慢性前列腺炎在急性附睾炎发病中的关联度分析

目的 探讨慢性前列腺炎(CP)在急性附睾炎(acute epididymitis.AE)发病中的作用及两者发病的关联度.方法 将1998年1月至2009年1月年以来222例慢性前列腺炎与181例急性附睾炎患者随机分为急性附睾炎组及慢性前列腺炎组,比较AE伴有CP发病率与CP伴发AE的发病率,分析两者发病率差异性及关联度.结果 急性附睾炎组同时伴发慢性前列腺炎发病率为96.68%(175/181例),未伴发CP者6例.慢性前列腺炎组急性附睾炎发病率为13.96%(31/222例),未伴发CP者191例.附睾炎组CP发病率高于慢性前列腺炎组AE发病率,采用t检验两者差异有统计学意义.结论 附睾炎组CP发病率明显高于慢性前列腺炎组AE发病率,CP的存在是急性附睾炎发病的重要基础性因素,但不能排除急性附睾炎引起前列腺炎的可能,两者有重要关联度.     

Ectopic ureter presenting with epididymitis in childhood: report of 5 cases

We report 5 cases of an ectopic ureter opening into the seminal tract. All of the patients presented with the clinical features of acute or chronic epididymitis. Our experience has shown that the rare occurrence of epididymitis in prepubertal children necessitates a complete urological evaluation and that an underlying urological problem, including an ectopic ureter, should be sought.     

Color Doppler ultrasonography in the diagnosis of the acute scrotum

PURPOSE: To determine the value of color Doppler ultrasonography (CDUS) in the diagnosis of acute scrotum. MATERIALS AND METHODS: 10 patients referred to our hospital with acute scrotal pain were included in this study. All patients were evaluated with CDUS after the initial clinical examinations. Blood flow of the involved testis was compared semiquantitatively to that of the opposite testis. Patients with a diagnosis of testicular torsion by CDUS underwent surgical exploration. Patients with CDUS diagnosis of epididymitis were treated with intravenous antibiotics. RESULTS: Of the 10 patients evaluated, CDUS diagnosed 5 patients with testicular torsion and 5 patients with epididymitis. All cases of torsion were confirmed intraoperatively. 2 cases with no intratesticular blood flow on CDUS had necrotic testes and underwent orchiectomy with orchiopexy of the contralateral testes. A case with absent flow and 2 cases with decreased flow had bilateral orchiopexy. CDUS findings of normal or increased flow were present in all patients with epididymitis. No cases of testicular atrophy were encountered on long-term follow up in patients with epididymitis. CONCLUSION: CDUS is helpful in detecting the perfusion of the testis as well as in getting anatomical information. CDUS is a very useful device which causes a minimal burden to the patient with acute scrotum. In most cases it will rapidly provides us the correct information although it may not be regarded as the definitive adjunct.     

Clinical study on operative treatment of acute scrotum

Between July 1986 and March 2006, 102 patients underwent an operation for acute scrotum. Median age was 12.0 years old (range 0-51). Post-operative diagnosis revealed 50 cases (49%) of spermatic cord torsion, 29 cases (28%) of epididymal appendix torsion, and 13 cases (13%) of acute epididymitis. Spermatic cord torsion was most frequent in the age between 0 and 5, and 11 and 20, while epididymal appendix torsion was most frequent between 6 and 10. Moreover, acute epididymitis was most frequently seen in the age over 20. There were no apparent differences in the clinical symptoms such as scrotal pain, scrotal swelling, and abdominal pain. In the physical examinations, pyuria was the only finding to indicate acute epididymitis. In case of spermatic cord torsion, 'golden time' is defined as the time from onset to operation when testicular function can be expected for preservation. In this study golden time was defined as 8 hours because the testes was preserved in all 23 patients receiving the operation within 8 hours, but in only 10 (37%) out of 27 patients receiving the operation after 8 hours. Moreover, the operation within 24 hours saved the testes in approximately 90% of the patients. In patients with acute scrotum, emergency operation should be performed as speedily as possible for preservation of testicular function.     

