Management of pediatric pyocele using percutaneous imaging-guided aspiration

Oberlin, Daniel T.; Cheng, Earl Y.

doi:10.1016/j.ijscr.2015.09.003

Cited by 7 publications

(14 citation statements)

References 32 publications

(38 reference statements)

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“…Kraft et al [11] reported 2 cases of pyocele in critical conditions, and however, they cannot withstand the surgical treatment, so they received the intravenous antibiotics treatment, were finally cured, and subsequently were followed up for 6 weeks and 9 months, respectively, with normal scrotal physical examination. Some scholars also used percutaneous aspiration to obtained pathogenic bacteria specimens while draining the purulent fluid [12]. In our study, specimens of the purulent fluid from 40 cases were collected via surgery or percutaneous aspiration, and its matching rate with the acquired primary bacterial culture was 95.5%.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

Zhu

et al. 2021

Urol Int

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Objective: This study aimed to explore the clinical characteristics, treatment methods, and prognosis of neonatal pyocele of tunica vaginalis and to provide a reference for the clinical treatment. Methods: A total of 56 newborns with pyocele of tunica vaginalis were admitted to our hospital due to the scrotal emergency from January 2015 to January 2020. Our study retrospectively analyzed these 56 cases. Of the 56 cases, including 32 full-term infants and 24 premature infants, age ranged from 1 to 27 days. Initially, conservative treatment (intravenous antibiotic treatment) was applied to 42 cases, and surgery to 14 cases. Then, 7 underwent surgical exploration during the conservative treatment, and 2 cases with initial surgical treatment experienced orchiectomy because of complete necrosis. For 56 cases, the average follow-up time was 18 months. Results: The clinical recovery time of cases with conservative treatment ranged from 8 to 17 days, with an average of 11.02 ± 2.31 days. The clinical recovery time of cases with surgery ranged from 6 to 15 days, with an average of 9.28 ± 2.78 days. During the follow-up, for 56 cases, except for the 2 cases with orchiectomy, the testicular position and Doppler flow both went back to normal, of the 42 cases with initial conservative treatment, 1 case experienced testicular retardation, of the 14 cases with initial surgical treatment, 2 cases experienced testicular retardation, and hydrocele of 42 cases were self-healed. Conclusions: Neonatal pyocele of tunica vaginalis is mostly secondary to intra-abdominal infection. Color Doppler ultrasound is helpful for the diagnosis. The percutaneous aspiration is a way of collecting pathogenic bacteria during the conservative treatment. If the color Doppler suggests testicular involvement, surgical exploration should be performed.

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Section: Discussionmentioning

confidence: 99%

Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

Zhu

et al. 2021

Urol Int

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“…The main pathogens described in pyocele are Echerichia coli and Staphylococcus spp., but Klebsiella pneumoniae and other coliforms, β-hemolytic streptococci, Salmonella spp, Bacteroides fragilis and Proteus mirabilis have also been reported as etiological agents. Nonetheless, the majority of cases of pyocele are idiopathic in aetiology and the source of infection remains unrecognized (1,(3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

“…If the pyocele remains untreated, it can organize into a scrotal abscess with a distinct well-demarcated hyperaemic wall around the purulent fluid collection (4)(5)(6). The majority of published cases have been definitively treated with surgical drainage, however many patients ultimately require orchiectomy due to disease progression or its severity (1,2,3,5,7). Percutaneous image-guided aspiration described by some authors is an effective management option for paediatric pyocele avoiding the risks of an invasive procedure, orchiectomy and general anaesthesia (1).…”

Section: Discussionmentioning

confidence: 99%

“…Due to the purulent collection within the potential space between the visceral and parietal tunica vaginalis around the testicle, it is also described as an infected hydrocele. It typically manifests with fever, tenderness of the scrotum or inguinal canal, erythema and sometimes scrotal discol-oration (1)(2)(3)(4). Since 1975 only a few cases of neonatal pyocele have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…It typically manifests with fever, tenderness of the scrotum or inguinal canal, erythema and sometimes scrotal discol-oration (1)(2)(3)(4). Since 1975 only a few cases of neonatal pyocele have been described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Herein, we present a case of a septic ten-dayold neonate admitted to the Department of neonatology with an acute scrotum; postnatal testicular torsion with non-viable testicle, testicular malignancy or severe epididymoorchitis were suspected but the condition turned out to be a pyocele, caused by Streptococcus pneumoniae.…”

Section: Introductionmentioning

confidence: 99%

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Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Lozej¹,

Paro–Panjan

Thaler

et al. 2019

CEJoP

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Objective -Bacterial infection of the scrotal appendages (scrotal pyocele) is a rare condition, especially in neonates. It is easy to confuse with other scrotal emergencies that require surgical intervention and orchiectomy. We present a case where pre-and intraoperative diagnosis was not clear and orchiectomy was performed; additionally, review of the literature, diagnostics, treatment options and lessons learned are discussed. Case report -A ten-day old full term neonate, born with bilateral hydroceles and glandular hypospadias, presented with a six day history of poor feeding and irritability; clinical examination revealed an enlarged, erythematous and tender right hemiscotum. Blood cultures, routine laboratory examinations and ultrasound (US) imaging was performed. Postnatal torsion with non-viable testicle, testicular malignancy and epididymo-orchitis were considered in the differential diagnosis. Upon surgical exploration, the testicle appeared non-viable due to severe inflammation and was removed. The patient was treated initially with ampicillin and gentamicin. After Streptococcus pneumoniae was cultured from specimens, treatment was continued with benzyl penicillin. Conclusion -Neonatal scrotal pyocele is an extremely rare condition. The main suggestive features are clinical presentation with signs of infection and an enlarged painful scrotum. US is the investigation of choice to differentiate from a surgical emergency. Free fluid in the scrotal cavity with septae, normal looking testicle on US and no signs of torsion at exploration are diagnostic signs. If diagnosed early, the first line of management is surgical aspiration or decompression, followed by broad-spectrum antibiotic treatment. With delay in diagnosis, the testicle may look non-viable and push surgeons for orchiectomy.

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Common Acquired Diseases of the Scrotum

Piçarro

Lima

2021

Normal and Abnormal Scrotum

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Management of pediatric pyocele using percutaneous imaging-guided aspiration

Cited by 7 publications

References 32 publications

Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

Scrotal Pyocele in a Neonate: Review of the Literature and the Lessons Learned

Common Acquired Diseases of the Scrotum

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