Toscana virus are we missing? Int J Infect Dis 2020; 93:198-200. [PMID: 32062059 DOI: 10.1016/j.ijid.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/18/2022] Open
Abstract
Toscana virus (TOSV) is a common cause of meningitis in Mediterranean area. However, rare publications reported extra-meningeal signs. We report the third case of testicular pain associated with TOSV meningitis despite the fact that there is no evidence of semen involvement in other well-known arboviruses, except in Zika virus.
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Affiliation(s)
- Hélène Mascitti
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Ruxandra Calin
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Aurélien Dinh
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Sabrina Makhloufi
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Benjamin Davido
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France.
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Aoun F, Malek E, Kazan D, Albisinni S, Peltier A, Bollens R, Roumeguère T. Management of chronic testicular pain due to thoracolumbar junction syndrome: A pilot study. Prog Urol 2020; 30:114-118. [PMID: 31980366 DOI: 10.1016/j.purol.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/05/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Thoracolumbar dysfunction (TLD) had been evoked as a possible etiology of chronic testicular pain. Our study investigated the efficacy of osteopathic diagnosis and treatment of TLD in men with chronic testicular pain. METHODS Patients suffering from testicular pain were examined for thoracolumbar dysfunction and enrolled in a prospective trial if they have both conditions. Following standardized examination, all patients were prescribed 1 to 3 osteopathic treatment sessions, usually at weekly interval. Treatment success was evaluated using the Visual Analog scale and durability was assessed by regular follow-up. Patient satisfaction was also assessed. Comparison of pain improvement was done using Wilcoxon matched-pairs signed-ranks test. Logistic regression was used to assess for risk factors of success. A P<0.001 was used for significance. RESULT Out of 62 patients enrolled, 41 patients (median age 32 years, IQR 24-37) were suffering from chronic testicular pain and TLD. 37 of the 41 participants completed the treatment and follow-up according to the plan. Patients underwent a median of 2 osteopathic treatment sessions (range 1-3). Overall, pain disappeared completely in 25 patients (67.5%) and improvement was noted in 7 patients (18.9%). After initial improvement, two patients experienced relapse at their last visit (5.4%). Five patients (13.5%) had no improvement of their symptoms after osteopathic treatment. Statistically, improvement was significant with a P<0.001 and on logistic regression, site of pain and duration of pain were the sole predictors of failure. CONCLUSION TLD is a pathology that should be considered in the differential diagnosis in patients with chronic testicular pain and osteopathic manipulation of the spine appears to be an effective treatment option.
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Affiliation(s)
- F Aoun
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon.
| | - E Malek
- Osteopathic Medicine department, Levant Hospital, Lebanon
| | - D Kazan
- Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon
| | - S Albisinni
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Peltier
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Bollens
- Urology department, Centre Hospitalier de Wallonie picarde, Belgium
| | - T Roumeguère
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Abstract
Sarcoidosis is a systemic granulomatous disease, with genitourinary tract involvement being very rare (0.2% of all sarcoidosis cases). Genitourinary sarcoidosis may present with a scrotal mass with or without testicular pain, often mimicking epididymo-orchitis or malignancy. Only 8 cases of genitourinary sarcoidosis have been reported in the literature in the last 14 years. We describe the case of a 25-year-old man who was referred with testicular pain. Scrotal ultrasonography demonstrated multiple bilateral hypoechoic testicular lesions that were of similar size and distributed unusually throughout the testicular parenchyma. Computed tomography detected a nodule in the middle lobe of the right lung, multiple small volume nodes in the retrocaval and left para-aortic regions, and enlarged bilateral external iliac and inguinal nodes, similar to those found in metastatic testicular cancer. Following ultrasound guided excision of one of the lesions, histopathological examination confirmed granulomatous inflammation consistent with sarcoidosis.