The value of routine intravenous urography in acute epididymitis

The urographies of 106 patients with acute epididymitis are reviewed. In 71 cases the urography was completely normal, while in the remaining 35 patients abnormalities were found. In 25 patients the findings were consistent with hypertrophy of the prostate. More than half of the patients had known urological diseases and had undergone cystoscopy and/or catheterization prior to the onset of acute epididymitis. All 35 patients had demonstrated symptoms that would otherwise have resulted in intravenous urography independent of the epididymitis. No cases of urogenital tuberculosis were found. The authors conclude that routine urography under the age of 50 is not recommended. Over the age of 50 concomitant urological diseases are so common that urography is often indicated, but acute epididymitis in itself is only a relative indication.     

Acute and Chronic Epididymitis

Epididymitis is a relatively common clinical condition presenting as acute or chronic forms. Acute epididymitis is the inflammation of epididymitis accompanied by pain and swelling, while chronic epididymitis may present only with pain. Etiological factors may be infectious or noninfectious, for example urinary obstruction, drug induced, or idiopathic. Bacterial ascent through the urogenital tract is the most common etiology in acute epididymitis, with Chlamydia trachomatis being isolated in all adult age groups. Diagnosis is generally based on patient history, symptoms, and clinical findings. Recent data indicate that sexually active patients with acute epididymitis should be screened for sexually-transmitted diseases, regardless of their age. Additional laboratory investigations and imaging may be required for differential diagnosis with other intrascrotal conditions, particularly with testicular torsion. Although no evidence-based recommendations can be given for the antimicrobial treatment of acute epididymitis, >85% of bacterial strains causing acute epididymitis are susceptible to fluoroquinoles and third-generation cephalosporins. Chronic epididymitis has not been investigated as thorough as acute epididymitis; however, the development and use of a symptom index is promising in terms of achieving a widely-accepted standardization of diagnosis and evaluation. A conservative approach may be beneficial; medical treatment employing antibiotics, anti-inflammatory agents, pain medication, and others are also being utilized without any evidence-based data. Spermatic cord block with short-term and long-term acting agents as well as surgical treatment including epididymectomy microdenervation of the spermatic cord are other treatment alternatives in patients with chronic epididymitis.Patient summaryIn this article, we provide an update on the definition, epidemiology, etiology, diagnostics, and therapy in terms of acute and chronic epididymitis.     

Epididymitis: aspects concerning etiology and treatment

Extended microbiological studies were performed on 49 patients with acute or chronic epididymitis, including bacteriology of epididymal specimens in cases of scrotal surgery. In no patient had instrumentation or catheterization resulted in epididymitis. The microbiological data showed a prevalence of Chlamydia trachomatis epididymal infections in men less than 40 years old, whereas common urinary tract pathogens prevailed in older patients. Cultures of urethral swabs and midstream urine provided reliable information on the type of microorganism that caused epididymitis. Ofloxacin, an antibiotic of the new quinolone group, was proved to be highly effective in the treatment of acute and chronic bacterial as well as chlamydial epididymitis.     

尿道下裂术后尿道狭窄继发附睾炎的诊治

【摘要】〓目的〓探讨尿道下裂术后尿道狭窄继发附睾炎的临床特点与疗效。方法〓2005年1月至2011年2月收治的尿道下裂术后尿道狭窄46例患者中8例继发附睾炎,对该类患者予抗感染及对症治疗后,尽早行尿道探查、尿道狭窄段切开或切除及组织瓣移植尿道成形术等方法修复尿道狭窄。结果〓8例尿道狭窄继发急性附睾炎患者术后8天内附睾炎症状基本消失。1例患者阴茎伤口感染致阴茎中部尿瘘于3月后成功行尿瘘修补术,余7例患者伤口愈合良好,无尿瘘发生,排尿通畅,尿线粗。随访3~12月,8例患者均无尿道狭窄复发,无急性附睾炎复发,慢性附睾炎者临床症状较术前明显改善。结论〓本组患者中,尿道下裂术后尿道狭窄继发附睾炎见于严重的尿道狭窄患者及年龄偏大患者;尿道下裂术后尿道狭窄应积极处理,一旦出现急性附睾炎时应在抗感染等保守治疗前提下,尽早行尿道成形修复狭窄段尿道,恢复正常尿流。     

