Prostadynia, Orchitis, Spermatocele, Hydrocele, Varicocele
How often does unilateral testicular atrophy occur in patients with orchitis?
60%
What is a hydrocele?
A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum. About one in 10 male infants has a hydrocele at birth, but most hydroceles disappear without treatment within the first year of life. Men — usually older than 40 — can develop a hydrocele due to inflammation or injury within the scrotum.
What is prostadynia and what causes it?
A non-inflammatory disorder, affects young and middle-age men. Variable causes including pelvic floor musculature dysfunction and voiding disorders.
What can distinguish a hydrocele from an inguinal hernia?
Abdominal flat plate
What are the 2 complications of a varicocele?
Atrophy & infertility
When do bacterial causes of orchitis usually occur?
Bacterial causes usually spread from an associated epididymitis (rarely occurs without epididymitis) in sexually active men or men with BPH; bacteria include Neisseria gonorrhoeae, Chlamydia trachomatis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species.
What is some supportive care for orchitis?
Bed rest COLD packs for analgesia Elevation of scrotum & place ice on affected testis Put a small pillow or towel between the legs to elevate the scrotum, & place ice on the affected testis for 10-15 minutes, 4 times a day, until pain resolves.
What can cause a hydrocele?
Can develop as a result of epididymitis or orchitis
What is a caaricocele?
Enlargement of the veins within the scrotum, similar to a varicose vein in the leg. Abnormal valves within the veins prevent normal blood flow.
True/False: one of the biggest complications of orchitis is sterility
False-very rare
Describe infertility secondary to a varicocele
It's not clear how varicoceles affect fertility. Some experts believe the testicular veins cool blood in the testicular artery, helping to maintain the proper temperature for optimal sperm production. By blocking blood flow, a varicocele may keep the temperature too high, affecting sperm formation and motility.
Treatment of spermatocele
Most spermatoceles require no treatment. If painful use acetaminophen or ibuprofen, etc. Repair requires surgery to remove cyst
What is the most common cause of isolated Orchitis?
Mumps
What are etiologic agents of immunocomprised patients developing orchitis?
Mycobacterium avium complex, Cryptococcus neoformans, Toxoplasma gondii, Haemophilus parainfluenzae (this is not the same as H. influenza, this one causes endocarditis), and Candida albicans.
Treatment of viral orchitis
None
Treatment of hydrocele
None, only if it gets large enough to cause discomfort or disfigurement -Surgical excision (hydrocelectomy) -Needle aspiration (risks include infection & scrotal pain)
Symptoms of a varicocele
Often produces no symptoms. Rarely, it may cause pain that worsens over the course of a day because of physical exertion and typically is relieved by lying down. With time, varicoceles may grow larger and become more noticeable. Most common around left testicle, most likely because of the position of the left testicular vein. -However, a varicocele in one testicle can affect sperm production in both testicles
What is Orchitis?
Orchitis is an acute inflammatory reaction of the testis secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis.
Tests and diagnosis of spermatocele
PE may cause discomfort when the mass is palpated. Transillumination of the scrotum will indicate that the mass is fluid-filled rather than solid. Ultrasound-If transillumination indicates a fluid-filled mass ultrasound can confirm the diagnosis. If transillumination doesn't clearly indicate a cyst, order an ultrasound.
Tests and diagnosis of hydrocele
PE: non-tender enlarged scrotum Putting pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia. Transillumination: fluid in a hydrocele usually is clear; shine a light through the scrotum which will outline the testicle, indicating that clear fluid surrounds it. If inflammation is suspected (epididymitis) evaluate for such.
Tests and diagnosis of a varicocele
PE: twisted, nontender mass above the testicle "bag of worms" If PE is inconclusive order a scrotal ultrasound.
What is a spermatocele?
Small (usually less than 1 cm though may be larger) cyst that develops in the epididymis. Generally painless and noncancerous, usually is filled with milky or clear fluid that may contain sperm. Common, affecting as many as three in 10 American men. Typically don't impair fertility or require treatment.
When do prepubertal patients develop orchitis?