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Affiliation(s)
- F Chierigo
- University College London Hospitals NHS Foundation Trust , UK
| | - H M Alnajjar
- University College London Hospitals NHS Foundation Trust , UK
| | - A Haider
- University College London Hospitals NHS Foundation Trust , UK
| | - M Walkden
- University College London Hospitals NHS Foundation Trust , UK
| | - T Shaikh
- West Hertfordshire Hospitals NHS Trust , UK
| | - A Muneer
- University College London Hospitals NHS Foundation Trust , UK.,NIHR Biomedical Research Centre, University College London Hospital
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14
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Holtel M, Baranello RJ, Hale A, Springhart P. Use of Spermatic Cord Block Systematically Identifies a Paraspinal Tumor as Source of Orchialgia. Rev Urol 2019; 21:49-52. [PMID: 31239833 PMCID: PMC6585180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Orchialgia is a common urologic complaint with a myriad of etiologies. Workup for orchialgia requires a broad differential diagnosis and a thorough understanding of relevant anatomy. We report the case of a 43-year-old man who presented to a urologist with right testicular pain. Following a negative workup, the patient received a spermatic cord block for therapeutic and diagnostic purposes. Two months after the block, the patient returned with new complaints of ipsilateral inner thigh paresthesias, suggesting a pathologic process proximal to the genital branch of the genitofemoral nerve. A subsequent MRI of the lumbosacral spine revealed a paraspinal mass involving nerve roots at L1-2. We highlight the utility of the spermatic cord block and its role in the diagnosis of a paraspinal tumor as an uncommon cause of orchialgia.
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Affiliation(s)
- Mason Holtel
- University of South Carolina School of Medicine Greenville Greenville, SC
| | - Robert J Baranello
- University of South Carolina School of Medicine Greenville Greenville, SC
| | - Allyson Hale
- Regional Urology, Prisma Health System Greenville, SC
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15
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Abstract
Segmental testicular infarction is a rare cause of acute scrotum and only a few cases have been reported. Torsion of the testis, testicular tumor and infection are important differential diagnoses. The present case report describes a 61-year-old man with left-sided testicular pain increasing over 24 h. The diagnosis of segmental testicular infarction was considered after color Doppler ultrasound of the left scrotum and it was confirmed by surgical exploration and pathological examination. Although it is uncommon, segmental testicular infarction should be taken into consideration when acute scrotal pain is encountered, especially for younger patients, since a testis-sparing treatment strategy can be performed.
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Affiliation(s)
- V Gkolezakis
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland.
| | - A Petrolekas
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland
| | - A Koutsouri
- Klinik und Poliklinik für Innere Medizin, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - V Ouranos
- Klinik und Poliklinik für Radiologie, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - P Arapantoni
- Pathologisches Institut, Errikos Ntynan Hospital Center, Athen, Griechenland
| | - P Sidiropoulos
- Urologische Klinik und Poliklinik, Errikos Ntynan Hospital Center, Leoforos Mesogeion 107, 11526, Athen, Griechenland
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16
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Ouanes Y, Sellami A, Chaker K, Mokhtar B, Ben Rhouma S, Nouira Y. Thrombosis of the pampiniform plexus: About a case report. Urol Case Rep 2018; 20:28-29. [PMID: 29988786 PMCID: PMC6031866 DOI: 10.1016/j.eucr.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | | | - Kays Chaker
- Departement of Urology, La Rabta Hospital, Tunisia
| | - Bibi Mokhtar
- Departement of Urology, La Rabta Hospital, Tunisia
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17
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Abstract
The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men's health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.
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18
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Tang YH, Yeung VHW, Chu PSK, Man CW. A 55-Year-Old Man with Right Testicular Pain: Too Old for Torsion? Urol Case Rep 2017; 11:74-75. [PMID: 28194328 PMCID: PMC5299137 DOI: 10.1016/j.eucr.2016.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/20/2016] [Accepted: 11/25/2016] [Indexed: 11/29/2022] Open
Abstract
Testicular torsion is predominantly a disease of adolescence, but age itself should not be an exclusion criterion for the diagnosis. A lack of suspicion for testicular torsion in older patients may result in a missed or delayed diagnosis which jeopardizes the chance of testicular salvage. In this article, we report a case of testicular torsion in a 55-year-old Chinese man.
