Testicular abscess

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In the present literature review modern view on the etiopathogenesis, clinical course, diagnosis, treatment and prognosis of testicular abscess, which is a rare disease, are described. Testicular abscess develops most often as a result of acute epididymo-orchitis (more than 80% of all cases), much rarer due to testicular inversion and injury. The etiological agent is often E. coli. The disease occurs at any age, especially in immunocompromised patients. Clinical and laboratory picture of testicular abscess has symptomatic nature and consists of local and general signs of purulent inflammation. There are no pathognomonic clinical symptoms. Testicular abscess may occur under the guise of acute inguinal and scrotal area diseases, in a quarter of patients it is characterized by inapparent clinical and laboratory course, simulating testicular tumor or tuberculous orchitis. Diagnostic difficulties are caused by nonspecific clinical and laboratory characteristics and radiation patterns, disease infrequency and a lack of awareness among physicians. Suspicion of testicular abscess arise in ineffectiveness of antibiotic therapy for acute epididymo-orchitis during the first 5-7 days of disease and makes physician to perform necessary X-ray studies. The method of choice for the testicular abscess diagnosis is ultrasound examination. The diagnostic capabilities of other radiation techniques have currently been studying. Ultrasound picture of testicular abscess depending on the disease stage is varying and does not differ from the ultrasound picture of abscess of other localization. The most difficult is differential diagnosis of abscess and testicular tumors. In diagnostically ambiguous cases, ultrasound-guided percutaneous testicle biopsy or exploratory surgery are performed. Choice of treatment method is determined by the disease stage. A variety of conservative and surgical treatment methods of the testicular abscess are applied, such as antibiotic therapy, percutaneous puncture and ultrasound-guided abscess aspiration, abscessotomy and orchiectomy. Prognosis for life is favorable with timely treatment of disease.

