Self-catheterization during adolescence

OBJECTIVE

It has been suggested that clean intermittent catheterization (CIC) during the teenage years is associated with poor motivation to comply with the treatment, recurrent urinary tract infections and epididymitis. The aim of this study was to identify the main problems and complications associated with self-CIC in a group of adolescents with no overt neurological problems.

MATERIAL AND METHODS

The medical records of 24 boys and girls aged >/=12 years on self-CIC with severe bladder dysfunction and intact perineal sensibility and motor function in the lower limbs were reviewed. The median age of the patients was 16.5 years (range 12-24 years) and they had been on CIC for a median of 11 years (range 2-16 years).

RESULTS

No urethral damage was reported. Of the 11 patients (46%) who had good CIC routines, two had cystitis and none had epididymitis. Thirteen patients (54%) reported a poor CIC regimen at a median age of 11.5 years (range 9-16 years). In this group, 10 had recurrent cystitis, five had pyelonephritis, four had increasing creatinine levels and three of nine boys had epididymitis.

CONCLUSIONS

One of the main problems associated with CIC during adolescence is poor compliance with the treatment. Epididymitis and recurrent urinary tract infections were seen more frequently in connection with poor CIC routines.

Rapid Diagnosis of Brucella Epididymo-Orchitis by Real-Time Polymerase Chain Reaction Assay in Urine Samples

PURPOSE

We studied the diagnostic yield of a real-time polymerase chain reaction assay in urine samples for the rapid diagnosis of brucella epididymo-orchitis compared to that of conventional microbiological techniques.

MATERIALS AND METHODS

We used an SYBR Green I LightCycler based real-time polymerase chain reaction to retrospectively study 10 urine samples from patients with Brucella epididymo-orchitis. The assay amplifies a 223 bp sequence of a gene that codes for the synthesis of an immunogenetic membrane protein specific for Brucella genus (BCSP31). After amplifying this 223 bp sequence we performed melting curve analysis to verify the specificity of polymerase chain reaction products.

RESULTS

Brucella melitensis was isolated from blood cultures in 9 cases (90%). Wright's seroagglutination was negative or inconclusive in 30% of cases. Brucella was isolated from urine in only 1 case, whereas real-time polymerase chain reaction assay in urine was positive in 9 (90%). Also, results were available in 4 hours, whereas mean time to availability of the final blood culture results was 5.8 days (range 4.5 to 7).

CONCLUSIONS

SYBR Green I LightCycler based real-time polymerase chain reaction assay in urine samples is highly sensitive and specific, and easy to perform. It could provide the clinician with results in less than 5 hours. The technique could be a practical and useful tool for the rapid diagnosis of genitourinary complications of human brucellosis.

[Methods of laboratory studies in the etiology of acute epididymitis]

A laboratory study in order to establish etiology of acute epididymitis (AE) was made in 243 patients. The complex of etiological diagnosis included: microscopic investigation of urethral discharge or urine, bacteriological examination of an initial urine portion and wound discharge in the operated on patients. In addition, urethral discharge/urine was studied with polymerase chain reaction (PCR) in 96 patients; in 46 men PCR examined operative material. It was found that in sexually active young patients AE was caused primarily by infectious agents of sexually transmitted diseases. Targeted etiotropic therapy results in clinical cure in the majority of the cases. In older patients the disease was of bacterial origin (gram-negative bacteria, as a rule, are causative agents) and in some cases is associated with development of pyodestructive epidydimitis.

Study of the seminal vesicles in acute epididymitis

Although it has been suggested that seminal vesiculitis is present in patients with epididymitis, it has not been proven. We performed rectal ultrasound assessment of the seminal vesicles in 18 consecutive patients with epididymitis. The seminal vesicles on the same side as the epididymitis was significantly enlarged in 75% of cases; 92% of these enlarged vesicles returned to normal size in 12 weeks. A persistently enlarged seminal vesicle was associated with unresolved epididymitis, and further bacteriological studies in these cases demonstrated continued Chlamydia infection in some patients over 35 years of age.

Intravenous urography as a routine investigation in epididymitis

One hundred and forty-two patients were admitted to the Jordan University Hospital with acute epididymitis between 1973 and 1983. Sixty-five had intravenous urograms which revealed renal tuberculosis in 1 patient, renal or ureteric stones in 10, bladder neck obstruction in 3, unrelated congenital anomalies in 10 and no abnormalities in 41. Twelve patients developed epididymal abscesses.

Case report: possible diagnostic error: the use of urinary human chorionic gonadotropin tests to differentiate testicular tumor from inflammatory lesions within the scrotum

A case of a probable falsely positive urinary human chorionic gonadotropin (pregnancy screening) test is reported in association with chronic epididymitis in a patient with a single testis. The urinary human chorionic gonadotropin test was used in an asymptomatic patient to attempt to differentiate a firm mass that was associated intimately with the lower pole of the testis and obliterated the lower pole of the epididymis. The use of currently available tests for human chorionic gonadotropin in the male subject is discussed.