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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 19 year old man presented with unilateral testicular swelling and pain. An initial diagnosis of epididymo-orchitis was modified to a presumed testicular neoplasm following ultrasonography. The final diagnosis of isolated testicular vasculitis was established following histological examination of the orchidectomy specimen. Staining for antineutrophil cytoplasmic antibodies was negative. Despite immunosuppressive treatment, the patient developed further symptoms affecting the remaining testis one year later. He responded well to an increase in immunosuppressive therapy and has remained asymptomatic 18 months from diagnosis. Symptomatic vasculitis confined to the testis is extremely rare, but must be considered in the differential diagnosis of testicular swelling and may be the presenting feature of a systemic vasculitis such as polyarteritis nodosa. The risk of progression to systemic disease in such cases is unknown. Immunosuppressive therapy must be considered carefully and long term follow up is important.
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PMID:Isolated testicular vasculitis mimicking a testicular neoplasm. 762 3

Vasectomy is the most reliable method of birth control. More than 33 million couples now rely on it in the United States, the United Kingdom, India, China, Thailand, South Korea, Canada, the Netherlands, and New Zealand. Many of the problems associated with vasectomy can be prevented by discussion about the procedure beforehand with the couple concerned, with clear warning that complications can sometimes occur. Recently, a no-scalpel technique has been introduced by Dr Li Shunqiang in China with good results. During 10 and 12 weeks follow-up, semen should be examined. The detailed study of 1000 vasectomies performed under local anesthetic at the Margaret Pyke Centre in London defined the expected complication rate. Two patients suffered vasovagal attacks during the operation and required resuscitation. Minor hematomas occurred in 3.5%. 12 developed minor sepsis but only one abscess occurred. Three cases of epididymo-orchitis were seen. Altogether, 5.6% of patients complained of minor local symptoms including bruising. In the large Oxford Series, 7.7% sought medical advice for local pain and 3.6% for bleeding. Scrotal hematoma developed in 0.9%. 80% returned to work in 3 days and 96% within 1 week. Spermatozoa have been found in a para-aortic lymph node one year after vasectomy in a man undergoing laparotomy, and circulating antisperm antibodies can be detected by sperm-agglutination tests in the serum of 60-80% of men following vasectomy. Technical difficulties with vas anastomosis and secondary changes in the epididymis make the chances of successful restoration of fertility only a little better than 50%. There are four causes of failure of vasectomy reversal: 1) in about half of patients there is stenosis or blockage of the previous vaso-vasostomy, 2) the second most common cause is epididymal blockage, 3) development of a very high antisperm antibody response to the vasectomy, and 4) cessation of spermatogenesis.
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PMID:Vasectomy and vasectomy reversal. 819 17

The method of and the results obtained with testicular scintigraphy in the differential diagnosis of acute scrotal pain are described. Both sensitivity and specificity were found to be high and in excess of 90%. Misinterpretation of findings is rare and is seldom reported except in case reports. Normal findings usually genuinely reflect absence of disease, and only in the case of suboptimal imaging conditions they might correspond to a false-negative finding in the presence of acute torsion. Chronic torsion may be missed on scintigraphy because of intermediate normalization of arterial perfusion at the time of the investigation. Missed torsion presents a characteristic activity pattern. The halo sign is a proven sign of avitality of the testicle. Orchitis and epididymitis are correlated with hyperperfusion and hyperaemia and are reliably diagnosed by scanning. When testicular scintigraphy is needed immediate availability is essential. In a nuclear medicine department with standard equipment, the investigation can be started within 5 min; it takes about 15 min to perform and the findings can be evaluated within another 5 min. Acute testicular torsion that has already been reliably diagnosed by clinical examination is not an indication for testicular perfusion scintigraphy. This diagnostic procedure is, however, valuable if the clinical findings are equivocal and, especially, if a conservative treatment is planned.
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PMID:[Diagnostic evaluation of acute scrotum--testicular perfusion scintigraphy]. 847 7

Acute scrotal pain requires immediate medical attention to determine the underlying cause and to treat accordingly. The diagnosis may not be straightforward and in some patients, immediate surgery may be necessary in order to treat torsion of the testes early to achieve good results. The aim of this retrospective study is to evaluate the underlying causes and the outcome of acute scrotal pain. It includes a total of 116 patients over a period of 18 months who were admitted to the general urology ward. Seventy-six percent of the patients complained of pain only, 13% complained of pain with fever, 7% complained of urinary symptoms and 4% a combination of the three. After evaluation, 44 patients were diagnosed to have torsion of the testes and all of these patients were below 20 years old. Thirty-eight of the patients complained of pain only and 2 had pain with fever. Two patients were thought to have torsion and exploration was performed. They were found to have infection. The rest had orchidopexy done and only 2 had orchidectomy due to infarction. Fifty-two patients had acute epididymo-orchitis, 50 of these were above 20 years old and half (n = 25) of this group of patients admitted to having had exposure to sexually transmitted diseases, 11 patients had a history of instrumentation and 14 had no known causes. From this study, age appeared to be the main differentiating point between torsion and epididymo-orchitis. for equivocal cases, new technology such as the Doppler ultrasound and testicular scan may be useful in future to improve the diagnosis of this urogenital emergency.
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PMID:An overview of acute scrotal pain. 857 18

