Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up

Abstract

Background Nowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes. Methods Patients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available. Results Eighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%). Conclusions We recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

Unilateral Testicular infarction a very rare complication of genitourinary tuberculosis: a case report and literature review

“…Implantation of the bacillus into genital organs mainly occurs through hematogenous deposition during early miliary spread (primary infection) or through lymphatic pathways. Sexual transmission has also been reported in rare cases of penile TB (5,6,11,13). The dissemination of the tubercle is again evident secondarily via local, direct spread from contagious infected organs through either the antegrade or retrograde route (13).…”

“…The epididymis, prostate, seminal vesicles, testes, vas deferens, and penis have rarely been described under the umbrella of male genital TB. The epididymis and prostate are the most frequently affected organs (5,6,11,12).…”

“…Likewise, the yield from urine AFB culture is low, although it was previously considered the gold standard, and the absence of growth of bacilli on culture medium does not rule out tuberculosis (6, 11). However, rapid microbiological diagnostic tests such as Gene X-pert have a relatively higher sensitivity than urine microscopy and culture (5,11).…”

Isolated epididymal tuberculosis: case report and review of literature

“…Medical therapy alone may be sufficient, although surgical management is required in cases of residual abscesses requiring drainage or if there are no signs of resolution within 2 months of medical treatment. 11,14,17…”

Tuberculosis Epididymo-Orchitis Mimicking Malignancy Resulting from Intravesical Bacillus Calmette–Guérin Immunotherapy for Bladder Cancer: A Case Report of a Rare Complication

“…The diagnosis of tuberculous epididymo-orchitis is made if there is a typical clinical presentation combined with one of the following criteria: (1) positive AFS in urine; (2) positive urine culture for M. tuberculosis ; (3) positivity of PCR for M. tuberculosis in urine; and (4) typical granulomatous inflammation with caseous necrosis in microscopy plus any positive result of Ziehl–Neelsen AFS or PCR for M. tuberculosis in any relevant tissue specimen [ 14 , 15 ]. However, because of the lack of diagnostic methods with high sensitivity and specificity, tuberculous epididymo-orchitis is often misdiagnosed as a bacterial infection or tumor [ 14 , 16 ].…”