单纯性附睾结核的诊治分析

目的:提高对单纯性附睾结核的诊治水平。方法:在35例附睾结核患者中通过尿路影像学检查无肾结核及尿抗酸杆菌检测阴性者,定义为单纯性附睾结核20例进行回顾性分析,均行强化抗结核治疗,即异烟肼(INH)、利福平(RFP)、链霉素(SM)或乙胺丁醇(EB)联合用药,2周后行病灶切除术,术中均行附睾结核病灶清除,术后继续常规抗结核治疗6～9个月。结果:随访6个月～5年,16例无异常情况,3例分别于术后3、3.5、5年出现泌尿系结核感染,1例于术后3.5年出现对侧附睾结核。结论:单纯性附睾结核可能为唯一或早期泌尿生殖系结核首发的表现,及时手术治疗,预后较好。     

Three-chamber priapism in a patient with primary epithelioid hemangioendothelioma of penis

The incidence of tuberculosis in the United States is on the rise, in part, because of its association with acquired immunodeficiency syndrome. Genitourinary tuberculosis remains one of the most common forms of secondary or extrapulmonary disease. We present an unusual case of tuberculous epididymitis with extensive retroperitoneal and mediastinal spread. The possible routes of dissemination, as well as the efficacy of antimycobacterial therapy in the management of tuberculous epididymitis, are discussed and the relevant literature is reviewed.     

A case of tuberculous epididymitis which was difficult to distinguish from a testicular tumor

A 70-year-old man complaining of painless right scrotal swelling was referred to our hospital. He had a past history of left nephrectomy for renal tuberculosis at the age of 28. Power Doppler ultrasonography revealed a hypoechoic and hypovascular tumor with septa in the scrotum. We suspected a right testicular tumor and therefore, performed a right high inguinal orchiectomy. On macroscopic findings, the fluid of the tumor was yellowish and mucinous and the ipsilateral testis was remarkably atrophic. The pathological diagnosis was tuberculous epididymitis with central necrosis. In recent years, tuberculous epididymitis is rare, and this case was considered to be the first report of power Doppler ultrasonographic findings in tuberculous epididymitis.     

附睾结核的MRI 诊断价值

目的 分析附睾结核的MRI 表现,总结其MRI 的诊断要点.方法 对8 例经病理确诊为附睾结核的MRI 进行回顾性分析,重点分析其部位、形态、MRI 信号、强化方式及泌尿生殖系其他部位的情况.结果 8 例患者中2 例为局限于附睾附睾头的单发实性圆形小结节灶,6 例累及整个附睾弥漫性或多发形态不规则结节灶;4 例为实性病灶,2 例为囊实性病灶;8 例病灶实性部分T1WI 均呈等信号,T2WI 均呈低信号,囊性部分T1WI 呈低信号,T2WI 呈高信号.增强扫描8 例病灶中T2WI 呈低信号实性部分均明显强化.8 例患者中伴有泌尿系、睾丸、前列腺、精囊腺、肺结核分别为4 例、4 例、2 例、1 例及1 例.结论 附睾结核常伴发其他泌尿生殖系结核,典型的附睾结核多累及整个附睾,表现为在T2WI 呈低信号的实性病灶,且增强扫描明显强化,此MRI 特异性表现可以对附睾结核进行准确定位和早期诊断.     

Intravenous urography as a routine examination in epididymitis-a re-evaluation

One hundred and twenty-seven intravenous urograms of patients with acute epididymitis were evaluated during a period of 9 years. The majority of these patients had normal urograms. A tuberculous renal lesion was found in only one case. Twenty-seven patients had prostatic enlargement and 10 of these were under 50 years of age. Other abnormalities which were found were not related to epididymitis. It is suggested that intravenous urography is indicated in patients with acute epididymitis only when there is evidence of previous tuberculosis or when laboratory findings arouse suspicion of genitourinary tuberculosis.     

Tuberculous epididymitis occurring 35 years after renal tuberculosis

An unusual case of tuberculous epididymitis occurring 35 years after renal tuberculosis is reported. The possible mechanisms of this delayed presentation of the epididymal lesion are discussed. This case emphasizes the importance of adequate treatment as well as long-term followup of patients with genitourinary tuberculosis.     