Sometimes those with mumps-This condition rarely occurs in postpubertal males with mumps. Bacterial orchitis is even rarer and is usually associated with a concurrent epididymitis.
What is orchitis characterized by?
Testicular pain and swelling
Describe atrophy secondary to varicocele
The bulk of the testicle is made up of sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It's not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
Pathophysiology of orchitis secondary to mumps
The onset of scrotal pain and edema is acute. Because mumps orchitis is responsible for most cases of isolated orchitis, diagnosis is usually based on a reported history of a recent mumps infection or parotitis with a presentation of testicular edema. Mumps orchitis presents unilaterally in 70% of cases. -In 30% of cases, contralateral testicular involvement follows in 1-9 days.
True/False: It is unlikely to develop a testicular tumor after an episode of orchitis
True
True/False: Some case reports have described mumps orchitis following immunization with the mumps, measles, and rubella (MMR) vaccine.
True
Labs with prostadynia
UA normal, expressed prostatic secretions may show increased leukocytes. If patients don't respond to empiric therapy, consider urodynamic testing which might show detrusor contraction without urethral relaxation, spasms of the urinary sphincter, or high urethral pressures.
Symptoms of a hydrocele
Usually are not painful, the only indication is usually a painless swelling of one or both testicles
Symptoms of spermatocele
Usually causes no signs or symptoms and may remain stable in size. If it becomes large enough, the following symptoms may appear in the affected testicle: -Discomfort -Pain -A feeling of heaviness
Treatment of a varicocele
Varicocele treatment may not be necessary. However, if infertility occurs or the varicocele causes pain or testicular atrophy, varicocele repair may be necessary. Treatment is aimed at sealing off the affected vein to redirect the blood flow into normal veins. Definitive repair is surgical
What is the most common age of mump orchitis?
Younger than 10 years old
What medications are indicated for acute bacterial orchitis in patients younger than 35 & sexually active?
antibiotic coverage for sexually transmitted pathogens (particularly gonorrhea and chlamydia) with ceftriaxone and either doxycycline or azithromycin is appropriate. Fluoroquinolones are no longer recommended by the Centers for Disease Control and Prevention (CDC) for treatment of gonorrhea because of resistance.
What are some rare viral etiologies of orchitis?
coxsackievirus, infectious mononucleosis, varicella, and echovirus.
Treatment of prostadynia
empiric alpha-blockers (for spasms) terazosin (Hytrin) 10 mg PO once daily Pelvic floor muscle dysfunction try diazepam or biofeedback. Sitz baths may give symptomatic relief
What is the most common reason and age for bacterial orchitis?
most cases are associated with epididymitis (epididymo-orchitis), and they occur in sexually active males older than 15 years or in men older than 50 years with benign prostatic hypertrophy (BPH).
How does bacterial orchitis typically present?
oPatients are usually sexually active and present with a gradual onset of pain and edema. oUnilateral testicular edema occurs in 90% of cases.
What will you see on PE of someone with orchitis?
oTesticular examination for enlargement, induration, tenderness oErythema and edema of scrotal skin oEnlarged epididymis associated with epididymo-orchitis oSoft boggy prostate (prostatitis) often associated with epididymo-orchitis oStool for occult blood oParotitis oFever
What is the treatment of bacterial orchitis in those older than 35?
require additional coverage for other gram-negative bacteria with a fluoroquinolone or TMP-SMX. Other appropriate medications include analgesics or antiemetics, as needed.
What is the most important thing to consider with orchitis?
rule out testicular torsion, as the two syndromes often present with similar symptoms.
What are the symptoms of prostadynia?
same as in chronic prostatitis without history of UTI. Also hesitancy and flow interruption
What will you find on PE of someone wtih prostadynia?
unremarkable but you may find increased anal sphincter tone and tenderness around the prostate.
What are some other symptoms patients may have through the course of orchitis?
•The course is variable and ranges from mild discomfort to severe pain. oFatigue oMalaise oMyalgias oFever and chills oNausea oHeadache Mumps orchitis follows the development of parotitis by 4-7 days.