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Affiliation(s)
- Yu Ho Tang
- Department of Surgery, Tuen Mun Hospital, 23 Tsing, Chung Koon Road, Tuen Mun, NT, Hong Kong
| | - Victor Hip Wo Yeung
- Department of Surgery, Tuen Mun Hospital, 23 Tsing, Chung Koon Road, Tuen Mun, NT, Hong Kong
| | - Peggy Sau Kwan Chu
- Department of Surgery, Tuen Mun Hospital, 23 Tsing, Chung Koon Road, Tuen Mun, NT, Hong Kong
| | - Chi Wai Man
- Department of Surgery, Tuen Mun Hospital, 23 Tsing, Chung Koon Road, Tuen Mun, NT, Hong Kong
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19
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Beck V, Grabbert M, Apfelbeck M, Schulz G, Stief CG, Tritschler S. [The acute scrotum - primary diagnostic approach and treatment]. MMW Fortschr Med 2016; 158:49-50. [PMID: 27704421 DOI: 10.1007/s15006-016-8779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vincent Beck
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland.
| | - Markus Grabbert
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
| | - Maria Apfelbeck
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
| | - Gerald Schulz
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
| | - Christian G Stief
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
| | - Stefan Tritschler
- Urologische Klinik und Poliklinik Klinikum der Universität München (LMU), Campus Großhadern, Marchioninistr. 15, D-81377, München, Deutschland
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20
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Abstract
Two males ages 16 and 23 years presented with new testicular pain while taking minocycline. Both patients experienced resolution of their symptoms only after minocycline discontinuation. Testicular pain with minocycline use has been previously described, however only in the setting of systemic autoimmune reactions (which were absent here). These cases represent probable rare adverse reactions to minocycline. For patients taking minocycline who experience otherwise unexplained testicular pain, a trial discontinuation of this medication should be considered.
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Affiliation(s)
| | | | - Guan Wu
- Corresponding author. Tel.: +1 585 275 2838
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21
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Narita M, Moriyoshi K, Hanada K, Matsusue R, Hata H, Yamaguchi T, Otani T, Ikai I. Successful treatment for patients with chronic orchialgia following inguinal hernia repair by means of meshoma removal, orchiectomy and triple-neurectomy. Int J Surg Case Rep 2015; 16:157-61. [PMID: 26476053 PMCID: PMC4643473 DOI: 10.1016/j.ijscr.2015.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 11/25/2022] Open
Abstract
Refractory orchialgia following inguinal hernia repair is challenging complication. There has been no established surgical treatment for orchialgia. We report a case treated by aggressive surgical intervention for orchialgia. The detailed preoperative assessment is important to distinguish the sort of pain. Triple neurectomy should be considered in patients with neuropathic orchialgia.
Introduction Orchialgia following inguinal hernia repair is rare complication and still challenging since there has been no established surgical treatment because of complexity of nerve innervation to the testicular area. Herein we report a case of postoperative orchialgia following Lichtenstein repair, which was successfully treated by mesh removal, orchiectomy and triple neurectomy. Case presentation A 65-year-old man was referred to our department because of chronic right orchialgia following Lichtenstein hernia repair. He walked with a limp and was unable to walk a long distance. Physical examination revealed the presence of meshoma in the groin area and hypoesthesia in the anterior skin of the right scrotum. His right testis was completely atrophic and located not in the scrotum but in the subcutaneous regions of right groin. He was diagnosed as both neuropathic and nociceptive orchialgia and underwent meshoma removal, triple-neurectomy, and orchiectomy to address these issues. Pathological examination revealed that meshoma was integrated with the structures of the spermatic cord, leading to foreign-body reaction and fibrosis around the genital branch of genitofemoral nerve. The resected right testis was completely-scarred without ischemic changes. Orchialgia disappeared immediately after operation and he was able to walk without a limp. Discussions It is important to distinguish between nociceptive and neuropathic orchialgia. Neuroanatomic understanding is essential to guide treatment options. Orchiectomy is an option but should be reserved for refractory cases with evidence of nociceptive pain accompanied by anatomical changes. Conclusions Triple neurectomy should be considered in patients with neuropathic orchialgia.