About the authors

A V Prokhorov

Moscow, Russia

Author for correspondence.
Email: botex@rambler.ru

References

  1. Давыдовский И.В. Общая патология человека. М.: Медицина. 1969; 369-430.
  2. Серов В.В., Пауков В.С. Воспаление. Руководство для врачей. М.: Медицина. 1995; 184-190.
  3. Al-Obeid K., Al-Khalifan N.N., Jamal W. et al. Epididymo-orchitis abscess caused by Salmonella enteritidis in immunocompromised patients in Kuwait. Med. Principles Practice. 2006; 15: 305-308. http://dx.doi.org/10.1159/000092996
  4. Avery L.L., Scheinfeld M.H. Imaging of penile and scrotal emergencies. RadioGraphics. 2013; 33: 721-740. http://dx.doi.org/10.1148/rg.333125158
  5. Banura O., Shulyak A. Acute epididymo-orchitis: staging and treatment. Central Eur. J. Urol. 2012; 65: 139-143. http://dx.doi.org/10.5173/ceju.2012.03.art8
  6. Basu S., Suri S., Kumar A. Scrotal abscess owing to Candida albicans in a newborn. Paediatr. Int. Child Health. 2013; 33: 53-55. http://dx.doi.org/10.1179/2046905512Y.0000000021
  7. Biswas S., Basu G. Causes & management of testicular abscess: findings of a study on eleven patients. J. Dent. Med. Sci. (IOSR-JDMS). 2013; 9: 26-30.
  8. Boldt B.M., Nguyen D. Post-traumatic intra-testicular haematoma may mimic a neoplasm or abscess on ultrasound. BMJ Case Rep. 2010. Nov. 5. http://dx.doi.org/10.1136/bcr.06.2010.3119
  9. Breysem L., Herman M., Moerman P. et al. High-resolution sonography of a scrotal abscess in a 2-week-old infant. Pediatr. Radiol. 2006; 36: 1195-1196. http://dx.doi.org/10.1007/s00247-006-0273-4
  10. Castillo Soria J.L., Bravo de Rueda Accinelli C. Genital brucellosis. A rare cause of testicular abscess. Arch. Esp. Urol. 1994; 47: 533-536.
  11. Cassidy F.H., Ishiora K.M., McMahon C.F. et al. MR imaging of scrotal tumors and pseudotumors. RadioGraphics. 2010; 30: 665-683. http://dx.doi.org/10.1148/rg.303095049
  12. Coskun O., Cem G.H., Mert G. et al. Brucellar epididymo-orchitis: a retrospective study. Trakya Universitesi Tip Fakultesi Dergisi. 2009; 26: 220-225.
  13. Danielson K.S., James E.M., Kurtz S.B., Schwartz G.L. High-resolution sonographic detection of gas-forming testicular abscess in a renal transplant patient. J. Ultrasound Med. 1984; 3: 45-47.
  14. Derouet H., Braedel H.U., Brill G. et al. Magnetic resonance tomography in the differential diagnosis of pathologic chages in scrotal contents - a comparison with computed tomography. ROFO. 1991; 155: 436-441. http://dx.doi.org/10.1055/s-2008-1033292
  15. Desai K.M., Gingell J.C., Haworth J.M. Localised intratesticular abscess complicating epididymo-orchitis: the use of scrotal ultrasonography in diagnosis and management. Brit. Med. J. 1986; 292: 1361-1362. http://dx.doi.org/10.1136/bmj.292.6532.1361-a
  16. Desai G. Tuberculosis in AIDS presenting as a testicular abscess. Br. J. Urol. 1994; 73: 325-326. http://dx.doi.org/10.1111/j.1464-410X.1994.tb07533.x
  17. Dogra V.S., Gottlieb R.H., Rubens D.J., Liao L. Benign intratesticular cystic lesions: US features. RadioGraphics. 2001; 21: S273-S281. http://dx.doi.org/10.1148/radiographics.21.suppl_1.g01oc15s273
  18. Dobroszycki J., Abadi J., Lambert G. et al. Testicular abscess due to Streptococcus pneumonia in an infant with human immunodeficiency virus infection. Clin. Infect. Dis. 1997; 24: 84-85. http://dx.doi.org/10.1093/clinids/24.1.84
  19. Drudi F.M., Valentino M., Di Leo N. et al. Color-/power Doppler ultrasound imaging and ultrasound contrast media in acute scrotum. Ultraschall. Med. 2013; 34: 72-81. http://dx.doi.org/10.1093/clinids/24.1.8410.1055/s-0032-1325563
  20. Duan G., Xu Y.K., Dai L., Zhang X.D. CT diagnosis and pathological findings of testicular lesion. Nan Fang YiKe Da Xue Xue Bao. 2007; 27: 98-100.
  21. Dubepuria R., Gupta A.K., Gupta A., Gupta A.K. An uncommon presentation of testicular abscess: a case report. Sch. J. Med. Case Rep. 2014; 2: 597-598.
  22. Dudea S.M., Ciurea A., Chiorean A., Botar-Jid C. Doppler applications in testicular and scrotal diseases. Med. Ultrasound. 2010; 12: 43-51.
  23. Egender G., Scheiber K., Stampfel G., Frommhold H. Echographic differential diagnosis of scrotal contents. A contribution to evaluation of the method. ROFO. 1985; 142: 304-309. http://dx.doi.org/10.1055/s-2008-1052654
  24. Ejlertsen T., Jensen H.K. Orchitis and testicular abscess formation caused by non-typhoid salmonellosis. A case report. APMIS. 1990; 98: 294-298. http://dx.doi.org/10.1111/j.1699-0463.1990.tb01035.x
  25. Fehily S.R., Trubiano J.A., McLean C. et al. Testicular loss following bacterial epididymo-orchitis: case report and literature review. Can. Urol. Assoc. J. 2015; 9 (3-4): E148-151. http://dx.doi.org/10.5489/cuaj.2174
  26. Goodman P., Maklad N.F., Verani R.R., Gottlieb H.E. Tuberculous abscess of the testicle in AIDS: sonographic demonstration. Urol. Radiol. 1990; 12: 53-55. http://dx.doi.org/10.1007/BF02923967
  27. Granados E.A., de la Torre P., Alberolla J. Echography, a diagnostic method in testicular abscess. Arch. Esp. Urol. 1991; 44: 669-771.
  28. Granados Loarca E.A., Del Monte G.R., Palou Redorta J., Villavicencio Mavrich H. Epididymo-testicular abscess. Arch. Esp. Urol. 1994; 47: 553-556.
  29. Granados Loarca E.A. Testicular abscess: a manifestation of tuberculosis. Arch. Urol. Esp. 1998; 22: 381-383.
  30. Grenader T. Testicular abscess an unusual cause for febrile neutropenia. Sci. World J. 2008; 8: 953-955. http://dx.doi.org/10.1100/tsw.2008.135
