Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis

Abstract

There is no clear consensus regarding investigating for accompanying genitourinary anomalies (GUAs) in patients with prepubertal acute epididymitis (AE). Moreover, risk factors for the recurrence and the need for a surgical intervention have never been discussed. The purpose of this study was to evaluate the different clinical courses of prepubertal AE based on knowledge of preexisting GUAs. Between January 2005 and December 2014, AE was diagnosed in 189 pediatric patients <10 years old. Clinical characteristics and treatments were retrospectively analyzed. The median age at first AE was 64.3 months. A GUA was detected prior to the development of AE in 49 patients (known GUA group) including 34 with hypospadias. Among the other 140 patients (unknown GUA status group), six patients were diagnosed with a GUA after the first AE episode. In the known GUA group, 35 patients (71.4%) experienced recurrence and the only risk factor associated with recurrence was the presence of cystic dilated prostatic utricle (p = 0.013). In the unknown GUA status group, the risk factors for an existing GUA were being <1-year-old (p<0.001) and positive urine culture (p = 0.015). Only nine patients (6.4%) in this group experienced recurrence. Vasectomy was recommended for patients with recurrent AE with an accompanying GUA and performed in 19 patients (10.1%). Most GUAs are diagnosed prior to AE development. Clinicians should consider different treatment approaches based on whether the AE patient has been diagnosed with a GUA previously, because the clinical characteristics and the recurrence rate are significantly different.

How useful is a complete urinary tract ultrasound in orchiepididymitis?

“…This conclusion is in line with the desire to rationalize unnecessary examinations and treatments in medicine. Our findings are similar to the results of a recent article by Lee et al [ 22 ]. However, the usefulness of urinary tract and kidney US for the detection of a urinary tract malformation associated with OE remains a subject of debate in the published literature.…”

“…However, the usefulness of urinary tract and kidney US for the detection of a urinary tract malformation associated with OE remains a subject of debate in the published literature. Some authors recommend a urinary tract and renal US in every case as they consider OE to be strongly associated with genitourinary tract malformation [ 6 , 7 , 23 ], while others recommend this type of investigation only in the case of relapse [ 4 , 8 , 14 , 16 ], associated UTI [ 8 , 22 ] or according to the age group [ 7 , 22 ]. For the latter reason, some recommend a urinary tract and renal US only in patients less than one year of age [ 7 , 22 ].…”

“…Some authors recommend a urinary tract and renal US in every case as they consider OE to be strongly associated with genitourinary tract malformation [ 6 , 7 , 23 ], while others recommend this type of investigation only in the case of relapse [ 4 , 8 , 14 , 16 ], associated UTI [ 8 , 22 ] or according to the age group [ 7 , 22 ]. For the latter reason, some recommend a urinary tract and renal US only in patients less than one year of age [ 7 , 22 ]. Lee et al [ 22 ] also suggested some risk factors, such as age less than one year-old and positive urinary culture, that should lead to investigation for a urinary tract malformation.…”

“…For the latter reason, some recommend a urinary tract and renal US only in patients less than one year of age [ 7 , 22 ]. Lee et al [ 22 ] also suggested some risk factors, such as age less than one year-old and positive urinary culture, that should lead to investigation for a urinary tract malformation.…”

“…This is a smaller proportion compared with what is found in the medical literature. Other studies found a urogenital malformation of 18% to 47%, depending on the population included [ 6 , 7 , 12 , 16 , 22 , 24 ]. What we share with those who looked for it, is that most if not all urogenital malformation where known before the OE episode [ 12 , 22 ].…”