Diffusion of sulbactam and cefoperazone into the prostatic tissue

Diffusion of sulperazone (SBT) and cefoperazone (CPZ) into the prostatic tissue was studied in 20 cases. Two g of SBT/CPZ was injected intravenously and 1 hour later, prostatic tissue was obtained surgically and venous blood was drawn simultaneously. The serum concentration of CPZ (58.0 micrograms/ml +9.2) was higher than that of SBT (25.9 micrograms/ml +/- 9.3) and the prostatic tissue concentration of CPZ (14.9 micrograms/ml +/- 6.1) was higher than that of SBT (10.9 micrograms +/- 6.1). However, the SBT concentration ratio of prostatic tissue to serum level (P/S ratio) was significantly higher (42.5%) than that of CPZ (25.9%). The SBT concentration in the prostatic tissue was high enough to enhance the antibacterial activity of CPZ. SBT/CPZ was appraised to be an effective chemotherapeutic agent for infections of prostate caused by susceptible organisms, especially by beta-lactamase producing bacteria.     

Chlamydial seminal vesiculitis without symptomatic urethritis and epididymitis

We previously reported that seminal vesiculitis was associated with acute epididymitis, and that Chlamydia trachomatis was the major causative pathogen for infection of the seminal vesicle, suggesting that seminal vesiculitis was a discrete disease entity. In this paper, we report two patients with bacteriologically and cytologically proven seminal vesiculitis who had asymptomatic urethritis but not epididymitis. The clinical courses of these patients suggest that chlamydial seminal vesiculitis may be a cause of asymptomatic infection of the urethra or subsequent development of acute epididymitis.     

Diagnosis of testicular torsion using doppler ultrasonic flowmeter

Thirty-one patients with intrascrotal disease process have been studied with the Doppler ultrasonic flowmeter to determine if testicular torsion can be differentiated from acute epididymitis when clinical characteristics are ambivalent. In all instances of proved torsion there was a loss of blood flow in the involved testes, whereas in acute epididymitis or other epididymal and gonadal diseases blood flow ranged from normal to hyperemic.     

Clinical study of urinary tract infections in transurethral surgery

Effect of prophylactic administration of antimicrobials on postoperative urinary tract infection was studied in 40 patients who had undergone transurethral surgery. Two gm of cefoperazone (CPZ) per day was administered intravenously starting on the day of surgery for 5 days consecutively. In group I, 1 g of CPZ was administered 1 hour before surgery and another 1 g after surgery, while in group II 2 g of CPZ was administered after surgery only. Thereafter, in either group, 1 g of CPZ was administered intravenously 2 times a day. Urinary tract infection (UTI) was diagnosed when urine specimens yielded 1 X 10(4)/ml or more cells. In group I, 8 patients (40%) had UTI before surgery. Of 8 patients, 3 had bacteria resistant to CPZ. Of the remaining 5 patients with bacteria sensitive to CPZ 4 patients were cleared of bacteria after surgery. All these patients had bacteria sensitive to CPZ and therefore all were cleared of bacteria after surgery. In either group of patients all without bacteriuria at the time of preoperative evaluation were free from bacteriuria after surgery. All bacteria yielded after surgery were weak pathogens. All patients except 1 had no postoperative infectious complication such as septicemia, epididymitis and UTI. One patient showed UTI with fever after surgery. Urine culture yielded S. faecalis. This study showed that the prophylactic administration of antimicrobials for patients undergoing transurethral surgery was valuable, but the both methods of administration were similarly effective.     

Acute nongonococcal epididymitis--pharmacological and therapeutic aspects of levofloxacin]

We performed basic and clinical studies on the effects of a new oral quinolone derivative, levofloxacin (LVFX, Code No. DR 3355) which is an optical l-isomer of ofloxacin, in acute epididymitis. LVFX was administered in a dose of 200 mg to prostatic cancer patients 2 hours before operation. The mean concentration of LVFX in the tissues of testis and epididymis were 4.73 micrograms/g and 313-3.6 micrograms/g, respectively. Tissue/Serum ratios were 1.63 and 1.16-1.32, respectively. LVFX was administered in a dose of 100 mg three times daily for 13 days to healthy male volunteers. Semen and blood samples were taken 2 hrs after 7th and last day of administration. The concentration of LVFX in semen were 1.19 micrograms/ml (7th day) and 1.32 micrograms/ml (13th day). Semen/serum ratios were 1.12 and 1.26, respectively. No affection of LVFX on the sperm was observed. Antimicrobial activity of LVFX to C. trachomatis showed good MICs of 0.25-1.0 micrograms/ml. LVFX was administered in a dose of 100 mg two or three times daily for 14 days to 23 patients with acute epididymitis. The overall efficacy rate based on a criteria for acute epididymitis showed 100% (excellent: 16, good: 4, 20/20). A better efficacy rate was obtained on the 14th day than 7th day. No subjective or objective adverse reactions were observed.     