Successful Surgical Treatment of an Infrarenal Abdominal Pseudoaneurysm Caused by Tuberculosis: Report of a Case

A 76-year-old man was admitted to our hospital for investigation of an apparent abdominal aortic aneurysm detected during treatment for epididymitis. A chest X-ray showed miliary shadows in the bilateral lung fields strongly suggestive of tuberculosis. The diameter of the aneurysm increased, and examinations showed impending rupture of a pseudoaneurysm. However, a definitive disease pathogenesis was not obtained before surgery. We performed a subemergency operation, which revealed an infrarenal abdominal pseudoaneurysm caused by tuberculosis. The pseudoaneurysm appeared to have resulted from direct extension of tuberculous lymphadenitis to the aortic wall, which ruptured. We review 24 other cases of tuberculous aortic aneurysms surgically treated in Japan before 2004.     

结核性附睾炎的超声诊断与鉴别诊断

目的 通过分析结核性和非结核性附睾炎的彩色多普勒声像图特征，提高对两种疾病声像图的认识和诊断准确率。方法 回顾分析经证实的90例非结核性附睾炎和15例结核性附睾炎的声像图特征。结果 附睾炎多位于附睾尾部或体尾部，以青壮年多见，两者的声像图相似，但又有区别，结核病灶旁阴囊壁层的结构破坏和睾丸受累是主要的鉴别点。结论 超声检查可作为结核性附睾炎症的重要辅助诊断和鉴别诊断方法。     

Granulomatous orchitis and spermatic granuloma

One case of granulomatous orchitis and three cases of spermatic granuloma are described and the clinical and pathologic features of the two syndromes are discussed. Since no certain diagnosis is possible on clinical grounds alone, it rests on the evidence of pathology. Both granulomatous orchitis and spermatic granuloma are of practical importance to the specialists, the first being apt to mimic tumours, and the second to tuberculous epididymitis. Histological study, possibly of biopsy specimens, permits to differentiate either process from malignancy and from tuberculosis with certainty. It is to be emphasized that in many cases of chronic epididymitis with clinical suspicion of tuberculosis careful histological search reveals spermatic granuloma. Since the processes under discussion are unresponsive to antibiotics, their therapy is surgical.     

Tuberculous epididymitis caused by intravesical BCG therapy: a case report

We describe a case of tuberculous epididymitis that occurred 35 months after completion of a course of intravesical Bacillus Calmette-Guerin (BCG). A 67-year-old man had received trasuretheral resection for bladder cancer in February 1997. Two weeks after the operation, a course of 8 weekly intravesical instillations of BCG (Tokyo 172 strain) was carried out between March and April, 1997. Under the diagnosis of benign prostatic hypertrophy, transuretheral resection of the prostate was performed in March 1998. Multiple tuberculous nodules were histopathologically detected in resected prostatic tissues. The patient complained of a small nodule in the right epididymal tail in August 2001. The nodule developed during 6 weeks, with spontaneous perforation of the scrotal skin and discharge of pus. The pus contained acid-fast bacilli, which were shown to be tubercle bacilli by polymerase chain reaction (PCR) with pan-mycobacterium primer. MPB64-T2, T6 and pncA-7, 11C were positive, while PT-1, 2 and pncA-7, 10 were negative by PCR. These results revealed that Mycobacterium bovis (BCG Organism) was the cause of the epididymitis. Drug therapy for 3 months with rifampicin, isoniazid and ethambutol was initiated in September 2001, and right orchiectomy was performed in October. Histopathological examination showed tuberculous epididymitis. In this case, persistent BCG organisms may have reached the epididymis from the prostate, and may have been activated by immunosuppression associated with aging. In addition, PCR with species-specific primers was useful in differentiating Mycobacterium bovis from Mycobacterium tuberculosis.     