  31. Hausegger K. Differential sonographic diagnosis of scrotal diseases. ROFO. 1987; 146: 538-543. http://dx.doi.org/10.1055/s-2008-1048535
  32. Ikeda D., Matsutani R., Fuse H., Hirano S. Testicular abscess: report of 2 cases. Hinyokika Kiyo. 2004; 50: 741-744.
  33. Kim W., Rosen M.A., Langer F.E. et al. US-MR imaging correlation in pathologic conditions of the scrotum. RadioGraphics. 2007; 27: 1239-1253. http://dx.doi.org/10.1148/rg.275065172
  34. Koc Z., Turunc T., Boga C. Gonadal brucellar abscess: imaging and clinical findings in 3 cases and review of the literature. J. Clin. Ultrasound. 2007; 35: 395-400. http://dx.doi.org/10.1002/jcu.20330
  35. Lopez-Fontana G., Lopez-Fontana R., Valdemoros P. et al. Non palpable testicular tumors. Retrospective series. Prog. Urol. 2014; 24: 46-50. http://dx.doi.org/10.1016/j.purol.2013.06.001
  36. Lung P.F., Jaffer O.S., Sellars M.E. et al. Contrast-enhanced ultrasound in the evaluation of focal testicular complications secondary to epididymitis. AJR Am. J. Roentgenol. 2012; 199: W345-354. http://dx.doi.org/10.2214/AJR.11.7997
  37. Mevorach R.A., Lerner R.M., Dvoretsky P.M., Rabinowitz R. Testicular abscess: diagnosis by ultrasonography. J. Urol. 1986; 136: 1213-1216.
  38. Moschouris H., Stamatiou K., Lampropoulou E. et al. Imaging of the acute scrotum: a place for contrast-enhanced ultrasonography? Int. Braz. J. Urol. 2009; 35: 702-705. http://dx.doi.org/10.1590/S1677-55382009000600008
  39. Muttarak M., Chiangmai W.N., Kitirattrakarn P. Necrotising epididymo-orchtis with scrotal abscess. Biomed. Imaging Interv. J. 2005; 1: 1-3. http://dx.doi.org/10.2349/biij.1.2.e11
  40. Nakajima N., Nishizawa K., Miakita H. et al. Testicular scanning in intrascrotal lesions. Hinyokika Kiyo. 1986; 32: 1275-1281.
  41. Onoura V.C., Patil M.G. The limitations of ultrasonography in the management of testicular abscesses. East Afr. Med. J. 1993; 70: 449-451.
  42. Oscar H., Kapur J. Role of ultrasound in management of scrotal abnormalities in children. Med. J. Malasysia. 2012; 67: 549-555.
  43. Parenti G.C., Feletti F., Brandini F. et al. Imaging of the scrotum: role of MRI. Radiol. Med. 2009; 114: 414-424. http://dx.doi.org/10.1007/s11547-009-0377-7
  44. Pepe P., Panella P., Pennisi M., Aragona F. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur. J. Radiol. 2066; 60: 120-124. http://dx.doi.org/10.1016/j.ejrad.2006.04.016
  45. Pilatz A., Wagenlehner F., Bschleipfer T. et al. Acute epididymitis in ultrasound: results of a prospective study with baseline and follow-up investigations in 134 patients. Eur. J. Radiol. 2013; 82: e762-768. http://dx.doi.org/10.1016/j.ejrad.2013.08.050
  46. Raveenthiran V., Cenita S. Scrotal abscess mimicking testicular torsion in infants and neonates. J. Pediatr. Surg. 2007; 42: 597-598. http://dx.doi.org/10.1016/j.jpedsurg.2006.02.040
  47. Rifkin M.D., Kurtz A.B., Pasto M.E., Goldberg B.B. Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation. J. Ultrasound Med. 1985; 4: 13-19.
  48. Rodriques-Patron R.R., Mayayo D.T., Lennie Z.A. et al. Testicular ultrasonography. Arch. Esp. Urol. 2006; 59: 441-454.
  49. Satchithananda K., Beese R.C., Sidhu P.S. Acute appendicitis presenting with a testicular mass: ultrasound appearances. Br. J. Radiol. 2000; 73: 780-782. http://dx.doi.org/10.1259/bjr.73.871.11089472
  50. Sharma V., Masson P., Choy J.T. et al. Outcomes of inpatient testicular abscesses complicating epididymitis and orchitis among hospitalized patients. J. Urol. 2013; 189: E476. http://dx.doi.org/10.1016/j.juro.2013.02.803
  51. Suhani A., Choudhari V., Thomas S. Case report: testicular abscess: an uncommon complication of a common entity. Frontiers in Clin. Med. 2014; 1: 12-13.
  52. Suzer O., Ozcan H., Kupeli S., Gheiler E.L. Color Doppler imaging in the diagnosis of the scrotum. Eur. Urol. 1997; 32: 457-461.
  53. Tena D., Leal F., Pozo B., Bisquert J. Bilateral testicular abscess due to Streptococcus pneumonia. Int. J. Infect. Dis. 2008; 12: 343-344. http://dx.doi.org/10.1016/j.ijid.2007.09.003
  54. Tsuchiyama K., Iwasaki H., Fuse H., Imamura Y. A case of testicular abscess with low-grade inflammation. Hinyokika Kiyo. 2013; 59: 461-464.
  55. Turhan V., Acar A., Ates F. et al. Orchiectomy perfomed in two patients with Brucella orchitis mimicking testicular tumor. West Indian Med. J. 2013; 62: 557-560. http://dx.doi.org/10.7727/wimj.2012.042
  56. Valentino M., Bertolotto M., Derchi L. et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur. Radiol. 2011; 21: 1831-1840. http://dx.doi.org/10.1007/s00330-010-2039-5
  57. Ye L., Wang X., Zhang Y. et al. Nonpalpable testicular masses incidentally discovered by ultrasound. Zhonghua Wai Ke Za Zhi. 1999; 37: 168-170.
  58. Yemisen M., Karakas E., Ozdemir I., Karakas O. Brucellar testicular abscess: a rare cause of testicular mass. J. Infect. Chemother. 2012; 18: 760-763. http://dx.doi.org/10.1007/s10156-011-0354-7
  59. Yusuf G., Sellars M.E., Kooiman G.G. et al. Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. J. Ultrasound Med. 2013; 32: 175-180.
  60. Zaid U.B., Bagga H.S., Reese A.C., Breyer B.N. Intratesticular abscess in a solitary testicle: the case for testicle sparing management. Case Reports Med. 2013: 184064. http://dx.doi.org/10.1155/2013/184064

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