Scrotal ultrasonography: a predictor of complicated epididymitis requiring orchiectomy

The decision between continued medical therapy and surgical exploration in patients with complicated epididymitis is difficult. We evaluated scrotal ultrasonography as a noninvasive aid in such problematic cases. During a 48-month period 95 patients were hospitalized for treatment of epididymitis; 23 underwent scrotal ultrasonography and 10 required orchiectomy. Analysis of the 21 cases with abnormal findings demonstrated that orchiectomy was necessary in 1 of the 10 patients (10 per cent) with epididymal enlargement only, in 2 of 8 (25 per cent) with epididymal enlargement plus hypoechoic testes and in all 3 with epididymal enlargement plus testicular inhomogeneity (p equals 0.0099). Patients with progressive testicular changes on serial ultrasound examinations uniformly required orchiectomy (5 of 5). Sonographic findings of testicular inhomogeneity correlated with testicular infarction and findings of decreased testicular echogeneity correlated with acute or chronic orchitis. In the appropriate clinical setting gray scale ultrasonography provides objective information supporting the need for surgical intervention in selected patients with complicated epididymitis.     

Concentration of antibiotics (cefoperazone) in human brain, brain tumor tissue and cerebrospinal fluid

The transfer of cefoperazone (CPZ) into cerebrospinal fluid (CSF), brain or brain tumor tissue was studied in 13 cases with brain tumor, chronic subdural hematoma and benign intracranial hypertension in 1982. The peak values of CPZ in serum came up immediately after its rapid intravenous administration and then decreased exponentially. The concentration of CPZ in CSF started to increase with a long delay of about 60 min. The average peak level in CSF remained 21.6 micrograms/ml and corresponded to 10.3% of the peak level in serum. The best transfer of chloramphenicol into CSF has been reported, while that of CPZ would be one of the next. The CPZ levels in CSF showed a slower decay than in serum. The concentration of CPZ in brain reached the peak level in less than 30 min and the average peak level was 36.5 micrograms/g cerebral tissue. The brain to blood rate of the CPZ concentration was 11.1%. The CPZ levels in the brain showed a rapid decrease like the transition of antibiotic levels in serum. The antibiotic levels in brain tumors were divided into two groups. The one showed sharp peak about one tenth of the values in serum. The other was of a slowly increasing type.     

药物治疗急性非特异性附睾炎的效果与复发原因

目的：探讨药物治疗急性非特异性附睾炎的效果及复发的原因。方法：对179例经正规药物治疗的急性非持异性附睾炎患者(药物组)进行疗效观察,并对40例经药物治疗后行附睾切除术的附睾标本(手术组)进行细菌培养及药敏试验。结果：药物组经治3个月后,153例(85．5％)患者仍存在附睾硬结,27例(15．1％)于症状完全消失后2～8周出现复发;手术组11例(27．5％)细菌培养结果为阳性,其中有6例发现L型细菌,药敏试验情况各异。结论：药物治疗对本病患者有较好的效果;但部分患者难以治愈,主要是附睾结节内残留的病原体,尤其是L型细菌引起,故治疗中应选用作用于细胞膜的药物,并适当结合手术治疗。     

Is seminal vesiculitis a discrete disease entity? Clinical and microbiological study of seminal vesiculitis in patients with acute epididymitis