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Affiliation(s)
- Masato Narita
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
| | - Koki Moriyoshi
- Department of Pathology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Keita Hanada
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Ryo Matsusue
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Hiroaki Hata
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Takashi Yamaguchi
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Tetsushi Otani
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Iwao Ikai
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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22
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Rüb J, Rehmann R, von Landenberg N, Roghmann F, Stude P, Tegenthoff M, Noldus J, Pastor J. [Segmental testicular infarction. Unusual complication of intravenous immunoglobulin therapy for multifocal motor neuropathy]. Urologe A 2015; 54:1421-4. [PMID: 26303740 DOI: 10.1007/s00120-015-3941-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We describe the previously unknown case of segmental testicular infarction as an iatrogenic complication of intravenous immunoglobulin administration in a patient with multifocal motor neuropathy.
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Affiliation(s)
- J Rüb
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland.
| | - R Rehmann
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - N von Landenberg
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - F Roghmann
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - P Stude
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - M Tegenthoff
- Neurologische Klinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland
| | - J Noldus
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
| | - J Pastor
- Klinik für Urologie und Neurourologie, Marien-Hospital Herne, Ruhr-Universität Bochum, Widumer Straße 8, 44627, Herne, Deutschland
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23
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Oomen RJA, Witjens AC, van Wijck AJM, Grobbee DE, Lock TMTW. Prospective double-blind preoperative pain clinic screening before microsurgical denervation of the spermatic cord in patients with testicular pain syndrome. Pain 2014; 155:1720-1726. [PMID: 24861586 DOI: 10.1016/j.pain.2014.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
Testicular pain syndrome (TPS), defined as an intermittent or constant pain in one or both testicles for at least 3 months, resulting in significant reduction of daily activities, is common. Microsurgical denervation of the spermatic cord (MDSC) has been suggested as an effective treatment option. The study population comprised 180 TPS patients admitted to our outpatient urology clinic between 1999 and 2011. On 3 different occasions, patients were offered a double-blind, placebo-controlled temporary blockade of the spermatic cord. A single blockade consisted of 10 mL 2% lidocaine, 10 mL 0.25% bupivacaine, or 10 mL 0.9% sodium chloride. If the results of these blockades were positive, MDSC was offered. All MDSCs were performed by a single urologist (M.T.W.T.L.) using an inguinal approach. Pain reduction was determined at prospective follow-up. This study evaluated 180 patients. Most patients (61.1%) had undergone a scrotal or inguinal procedure. Patients had complaints during sexual activities (51.7%), sitting (37.5%), and/or cycling (36.7%); 189 randomized blockades were offered to all patients. There was a positive response in 37% and a negative response in 51%. MDSC was performed on 58 testicular units, including 3 patients with a negative outcome of the blockades. At mean follow-up of 42.8 months, 86.2% had a ≥ 50% reduction of pain and 51.7% were completely pain free. MDSC is a valuable treatment option for TPS patients because in this study 86.2% experienced a ≥ 50% reduction of pain. To prevent superfluous diagnostics and treatment, it is mandatory to follow a systematic protocol in the treatment of TPS.
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Affiliation(s)
- Robert J A Oomen
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands Department of Urology, Central Military Hospital, Utrecht, The Netherlands Department of Urology, Radboud University Nijmegen Medical Center, Utrecht, The Netherlands Pain Clinic, University Medical Center Utrecht, Utrecht, The Netherlands Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands Clinical Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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