Clinically Symptomatic Vasitis: Clinical Correlations in a Rare Condition

Abstract

Vasitis, or inflammation of the vas deferens, is a rare condition. When diagnosed pathologically, it has been linked to vasectomy, prostatectomy, and herniorrhaphy. When diagnosed clinically, relationships with potential causative factors are unclear. We investigated the clinical factors associated with clinically symptomatic vasitis in a retrospective series of patients. From the history, physical examination, and clinical course, we analyzed associated risk factors. Clinical care patterns were also examined to assess the effectiveness of different treatments. Among 11 patients, the mean patient age at presentation was 47 years (range 29-60 years). The mean diameter of the affected vas deferens was 0.97 cm. Associated procedures included ipsilateral herniorrhaphy (4 patients), radical prostatectomy (2 patients), perianal fistulectomy (1 patient), and bilateral testicular biopsy (1 patient). Furthermore, epididymitis was reported in one patient after testicular trauma, and another patient had congenital unilateral absence of the vas deferens. No patient had a history of vasectomy. Three patients were HIV positive and 6 were active smokers. Six of the 11 patients improved with medical management that included nonsteroidal and steroidal anti-inflammatories and antibiotics. One patient was lost to follow-up. Similar to studies of pathologically detected vasitis, this unique study of clinical vasitis suggests that prior herniorrhaphy, prostatectomy, and possibly HIV infection may be risk factors for its development. In addition, the use of anti-inflammatories and antibiotics warrants further investigation as potentially effective treatments.

Vasitis: a rare diagnosis mimicking inguinal hernia: a case report

“…Of the eleven subjects, eight had previous surgeries in the neighboring regions, such as herniorrhaphy, prostatectomy, and perianal fistulectomy. The review also proposed other risk factors such as trauma history, concurrent human immunodeficiency virus/herpes simplex virus infections, and smoking habits [10]. Interestingly, our patient had none of the aforementioned risks factors.…”

“…Due to the low prevalence nature of acute vasitis, other risk factors have not been credited to this condition. A retrospective review was conducted by Clavijo et al in 2010 where the clinical characteristics of eleven patients were thoroughly evaluated [10]. Of the eleven subjects, eight had previous surgeries in the neighboring regions, such as herniorrhaphy, prostatectomy, and perianal fistulectomy.…”

“…A reported pediatric vasitis case suggested only partial regression of the inguinal swelling symptoms with 7 days of oral antibiotic use, and the patient was later admitted and treated successfully with intravenous antibiotics [13]. Surgical exploration and drainage may be necessary in more severe cases that are not responsive to antibiotic treatment [10]. En bloc excision of the vas deferens is uncommon and is usually performed for the exceptionally rare cases of Tuberculous vasitis [14].…”

“…Acute vasitis or inflammation of the vas deferens is an extremely rare disease, with only about twenty adult case reports published since 1980. Few of these contain computed tomography (CT) images [1–10]. Clinically, it presents with nonspecific symptoms of inguinal swelling and local pain that can mimic orchitis, epididymitis, testicular torsion, and inguinal hernia.…”

Pediatric vasitis: A rare complication of epididymitis

“…Previous reviews showed this to be predominantly an "adult" disease. 3,4 The more rare form of vasitis, known as infectious vasitis, is considered to be secondary to a local spread of urogenital pathogens (i.e., Escherichia coli and Hemophilus influenza) from common infectious processes, such as epididymitis and orchitis. 3 Rare pathogens, such as brucella and…”