附睾肿物的超声诊断与鉴别诊断

目的:通过分析附睾肿物的超声特征,提高对附睾肿物的超声诊断及鉴别诊断水平。方法:回顾性分析1990年1月~2004年12月在我院接受手术治疗的179例附睾肿物患者,对病理诊断和超声特征进行分析。结果:179例患者,年龄(51.4±14.7)岁。附睾肿物包括附睾囊性肿物98例,非特异性附睾炎症27例,附睾结核33例,附睾肿瘤21例。附睾疾病中囊性肿物超声诊断率93.8%;附睾结核与附睾炎不易鉴别,两者主要区别在于附睾结核常同时合并肾、输尿管、膀胱、前列腺和睾丸等多脏器结核,在出现寒性脓疡、钙化灶,与皮肤形成窦道时易诊断;附睾肿瘤多为良性,恶性少见,应结合病史、体格检查和超声特征综合鉴别。结论:超声检查对附睾肿物的诊断和鉴别具有重要临床价值,是附睾疾病的首选影像学检查方法。     

Tuberculous epididymo-orchitis and prostatitis: a case report

The worldwide prevalence of tuberculosis (TB) is still high, remaining almost unchanged over the past century. The genitourinary tract belongs to one of the most common sites of extrapulmonary TB. Although rare, epididymal TB may be the only clinically evident location of infection. We present an unusual case of tuberculous epididymitis and prostatitis, demonstrating the need for insistent diagnostic procedures to confirm diagnosis. The treatment of choice is primarily medical, consisting of a combination of three or four anti-TB drugs, sometimes combined with surgery.     

Tuberculous epididymitis： a case report and literature review

Tuberculous epididymitis is a rare urological disease difficult to diagnose. The conventional methods for diagnosis are often time-consuming and invasive. The combined use of scrotal magnetic resonance imaging （MRI） and urinary polymerase chain reaction （PCR）-based assay for mycobacterial DNA （the latter because of its high sensitivity and specificity to demonstrate mycobacterial DNA） is a valuable method for rapid diagnosis of tuberculous epididymitis. We report a 79-year-old man who was admitted with the chief complaints of bilateral scrotal swelling and pain. The combined use of scrotal MRI and urinary PCR allowed prompt diagnosis of tuberculous epididymitis and adequate antituberculous therapy. （Asian J Androl 2005 Sep; 7： 329-332）     

Case of tuberculous epididymitis caused by intravesical BCG therapy

Intravesical Bacillus Calmette-Guerin (BCG) therapy is commonly used against superficial urothelial carcinoma, especially carcinoma in situ (CIS). We report a case of tuberculous epididymitis that occurred during a course of intravesical BCG therapy. A 76-year-old man had received intravesical BCG therapy for multiple superficial bladder cancer and CIS in prostatic urethra after transurethral resection of bladder tumor (TUR-Bt). He recognized hard nodules in the left scrotum after 4 times intravesical BCG therapy. Skin fistula in scrotum occurred 5 months later. We performed left orchiectomy with scrotum skin resection. Histological diagnosis was tuberculous epididymitis. Postoperatively, he was administered chemotherapy consisting of isoniazid, refampin and ethambutol.     

IFN-γ酶联免疫斑点法与结核菌素皮试在附睾结核检测中的应用比较

目的:将新兴的结核特异性IFN-γ酶联免疫斑点法(ELISPOT)应用于附睾结核检测,并比较其与传统的结核菌素皮试(PPD)在附睾结核及健康对照组中检测的差异,探讨ELISPOT在附睾结核诊断中的应用前景。方法:采用自主研制的ELISPOT试剂盒对13例附睾结核患者进行检测;采用PPD对11例附睾结核患者检测。同时采用2种方法对57例健康男性志愿者进行平行检测。结果:附睾结核患者,ELISPOT阳性率92.3%(12/13),PPD阳性率90.9%(10/11),2种方法差异无显著性(P>0.05)。健康志愿者中ELISPOT阳性率14.0%(8/57),PPD阳性率49.1%(28/57),两者差异有极显著性(P<0.01)。结论:附睾结核检测中ELISPOT在敏感性上与PPD一致,在区分附睾结核与健康人方面特异性优于PPD,在附睾结核诊断上有较好的应用前景。     

A case of tuberculosis of the prostate presenting as endoscopically cavitary change]

A 62-year-old man was admitted to our hospital with the chief complaint of terminal macroscopic hematuria. He had a history of left tuberculous epididymitis in 1994. On digital rectal examination, the prostate was found to be a normal size and slightly hard with no elasticity. Transcrectal ultrasound showed hypoechoic lesions in the peripheral zone. T1-weighted MRI demonstrated cavitary lesions and T2-weighted MRI demonstrated relatively low signal intensity in the same zone. Urethrography revealed various cystlike lesions in the prostatic urethra. Cystourethroscopy revealed cavitary change with many septa in the left lobe of the prostate. TUR-P was performed and histological findings of the specimen revealed tuberculosis of the prostate. The patient was treated with an antituberculous regimen of INH, RFP and EB.     

