A Case of Functional Testicular Torsion Caused by Incarcerated Inguinal Hernia in a Newborn

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.

A Case Report on Treatment of Unilateral Testicular Pain with Korean Medicine for a Patient with Recurrent Varicocele

Objectives: This study aimed to determine whether Korean medicine could improve unilateral testicular pain caused by recurrent varicocele without unfavorable side effects.Methods: A 46-year-old man diagnosed with varicocele, identified with a scrotal ultrasound scan, had right-side testicular pain. We administered Banchong-san and Eunhoebanchong-san to observe changes in the degree of pain.Results: After one month of taking Banchong-san and Eunhoebanchong-san, testicular pain improved.Conclusion: This study suggests that Korean medicine might be effective for managing testicular pain caused by varicocele.

Idiopathic neonatal hemoperitoneum presented as scrotal hematoma: it’s a diagnostic challenge?

Background Idiopathic hemoperitoneum in the newborn is an entity very rarely encountered in clinical practice. Case presentation A case of scrotal hemorrhage (SH) associated with intrabdominal hemorrhaging and acute anemia is presented. Indications for early surgery included a massive scrotal hematoma, rapid onset of severe anemia, and unknown etiology. Conclusion Clinical and diagnostic approaches in a case of neonatal scrotal hematoma should be given careful consideration as abdominal in origin, and a pre-operative computed tomography (CT) scan or magnetic resonance image (MRI) in addition to an abdominal/scrotal ultrasound should be added as part of the diagnostic work-up.

EP.FRI.596 A Tale of Two Ultrasounds

Background Testicular torsion is a common cause of acute testicular pain, which requires immediate investigation and treatment. We describe a unique presentation of testicular torsion, which required the operating surgeon to assess the viability of a clinically dead testis through surgical manipulation, 16 hours after onset of pain. Case Report A 19 year old male presented with a 12 hour history of pain and swelling in the left scrotum. Examination revealed the left testes was hard, swollen and tender with a palpable spermatic cord. Clinical diagnosis of testicular mass or epididymo-orchitis was suggested and scrotal ultrasound was organised. This reported no blood flow in the left testis, and so torsion was suspected. Patient was taken immediately to theatre. Examination was performed under general anaesthetic, which revealed a hard, swollen testis, with no torsion clinically. Midline scrotal incision was made. On visual examination, left testis was black and hard, but there was no obvious torsion in the cord. However, during manipulation, the testis softened and started to change colour, eventually becoming dusky. A small incision into the testis showed bright red blood, and the decision was made to replace the testis and fix both testes. The patient made an excellent recovery post-operatively. Repeat ultrasound showed return of testicular vascularity. Conclusion This case showcases the importance of considering salvage in patients who have presented even after the generally accepted 6-8 hour time window. It also highlights the value of an experienced surgeon’s judgement in unusual presentations and with unexpected events intraoperatively.

Angiomyofibroblastoma férfiban – egy ritka paratesticularis eltérés és irodalmi áttekintés

Összefoglaló. A scrotum képalkotó vizsgálóeljárásai közül elsőnek választandó az ultrahang, mivel könnyen hozzáférhető, szenzitivitása és specificitása magas. Szerepe kiemelendő mind az intratesticularis eltérések differenciáldiagnózisában, mind pedig a kevésbé ismert paratesticularis eltérések esetében. Az urológiai ambulancián egy 56 éves férfi jelentkezett kivizsgálásra tapintható terime miatt. Ultrahangvizsgálattal paratesticularis elváltozás látszódott, mely a vizsgálat során az inguinalis csatorna irányába többször elmozdult. A laesio dignitása nem volt meghatározható, ezért műtéti eltávolításra került sor. A szövettani vizsgálat a férfiak körében ritkán előforduló angiomyofibroblastoma diagnózisát véleményezte. A paratesticularis elváltozások ugyan ritkán fordulnak elő, de a gyakoribb entitások és azok ultrahangos sajátosságainak ismerete elengedhetetlen a terápia tervezése szempontjából. Orv Hetil. 2021; 162(34): 1376–1382. Summary. Ultrasonography is the basic imaging technique for the evaluation of testicular structures because it is easily accessible and has high sensitivity and specificity. It plays a significant role in the differential diagnosis of intratesticular changes, in addition, its role should be emphasised in rare paratesticular abnormalities. A 56-year-old male presented in the urology department complaining of a palpable inguinal mass and was referred to ultrasonography for further evaluation. A scrotal ultrasound was performed, and it described a mobile paratesticular mass without any specific characterizations. Therefore the lesion was removed, and the histological analysis established the diagnosis of angiomyofibroblastoma. Paratesticular lesions are rare, but it is essential to know the frequent abnormalities and the corresponding ultrasound findings for planning of treatment. Orv Hetil. 2021; 162(34): 1376–1382.