Common causes of acute scrotal pain include testicular torsion, epididymo-orchitis and trauma. Epididymitis in adult men is typically associated with a history of urinary tract infection or prostatitis. Testicular torsion typically presents in young adults with a sudden onset of severe scrotal pain and, frequently, a history of recurrent episodes that have spontaneously resolved. With scrotal trauma, ultrasound may demonstrate testicular fracture, hematoceles and areas of hemorrhage or testicular infarction. Since both epididymitis and testicular torsion present with scrotal pain and swelling, and may be accompanied by fever and pyuria, Doppler ultrasound or radionuclide imaging may be necessary to make the diagnosis. In acute testicular torsion, color Doppler ultrasound shows absent flow to the epididymis and testis, while nuclear imaging shows central photon-deficient areas in the ischemic hemiscrotum. In epididymo-orchitis, color Doppler ultrasound shows increased flow to the epididymis and testis, while nuclear imaging shows increased perfusion of the affected testis and hemiscrotum.
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PMID:Diagnostic imaging of patients with acute scrotal pain. 862 98

The authors report the case of a 3-year-old child with tuberculous epididymo-orchitis. The only presenting symptom was testicular, epididymis and scrotal swelling and pain. Diagnosis was reached after histopathological examination of epididymis and testis tissues. The response to antitubercular drugs given with prednisolone was rapid. This case emphasizes the importance of considering tuberculosis in differential diagnosis of testicular and epididymal enlargement in young children in an endemic area despite the absence of systemic, pulmonary and urinary manifestations.
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PMID:A 3-year-old boy with tuberculous epididymo-orchitis. 903 25

In the diagnosis and treatment of acute scrotal pain and swelling it is important to differentiate between testicular torsion and epididymo-orchitis. A special case of a thirty-eight-year-old male asylant from Nepal was presented in the urological service with acute scrotal pain. To exclude testicular torsion, a diagnostic exploration of the scrotum was done with the findings of an acute funiculitis with abscess formation. Under surgical drainage of abscess together with medical treatment the acute inflammation disappeared. The diagnosis of filarial funiculitis was made after identifying the microfilariae in a blood vessel and in the peripheral blood smear. A filaricide medication with diethylcarbamacine citran was administered with good symptomatic relief.
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PMID:[Filaria: a tropical disease as the etiology of acute scrotum]. 912 88

The development of color-flow imaging has made ultrasound the primary imaging modality for the evaluation of testicular pathology. The ability to distinguish between epididymo-orchitis and torsion is of great clinical significance in those patients with acute onset of pain. Not only does the appropriate treatment depend on the correct diagnosis, but the outcome following that treatment is also dependent on establishment of the diagnosis. Although it is of less importance in the evaluation of testicular neoplasms, color-flow imaging does provide adjunctive information that can aid in establishment of the proper diagnosis in confusing clinical situations. The diagnosis of varicocele depends on color-flow imaging, and the prediction of testicular viability following trauma is essential for proper treatment. More studies concerning the use of power Doppler for imaging of scrotal disorders are necessary to determine what its role will be.
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PMID:Color-flow and power Doppler imaging of the testes. 954 13

We report 3 patients with acute epididymo-orchitis with abscess formation due to Pseudomonas aeruginosa, which is relatively unusual and difficult to treat. All patients presented with swollen testicles, pain and high fever. First, they were treated empirically with several antibiotics. After several weeks of antibiotics therapy, the swelling of scrotum still persisted. In one patient, dark yellow pus drained from a fistula of the scrotum. Finally, an orchiectomy was performed on all patients. During the operation, an abscess was found in each testis. Each culture of the pus yielded P. aeruginosa, which is susceptible to many antibiotics.
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PMID:Acute epididymo-orchitis with abscess formation due to Pseudomonas aeruginosa: report of 3 cases. 1121 12

Epididymo-orchitis in the elderly is usually associated with urinary tract infections, prostatitis, and urethral manipulations. It usually presents as acute scrotal pain, and specific complaints direct further exam and work up. As persons with dementia are unable to give a history or localize pain, it can be overlooked. It mimicked as hip fracture in the case presented here.
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PMID:Epididymo-orchitis: a differential diagnosis for hip pain in patients with dementia. 1281 14


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