Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

Abstract

<b><i>Objective:</i></b> This study aimed to explore the clinical characteristics, treatment methods, and prognosis of neonatal pyocele of tunica vaginalis and to provide a reference for the clinical treatment. <b><i>Methods:</i></b> A total of 56 newborns with pyocele of tunica vaginalis were admitted to our hospital due to the scrotal emergency from January 2015 to January 2020. Our study retrospectively analyzed these 56 cases. Of the 56 cases, including 32 full-term infants and 24 premature infants, age ranged from 1 to 27 days. Initially, conservative treatment (intravenous antibiotic treatment) was applied to 42 cases, and surgery to 14 cases. Then, 7 underwent surgical exploration during the conservative treatment, and 2 cases with initial surgical treatment experienced orchiectomy because of complete necrosis. For 56 cases, the average follow-up time was 18 months. <b><i>Results:</i></b> The clinical recovery time of cases with conservative treatment ranged from 8 to 17 days, with an average of 11.02 ± 2.31 days. The clinical recovery time of cases with surgery ranged from 6 to 15 days, with an average of 9.28 ± 2.78 days. During the follow-up, for 56 cases, except for the 2 cases with orchiectomy, the testicular position and Doppler flow both went back to normal, of the 42 cases with initial conservative treatment, 1 case experienced testicular retardation, of the 14 cases with initial surgical treatment, 2 cases experienced testicular retardation, and hydrocele of 42 cases were self-healed. <b><i>Conclusions:</i></b> Neonatal pyocele of tunica vaginalis is mostly secondary to intra-abdominal infection. Color Doppler ultrasound is helpful for the diagnosis. The percutaneous aspiration is a way of collecting pathogenic bacteria during the conservative treatment. If the color Doppler suggests testicular involvement, surgical exploration should be performed.

Neonatal pyocele originating from a urinary tract infection: a case report

“…Considered an emergency, pyocele is a rare cause of acute scrotum in the neonatal and infantile period, having occurred in cases with varying ages, with testicular torsion ruled out as a differential diagnosis [ 2 , 8 ]. The main suggestive features are clinical presentation indicating infection, including fever, scrotal and inguinal canal erythema, and tenderness [ 2 ].…”

“…Even though most cases of pyocele are idiopathic in etiology and the source of infection remains unrecognized, there have been descriptions of various possible mechanisms of pathogenesis in the literature [ 1 , 6 – 8 , 10 ]. These mechanisms include hematogenous seeding of the serosa lining, secondary infection of a hydrocele following orchitis or epididymitis, seeding from an intraperitoneal source through a patent tunica vaginalis, or reflux of urine into the vas deferens, which are the most common pathways at fault [ 3 , 12 , 13 ].…”

“…Furthermore, surgical exploration, though unwarranted for the pyocele itself, was carried out to rule out the possibility of testicular torsion. However, previously published studies have demonstrated the effectiveness of both interventional and conservative approaches [ 2 – 4 , 8 – 11 , 14 , 16 – 18 ]. For instance, one study reported the resolution of the infection with intravenous ampicillin and cefotaxime, with the former discontinued after obtaining the results from urine and blood cultures [ 3 ].…”

“…However, in one study on 56 newborns, 35 received only antibiotic therapy, while 21 underwent surgical exploration and drainage. Moreover, seven cases in the latter had an initial conservative management approach either due to unresponsiveness to the therapy or suffering from testicular necrosis [ 8 ]. These findings demonstrate that the physicians in charge of the patients’ treatment should thoroughly weigh the benefits against the risks of each of the mentioned approaches in a case-by-case manner and then decide on the most appropriate course of treatment.…”

“…Although other and more critical conditions, including testicular torsion, need to be considered in such presentations, one rare differential diagnosis is the infected hydrocele or pyocele, requiring emergent antibiotic therapy, and in some cases, surgical exploration with drainage or aspiration [ 2 – 4 ]. Though many are idiopathic, reports suggest the spread from an intraperitoneal infection (that is, via a patent process vaginalis) as the most common etiology [ 5 – 8 ]. Moreover, the pathogens in most reported cases were found to be bacterial, primarily Escherichia coli ( E. coli ) and, in some instances, Staphylococcus lugdunensis , Klebsiella pneumonia , β-hemolytic streptococci, Salmonella spp., Bacteroides fragilis , and Proteus mirabilis [ 2 – 6 , 9 ].…”