Epididymo-orchitis risk factors in traumatic spinal cord injured patients

Abstract

Study design: Retrospective audit and interview-based study of a traumatic spinal cord injured cohort, assessing the incidence and risk of epididymo-orchitis (E-O). Objectives: Assess the potential risk factors for E-O in this cohort (spinal cord injured patients). Setting: Janbazan Clinic for Spinal Cord Injuries, Mashad, Iran. Methods: A retrospective notes audit of 169 male traumatic spinal cord injured (SCI) patients was performed. In addition, interviews were performed to confirm any equivocal data. The following risk factors were assessed: history of recurrent urinary tract infections (UTIs), urethral stricture, urethral diverticuli, urinary fistula, urinary calculi, spinal injury type, neurogenic bladder type, autonomic dysreflexia, vesico-ureteral reflux, sphincterotomy, vasectomy, marriage status, bladder residual and emptying method, ejaculation, spinal injury level, micturation control, and muscular spasm, which included detrusor, external sphincter or lower limb spasm. Results: A total of 65 patients from our group (38.5%) had suffered E-O at least once. E-O presented on average, 3.9 years after the SCI. Patients with a history of muscular spasm appeared less likely to develop E-O (Po0.05). None of the vasectomised patients developed E-O. The relation between all the other factors and E-O were not significant. Conclusions: Our study has shown that the presence of muscular spasm decreases the risk of E-O, although the mechanism remains unclear. Surprisingly, the other historical risk factors showed no clear relation with E-O occurrence. Spinal Cord (2003) 41, 516-520. doi:10.1038/sj.sc.3101491Keywords: spinal cord injuries; spinal injuries; epididymitis; epididymo-orchitis; orchitis IntroductionLong-term follow-up of patients with traumatic spinal cord injuries (SCI) sustained during several wars demonstrated that urological complications were the leading cause of mortality, with 43% of all deaths related to renal diseases. 1 Lapides et al 2 introduced the concept of clean intermittent self-catheterisation (CISC), which improved the management of neuropathic bladders, and decreased the mortality.Epididymo-orchitis (E-O) is a common complication of SCI associated with neuropathic voiding dysfunction, and is associated with a 50% risk of azoospermia, and thus infertility in paraplegic patients. 3 We undertook a MEDLINEt search (OVIDt) between 1960 and April 2002 (keywords: epididymitis, orchitis and Epididymoorchitis, combined with spinal injuries, spinal cord, urogenital diseases, urological diseases, and urinary tract infection (UTI)), which revealed a lack of comprehensive studies dealing with potential risk factors for E-O in SCI patients.Thus, in an attempt to reduce the incidence of E-O and consequently the risk of infertility in these patients, we investigated risk factors predictive of E-O associated with SCI. Patients and methodsWe reviewed 169 male patients who sustained their wartime spinal injuries between 1980 and 1988. These patients were all victims of the Iran-Iraq war, and the Janbazan ...

Seminoma of Testis Masquerading as Orchitis in an Adult with Paraplegia: Proposed Measures to Avoid Delay in Diagnosing Testicular Tumours in Spinal Cord Injury Patients

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Organ-preserving treatment of an epididymal abscess in a patient with spinal cord injury

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