A case of tuberculous epididymitis after Bacillus Calmette-Guérin intravesical instillation therapy for bladder cancer

A 65-year-old male had undergone transurethral resection of bladder tumor (TUR-Bt) four times for recurrent bladder cancer, and each histopathological examination revealed non-invasive urothelial carcinoma, pTa, G2. To prevent further recurrence, he received eight weekly intravesical instillations of Bacillus Calmette-Guérin (BCG). Four months after the BCG therapy, he underwent cystoscopy. One week after the cystoscopy, he developed a painful and swollen left scrotum. Treatment with levofloxacin for acute epididymitis reduced the scrotal pain initially, but the pain increased and 3 months later, a fistula with suppurative discharge appeared at the bottom of the scrotum. A smear of the discharge revealed Gaffky 2, and a culture showed tubercle bacillus. Incisional drainage of the abscess and anti-tuberculosis chemotherapy for 2 months to treat tuberculous epididymitis was not completely effective. We performed a left orchiectomy with resection of the infected scrotal skin. Histopathological examination showed tuberculous epididymitis consisting of a caseating granuloma with epithelioid cells and Langhans giant cells. He received anti-tuberculosis chemotherapy for 4 months postoperatively and had no sign of recurrence 1 year postoperatively.     

Fine-needle aspiration cytology versus open biopsy for evaluation of chronic epididymal lesions: a prospective study

OBJECTIVE: To compare the efficacy of fine-needle aspiration cytology (FNAC) with that of open biopsy in the evaluation of chronic epididymal lesions. MATERIAL AND METHODS: Forty men evaluated for chronic epididymal lesions were studied. Men aged >25 years who did not intend to father any more children and had had local symptoms for >6 weeks were included. Of these 40 men, 23 who satisfied the above criteria were subjected to FNAC and open biopsy. The slides were reviewed by two independent pathologists. The sensitivity, specificity and positive predictive value of FNAC were compared with the results of open biopsy. RESULTS: Tuberculous epididymitis was the commonest cause of chronic epididymal lesions, followed by non-specific epididymitis, sperm granuloma, epdidymal cyst and normal epididymis. The sensitivity and specificity of FNAC for the diagnosis of tuberculous epididymitis were 87% and 93%, respectively. For the diagnosis of non-specific epididymitis, FNAC was 100% sensitive and 100% specific. The positive predictive value was 87% for the diagnosis of both tuberculous and non-specific epididymitis. CONCLUSIONS: FNAC has an overall sensitivity and specificity of 90% for diagnosing chronic epididymal lesions, with a positive predictive value of 87.5%. It is a valuable tool for evaluating chronic epididymal lesions. We suggest that FNAC should be the first-choice investigation for establishing the histopathological diagnosis of epididymal lesions.     

Bilateral tuberculous epididymitis after intravesical Bacillus Calmette-Guerin therapy

We describe a case of bilateral tuberculous epididymitis that occurred two weeks after intravesical Bacillus Calmette-Guerin (BCG) instillation. A 72-year-old man received transuretheral resection of bladder transitional cell carcinoma in November 2000. Although he had no recurrence for about 4 years, cystoscopy revealed small papillary tumors in the bladder in September 2004. A course of 8 weekly intravesical instillations of BCG was started. After the second BCG instillation (160 mg) he had bilateral painful scrotal swelling. Although he was administered isoniazid (INH) and rifampicin (RFP), scrotal swelling got worse. Right orchiectomy and left epididymectomy was performed in December 2004. Histological diagnosis was bilateral tuberculous epididymitis. Postoperatively, he was administered INH and RFP and had no recurrence for 3 months.     

肾结核的超声诊断与分型

目的：探讨肾结核超声诊断、分型及其临床价值。方法：回顾性分析资料完整的150例肾结核患者的超声声像图特点。结果：超声诊断肾结核的符合率为79．3％(119／150)，根据肾结核B超声像图特点，将肾结核分析归纳为6型，即囊肿型18例，积水型10例，积脓型6例，炎症萎缩型16例，钙化型31例，混合型38例。结论：超声检查具有价廉、无创等优点，对肾结核声像图的分型，有助于肾结核的诊断及鉴别诊断。