Inflamation of the testis and epidididymis in an otherwise healthy child: Is it a true bacterial urinary tract infection?

Epididymo-Orchitis in Pre-Pubertal Children. Epidemiology, Etiology, Management and Follow-Up Recommendations

“…In this series 24/70 (34%) had testicular torsion and the remaining 46 (66%) suffered from inflammation, 33 (47%) due to torsion of the gonad appendages and the remaining 13 had undefined inflammation. Halachmi et al [5] reported about 193 consecutive patients diagnosed with EO admitted to the emergency room during period of 5 years. The rate of EO could be estimated as ~60% as the rate of acute scrotum referals in this period was retrospectively estimated to 322 patients.…”

“…The situation may be accompanied by hydrocele and thickening of the scrotal wall, enlargement of the head of the epididymis, and increased testicular blood flow. Halachmi et al [5] repeated scrotal ultrasound in a child with clear sonographic diagnosis of gonadal appendix torsion. Within 24 -36 h following the first ultrasound, the whole epididymis and then the testis became inflamed, showing nonspecific inflammation masking the ability to identify the torsed appendix.…”

“…Another important conclusion from this work was the fact that there is no need for any further imaging studies for patients with nonbacterial inflammation. Halachmi et al [5] retrospectively described 31 patients that had additional imaging after being diagnosed with nonbacterial inflammation. In all 31 patients imaging studies, renal ultrasound, IVP, and voiding cysto-urethrography (VCUG) were normal, and did not show any pathology.…”

“…Special care should be taken with young infants and nonverbal children, or persons with intellectual disability. In these groups of patients, accurate medical history may not be properly obtained, and symptoms are not as pathognomonic as in adults [5].…”

“…Despite the fact that patients with nonbacterial EO do not present with any typical symptoms of urinary tract infection, there is a nonjustified tendency for the administration of antibiotics. Halachmi et al [5] showed that unnecessary antibiotic course was given to 142/169 (78%) children with nonbacterial EO. Graumman et al [34] also support these finding, urinalysis of 93 consecutive patients with EO the authors showed that in 92 cases urinalysis was normal and in all 93 cases urine culture was negative.…”