Epididymitis: Aspects Concerning Etiology and Treatment

Melekos, Michael D.; Asbach, H. W.

doi:10.1016/s0022-5347(17)42999-5

Cited by 55 publications

(38 citation statements)

References 10 publications

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“…Our data showed that pyuria correlated with fever (p=0.0159). In contrast to younger men, in whom sexually transmitted pathogens are predominant, in older patients with a history of subvesical obstruction, E. coli is the most frequent pathogen responsible [16]. These data support our data mentioned above and overcome the limited evidence for not only etiology but also treatments, especially in older patients.…”

Section: Discussionsupporting

confidence: 89%

What are the differences between older and younger patients with epididymitis?

et al. 2017

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PurposeAccording to the aging of society and the spread of antibiotic-resistant strains, it is worth considering the different aspects of epididymitis (EP) in older and younger patients, even though the etiology and therapeutic strategies of this disease are considered to be established. Thus, we investigated how age affects EP-related symptoms.Materials and MethodsData were gathered from 7 hospitals in Hyogo, Japan, and the correlations of age (older or younger) with urine findings such as pyuria or bacteriuria and EP-related symptoms such as fever were investigated.ResultsIn all 308 cases with full data for evaluation, there were 66 febrile (38℃ or higher) cases (21.4%) and bacteriuria was seen in 158 cases (51.3%). In the multivariate analysis, older age (65 years or older) was significantly correlated with the presence of pyuria (p=0.0156). Regarding the relationship between urine findings and EP-related symptoms, pyuria was significantly related to fever (37℃ or higher; p=0.0159).ConclusionsOur data showed that older patients with EP had pyuria significantly more often than did younger patients, which correlated with EP-related symptoms (fever). These data suggest that age-specific guidelines may be necessary.

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Section: Discussionsupporting

confidence: 89%

What are the differences between older and younger patients with epididymitis?

et al. 2017

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“…have presented that in men younger than 40 years old, 56% of epididymitis cases were caused by Chlamydia trachomatis and 18% by other bacteria. Whereas in those older than 40 years, the incidence of epididymitis resulting from urinary tract infection bacteria was 68% and only 18% from C. trachomatis [3]. The similar proportion was noted by De Jong Z. et al In a group of 12 patients older than 35 yrs., 10 pts.…”

Section: Discussionmentioning

confidence: 58%

URINARY TRACT INFECTION Acute epididymo-orchitis: staging and treatment

Banyra¹,

Shulyak²

2012

cejurol3/2012

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IntroductionAcute epididymo-orchitis (AEO) is an acute inflammatory disease of the epididymis and ipsilateral testis. Treatment should be started immediately after diagnosis and includes antibiotics, analgesics, and, if necessary, surgery.Materials and methodsAfter AEO diagnosis, patients were treated conservatively with analgesics and antibiotics. If no clinical improvement was observed within the first 48-72 hours of conservative treatment, patients underwent surgery. Depending on examination results, 254 patients (pts.) were divided into three groups: 1) with palpable differences between the epididymis and testis (E/T+), and without neither hydrocele, local softening (malacia), nor abscess of the epididymis or testis; 2) with E/T+, absence of malacia, presence of hydrocele, and none, one, or a few small abscesses within the epididymis/testis and 3) without palpatory differentiation between the epididymis and testis, with or without malacia, with hydrocele, and none, one, or more abscesses of any size. We analyzed the clinical outcomes in each group.ResultsAll of patients from the first group were successfully treated with antibiotics. In the second group, conservative treatment was effective in 70 pts. (85.4% of this group), but the other 12 pts. (14.6%) did not show clinical improvement and underwent organ-sparing surgery. The majority of patients from the third group did not demonstrate an objective response to antibacterial treatment during the first 48-72 hours and, therefore, underwent surgery. Based on examination results and clinical outcomes we developed a classification system for AEO, which divides AEO into three stages and recommends an approach to its treatment.ConclusionsOur classification is able to systematize treatment approaches in patients with AEO.

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“…In contrast to younger men where sexually transmitted pathogens are predominant, in older patients with a history of subvesical obstruction, E. coli is the most frequent pathogen responsible [2,3]. Immediate sequelae such as abscess formation are estimated to require surgical treatment in ª 10% [3,7] to 20% [6], depending on the antimicrobial agent used for therapy [7].…”

Section: Discussionmentioning

confidence: 99%

“…Epididymitis normally results from canalicular bacterial infection of the epididymis. Escherichia coli is the predominant pathogen in men over 35 years of age with infravesical obstruction [2,3]. One severe complication of acute epididymitis is impaired fertility, even when clinically the disease is unilateral [4,5].…”

Section: Introductionmentioning

confidence: 99%

Experimental Escherichia coli epididymitis in rats: a model to assess the outcome of antibiotic treatment

Ludwig

Johannes

Bergmann³

et al. 2002

BJU International

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Objective To assess the effect of initial antimicrobial therapy with a new highly potent quinolone (sparfloxacin) on the outcome of infection, especially acute and chronic inflammation, in a rat model of unilateral Escherichia coli epididymitis. Materials and methods The study included 60 SpragueDawley rats, each of which received 0.1 mL of an E. coli (0:6 strain) suspension (10 6 colony forming units/mL) injected into the right ductus deferens. At 24 h after infection an oral antimicrobial treatment with sparfloxacin was initiated in half of the animals. The rats were killed 14 days, 3 and 6 months after infection, and both epididymes and the prostate gland cultured to re-isolate E. coli . To evaluate the grade of inflammation in both epididymes, histological variables, including acute and chronic inflammation and scar formation, were evaluated and a total inflammatory score, representing the sum of all variables, computed. Results Whereas antimicrobial therapy eradicated the pathogen, in untreated animals the pathogen was detectable for up to 6 months after infection in the infected epididymis and/or the prostate gland, while the contralateral epididymis was sterile. The inflammatory reaction in the infected epididymis was significantly less in treated animals ( P < 0.001). Subclinical nonbacterial inflammation was present in the contralateral epididymis. Conclusions Although adequate antimicrobial treatment eradicated the pathogen and reduced the grade of epididymal damage, inflammation was not avoided. Subclinical inflammation of the contralateral epididymis may contribute to impaired fertility. These results indicate that an inflammatory reaction initiated by bacteria might persist as a nonbacterial process despite early therapy, or by bacteria undetectable by conventional culture techniques, and may compromise male fertility.

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Epididymitis: Aspects Concerning Etiology and Treatment

Cited by 55 publications

References 10 publications

What are the differences between older and younger patients with epididymitis?

What are the differences between older and younger patients with epididymitis?

URINARY TRACT INFECTION Acute epididymo-orchitis: staging and treatment

Experimental Escherichia coli epididymitis in rats: a model to assess the outcome of antibiotic treatment

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