The aetiology and current management of prepubertal epididymitis

Abstract

INTRODUCTION The aim of this study was to review the published evidence on the pathogenesis and management of acute epididymitis (AE) in prepubertal boys after the authors encountered an unexpectedly large number of such cases in their institution. METHODS Using MEDLINE ® , a literature search was performed for articles in English with the words "pre-pubertal" OR "boys" OR "p(a)ediatric" OR "children" AND "epididymitis" OR "epididymo-orchitis". RESULTS The literature suggests that it is rare to find a bacterial infection or anatomical anomaly as a cause for AE in this population. A postviral infectious phenomenon is the most likely explanation. The management should be supportive and antibiotics reserved for those with pyuria or positive cultures. Urodynamic studies and renal tract ultrasonography have been advocated for those with recurrent epididymitis. CONCLUSIONS AE in prepubertal boys is more common than believed previously. A careful history for recent viral illnesses should be included. Antibiotics, urinary tract imaging and functional studies should be used in selected cases.

Prospective Validation of Clinical Score for Males Presenting With an Acute Scrotum

“…Previous studies have demonstrated that most pediatric males with epididymitis do not have pyuria on urinalysis or a positive urine culture and, therefore, do not require routine antibiotic treatment . As there are no clear predictors for males with a bacterial etiology of epididymitis the general recommendation is for a urine culture to be performed on males with epididymitis, while the utility of a screening urinalysis for pyuria is less clear. In our study cohort urinalysis was performed in 86% of males without testicular torsion and 0% in males with torsion.…”

“…Nonetheless, the use of DUS may prolong the time in testicular ischemia and delay time to surgery for those with testicular torsion . In addition to DUS, laboratory testing with urinalysis and urine culture and for sexually transmitted infections (STIs) is used in the evaluation of testicular complaints to evaluate for other causes of the acute scrotum, including epididymitis …”

A Case with Chickenpox and Epididymoorchitis: More Than a Coincidence?

“…However, this is a controversial problem in prepubertal boys. The causes of epididymoorchitis in prepubertal boys are infectious agents (bacterial, viral, fungal), genitourinary tract abnormalities, postinfectious inflammatory reactions, vasculitides, certain medications or local trauma (3,5). In patients with epididymoorchitis, urine cultures correlate well with epididymal aspirates, so especially in children aspiration is not recommended, urine is sufficient for laboratory investigations.…”

Epididimoorşitle Seyreden Bir Suçiçeği Olgusu, Bir Tesadüften Fazlası mı?

“…Ancak bu prepubertal erkek çocuklarında tartışmalı bir sorundur. Prepubertal erkek çocuklarında epididimoorşit nedenleri enfeksiyöz etkenler (bakteriyel, viral, fungal), genitoüriner sistem anomalileri, postinfeksiyöz inflamatuvar reaksiyonlar, vaskülitler, bazı ilaçlar veya lokal travmalardır (3,5). Epididimoorşitli hastalarda, idrar incelemeleri ve kültürleri epididimal aspirat örneklerinin değerlendirlmesiyle iyi korelasyon gösterir.…”