93 Sexually Transmitted Infections Remain Under-Diagnosed and Under-Treated in Young Men Presenting with Acute Scrotal Pain

Introduction Epididymitis or epididymo-orchitis causing acute scrotal pain in men ≤35 years is a common presentation to primary and secondary care.Most are caused by sexually-transmitted-infections in this age group. Failure to identify or treat STIs in this population may lead to subfertility.We assessed our practice against British Association of Sexual Health and HIV guidelines. Method Men (age ≤35) diagnosed at our centre with epididymitis/epidiymo-orchitis between January2015 and January2020 were included (n = 313, age range 16-35). Data collected included microbiological and radiological reports,antimicrobial treatment prescribed and documentation of appropriate advice and follow-up.Patients with previous STI were excluded. Results 53 (16.9%) patients had mid-stream urine analysed;one identified bacterial growth (e.coli).15/313 patients were screened for c.trachomatis.228 (72.8%) patients had a scrotal ultrasound;167 (73.2%) reports suggested epididymitis.32 patients underwent immediate scrotal exploration;19 were epididymitis,one required orchidectomy. Advice to attend GU-Medicine-clinic was documented in 48cases (15.3%).20 patients (6.4%) received optimal antibiotic management; 83 (26.5%) received suitable antibiotics assuming non-gonococcal cause.210 patients received inadequate/inappropriate antibiotics. Conclusions Management of patients with acute scrotal pain is sub-optimal;most patients were inadequately investigated and most received inappropriate antibiotics which may lead to subfertility.Better education and written patient information on risks of STIs may improve outcomes in this population.

Ultrasound screening for cervical, abdominal and scrotal malignant and benign abnormalities in children

IntroductionUltrasonography plays an important role in evaluation of many diseases in pediatric population. The noninvasiveness of the method allows to its wide use in children. It is a first-line diagnostic test for detecting lymphadenopathy, benign and malignant abnormalities of the thyroid gland, abdominal structures or testes in boys. The Ultrasound Screening Program “No to Cancer in Children” was introduced to detect neoplastic lesions and possible developmental disorders in children with no symptoms to allow early diagnosis.Material and methodsThe children were scanned in special mobile ambulance - Ronald McDonald Care Mobile, equipped with two high-tech ultrasound devices. Ultrasound scans, including cervical, abdominal, pelvical and scrotal ultrasound were performed in population of asymptomatic children. In the years 2006-2019, 67.594 children, 34.892 boys and 32.702 girls aged from 9 months to 6 years were examined.ResultsTotally, 18.544 various abnormalities were detected. In case of the neck they were found in 7542 children, which represent nearly 11.2% of all patients. Changes in abdominal ultrasound were found in 4.496 cases (6.65%). Abnormalities of the male reproductive system were detected in 6.474 boys (18.5%). Twelve tumors were detected.ConclusionsScreening has proved to be very useful for the early identification cancerous as well as precancerous lesions. It is also worth continuing for a reason of effective detection of other childhood anomalies.

The fate of paratesticular masses: 13 years’ experience in a tertiary referral centre

Objective Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues. Methodology We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007–2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients’ history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates. Results A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions. Conclusion Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.

Effects of COVID-19 on Testicular Function

Background: The impact of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2) on testicular function is unclear. Objective: To clarify the effects of COVID-19 on male gonadal function. Methods: Pubmed search up to February 24, 2021. Search terms included COVID-19, testicles, testosterone, spermatogenesis, hypogonadism. Case reports, retrospective, prospective and autopsy studies are included. Results: Prevalence of patients hospitalized with COVID-19 having scrotal pain varies from 0-19%. Orchitis and/or epididymitis were demonstrated by scrotal ultrasound (US) in approximately 22-42% of men with COVID-19 admitted to the hospital and can be frequently asymptomatic. Circulating testosterone levels are reduced in men admitted with COVID-19 with concomitant elevation of luteinizing hormone (LH) suggesting testicular dysfunction. Men affected with COVID-19 exhibit abnormal semen parameters. Most, but not all, studies failed to detect SARS-CoV-2 in semen. Autopsy studies showed extensive damage of testicular tissues of men who died from severe COVID-19. Conclusion: COVID-19 negatively affects almost all aspects of male gonadal function. Physicians should evaluate testicular function during and after recovery from COVID-19 to preserve normal fertility.

Effects of COVID-19 on testicular function

Background: The impact of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-Cov-2) on testicular function is unclear. Objective: To clarify the effects of COVID-19 on male gonadal function. Methods: Pubmed search up to February 24, 2021. Search terms included COVID-19, testicles, testosterone, spermatogenesis, hypogonadism. Case reports, retrospective, prospective and autopsy studies are included. Results: Prevalence of patients hospitalized with COVID-19 having scrotal pain varies from 0-19%. Orchitis and/or epididymitis were demonstrated by scrotal ultrasound (US) in approximately 22-42% of men with COVID-19 admitted to the hospital and can be frequently asymptomatic. Circulating testosterone levels are reduced in men admitted with COVID-19 with concomitant elevation of luteinizing hormone (LH) suggesting testicular dysfunction. Men affected with COVID-19 exhibit abnormal semen parameters. Most, but not all, studies failed to detect SARS-CoV-2 in semen. Autopsy studies showed extensive damage of testicular tissues of men who died from severe COVID-19. Conclusion: COVID-19 negatively affects almost all aspects of male gonadal function. Physicians should evaluate testicular function during and after recovery from COVID-19 to preserve normal fertility.