PURPOSE: To our knowledge direct evidence of inflammatory involvement of the seminal vesicles has not previously been reported in patients with acute epididymitis. We verified the discrete disease entity of seminal vesiculitis associated with acute epididymitis. MATERIALS AND METHODS: The study included 13 patients who were clinically diagnosed with acute epididymitis. We report imaging, cytological and bacteriological findings in the seminal vesicles of patients with acute epididymitis. RESULTS: On transrectal ultrasonography 12 of the 13 patients (92.3%) had dilatation of the seminal vesicle on the side ipsilateral to epididymitis. Dilatation of the contralateral side was found in only 4 patients. Seminal vesicle fluid from the ipsilateral side showed inflammatory findings in all patients. In patients 40 years and younger Chlamydia trachomatis was detected in seminal vesicle fluid in 7 of the 8 patients with epididymitis with results positive for the microorganism on first voided urine. CONCLUSIONS: Inflammatory responses were found in the seminal vesicles of patients with acute epididymitis. Chlamydia trachomatis was the causative pathogen most frequently detected in seminal vesicle fluid. Seminal vesiculitis is clearly associated with acute epididymitis and it may be a discrete disease entity.     

Effects of chlorpromazine on the skeletal muscle--a study using skinned single fibers of the guinea pig

Chlorpromazine (CPZ) was reported to influence the functions of the sarcoplasmic reticulum (SR). To determine the action sites of CPZ on calcium functions in skeletal muscle, the calcium-induced calcium release (CICR) rates from SR, Ca2+ uptake rates into the SR, and Ca2+ sensitivity to the contractile system were examined using the single skinned fiber. CPZ enhanced slightly rates of CICR in a dose-dependent manner. The Ca2+ uptake rates into the SR were significantly attenuated at the concentrations of 10 and 30 microM of CPZ. CPZ in a concentration below 10 microM did not affect Ca2+ uptake rates. This agent did not enhance Ca2+ sensitivity of the contractile system. Although CPZ was suggested to increase Ca2+ release from the SR by Takagi, this observation might have resulted from either the increase of Ca2+ release or the inhibition of Ca2+ uptake since Ca2+ might be pumped up to the SR during the release of Ca2+ in his experimental conditions. Endo's method enabled us to analyze these functions independently. CPZ was found to act mainly on the inhibition of Ca2+ uptake and not to increase Ca2+ release from the SR in a concentration of CPZ (10 microM). These results suggest that CPZ may induce the increase of intracellular Ca2+ concentration. CPZ may be safely employed to MH susceptible patients, since CPZ at a clinical concentration showed no influence on Ca2+ related functions of the skeletal muscle.     

Acute scrotal pain in children: prospective study of diagnosis and management

Forty-eight boys were assessed for an acutely painful scrotum. Thirty-six (75%) of them underwent radionuclide scanning of the scrotum; the average age of this group was 11 years. The scan revealed epididymitis in 19 cases, spermatic cord torsion in 9, appendix testis torsion in 7 and acute hernia-hydrocele in 1. The diagnosis was confirmed at operation in all nine cases of spermatic cord torsion. Boys who had epididymitis received antibiotics only; all were available for short-term follow-up, and 16 were also assessed at a mean of 6 months after infection. Only one boy had testicular atrophy; he had undergone repair of an inguinal hernia, which could not be ruled out as a cause. Bacteriuric epididymitis occurred in three boys; two had known predisposing genitourinary anomalies, the third had no abnormalities. Boys who had nonbacteriuric epididymitis were investigated by renal and pelvic ultrasonography or voiding cystourethrography; no important abnormalities were detected. This prospective study indicates that radionuclide scanning can reliably differentiate spermatic cord torsion from other acute scrotal disease.     

Serum sialic acid levels in patients with acute prostatitis or acute epididymitis

The serum sialic acid concentration in 17 male healthy adults, 11 patients with acute prostatitis and 12 patients with acute epididymitis was measured with a specific enzymatic assaykit. The concentration was studied in relation to erythrocyte sedimentation rate, total serum protein and its fraction, C-reactive protein, and white blood cell count. Blood samples were obtained from the patients immediately before antimicrobial chemotherapy and the subsequent 3, 5, 7, 14, and 28 days. The pretreatment sialic acid concentration in the patients was significantly greater than that in the control subjects (P greater than 0.001). The mean serum sialic acid concentration in the patients reached a maximum level 3 days after the beginning of the treatment, and then gradually decreased. There was a significant correlation between the daily change of the serum sialic acid level and those of the erythocyte sedimentation rate, alpha2-globulin, and alpha1-globulin. Serum sialic acid proved to be a useful biochemical marker in acute prostatitis and acute epididymitis.