Acute scrotal pain is a common urological emergency where clinical judgement plays pivotal role in making the diagnosis. Scrotal pain secondary to spontaneous pampiniform plexus thrombosis is rare, and we are the first who report in the Asian region.A 50-year-old gentleman presented with left-sided scrotal pain & swelling. The diagnosis of pampiniform plexus thrombosis was confirmed by the ultrasound Doppler. He was treated with anticoagulant and good clinical result was obtained.Uncomplicated thrombosis could be managed non-surgically with good clinical outcome and radiological resolution. Ultrasound doppler remains first-line investigation to establish diagnosis, monitor the progression and treatment outcome.

BACKGROUND Prior to the coronavirus disease 2019 (COVID-19) pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE To investigate current telemedicine usage by urologists, urologist perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS We performed a global, cross-sectional web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists’ perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1%. Of the urologists without telemedicine experience, interest in usage of telemedicine increased from 43.7 to 80.8% during COVID-19. Among urologists that used telemedicine during the pandemic, 80.9% were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic and the top three barriers to implementing telemedicine were patient lack of technological comprehension, patient lack of access to required technology, and reimbursement concerns. CONCLUSIONS This is the first study to quantify the use, usability, and pervading interest in telemedicine amongst urologists during the COVID-19 pandemic. In the face of this pandemic, urologists’ usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.

Low-intensity shockwave therapy (LiSWT) has emerged as a promising non-invasive treatment modality for erectile dysfunction (ED) yet the well-designed randomized clinical trials are still lacking to prove its claimed benefits. A randomized, prospective, double-blinded sham-controlled study was conducted to evaluate the effectiveness and safety profile of short course LiSWT on vasculogenic ED patients. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) questionnaires were used for evaluation. Patients underwent weekly sessions for 4 weeks and were re-assessed at 1, 3 and 6 months post therapy. Fifty one patients were recruited and randomized into sham and treatment arms. The mean IIEF-5 scores were significantly improved in the treatment arm compared to worsening of scores in the sham arm after 1 month (14.1 vs. 9.3 p < 0.001), 3 months (14.9 vs. 8.6, p < 0.001) and 6 months (14.2 vs. 7.9, p < 0.001) post treatment. A significant improvement of EHS was demonstrated at 1 month (2.4 vs. 1.8, p = 0.001, 3 months 2.7 vs. 1.7, p < 0.001) and 6 months (2.7 vs. 1.6, p < 0.001) in the treatment arm compared to sham arm. The success rate based on IIEF score increment more than five points was 26% in treatment arm and 0% in sham arm. Improvement in EHS score ≥3 in the treatment versus sham arm was 63% and 4%, respectively.There was no adverse effect reported. This 4-week LiSWT protocol reflects better treatment compliance, and it prevents further deterioration of erectile function among this cohort of patients. This study proves that LiSWT is a well-tolerated treatment with modest improvements in erectile function and hardness, among patients with vasculogenic ED.

Highlights A rare case of bilateral epididymo-orchitis complicated with bilateral testicular infarction. Presentation was fever with persistent, unresolved pain and scrotal swelling. Antibiotic therapy failed to halt disease progression of bilateral testicular ischemia. Bilateral orchidectomy performed as both testes were not viable, resulting in castration and lifelong testosterone replacement.