OJU  Vol.3 No.2 , May 2013
Epididymo-Orchitis in Pre-Pubertal Children. Epidemiology, Etiology, Management and Follow-Up Recommendations
Abstract: Epididymo-Orchitis (EO) is a disease that may affect males in all ages. Neonates and elderly patients may suffer from bacterial infection due to congenital or aging processes affecting the urinary tract. In sexually active post pubertal and young males sexually transmitted organisms may cause EO. EO is also prevalent in pre pubertal healthy boys; however in this group the etiology, the needed imaging modalities and proper management are not clearly defined yet. This manuscript will systematically review the various etiologies causing EO in pre-pubertal boys, discus about the needed proper imaging, and image interpretation, will give treatment and follow-up recommendations.
Cite this paper: S. Halachmi and N. Katz, "Epididymo-Orchitis in Pre-Pubertal Children. Epidemiology, Etiology, Management and Follow-Up Recommendations," Open Journal of Urology, Vol. 3 No. 2, 2013, pp. 96-101. doi: 10.4236/oju.2013.32019.

[1]   P. A. Anderson and J. M. Giacomantonio, “The Acutely Painful Scrotum in Children: Review of 113 Consecutive Cases,” Canadian Medical Association Journal, Vol. 132, No. 10, 1985, pp. 1153-1155.

[2]   A. G. Lewis, T. P. Bukowski, P. D. Jarvis, J. Wacksman, and C. A. Sheldon, “Evaluation of Acute Scrotum in the Emergency Department,” Journal of Pediatric Surgery, Vol. 30, No. 2, 1995, pp. 277-281.

[3]   B. Klin, L. Zlotkevich, T. Horne, Y. Efrati, F. Serour and G. Lotan, “Epididymitis in Childhood: A Clinical Retrospective Study Over 5 Years,” The Israel Medical Association Journal, Vol. 3, No. 11, 2001, pp. 833-855.

[4]   J. Ben Chaim, I. Leibovitch, J. Ramon, D. Winberg and B. Goldwasser, “Etiology of Acute Scrotum at Surgical Exploration in Children, Adolescents and Adults,” European Urology, Vol. 21, No. 1, 1992, pp. 45-47.

[5]   S. Halachmi, A. Toubi and S. Meretyk, “Inflamation of the Testis and Epidididymis in an Otherwise Healthy Child: Is It a True Bacterial Urinary Tract Infection?” Journal of Pediatric Urology, Vol. 2, No. 4, 2006, pp. 386-389.

[6]   H. F. McAndrew, R. Pemberton, C. S. Kikiros and I. Gollow, “The Incidence and Investigation of Acute Scrotal Problems in Children,” Pediatric Surgery International, Vol. 18, No. 5-6, 2002, pp. 435-437.

[7]   E. Somekh, A Gorenstein and F. Serour, “Acute Epididymitis in Boys: Evidence of a Post-Infectious Etiology,” The Journal of Urology, Vol. 171, No. 1, 2004, pp. 391-394.

[8]   A. Siegel, H. Snyder and J. W. Duckett, “Epididymitis in Infants and Boys: Underlying Urogenital Anomalies and Efficacy of Imaging Modalities,” The Journal of Urology, Vol. 138, No. 4, 1987, pp. 1100-1103.

[9]   J. F. Squadrito Jr., M. D. Rifkin and S. G. Mulholland, “Ureteral Ectopia Presenting As Epididymitis and Infertility,” Urology, Vol. 30, No. 1, 1987, pp. 67-69.

[10]   T. Umeyama, T. Kawamura, A. Hasegawa and O. Ogawa, “Ectopic Ureter Presenting with Epididymitis in Childhood: Report of 5 Cases,” The Journal of Urology, Vol. 134, No. 1, 1985, pp. 131-133.

[11]   K. Shiraishi and H. Takihara, “Recurrent EpididymoOrchitis Caused by Posterior Urethral Valve Associated With Imperforate Anus,” International Journal of Urology, Vol. 11, No. 1, 2004, pp. 58-60.

[12]   D. I. Williams and J. Grant, “Urological Complications of Imperforate Anus,” British Journal of Urology, Vol. 41, No. 6, 1969, pp. 660-665.

[13]   B. Karmazyn, M. Kaefer, S. Kauffman and S. G. Jennings, “Ultrasonography and Clinical Findings in Children With Epididymitis, with and Without Associated Lower Urinary Tract Abnormalities,” Pediatric Radiology, Vol. 39, No. 10, 2009, pp. 1054-1058.

[14]   B. Lindehall, K. Abrahamsson, K. Hjalmas, U. Jodal, I. Olsson and U. Sillen, “Complications of Clean Intermittent Catheterization in Boys and Young Males With Neurogenic Bladder Dysfunction,” The Journal of Urology, Vol. 172, No. 4, 2004, pp. 1686-1688.

[15]   P. Vogt, P. Francioli, J. Bille and M. P. Glauser, “Brucellosis: A Varied Clinical Presentation in 9 Patients,” Schweizerische Medizinische Wochenschrift, Vol. 114, No. 51, 1984, pp. 1906-1909.

[16]   A. Chattopadhyay, V. Bhatnagar, S. Agarwala and D. K. Mitra, “Genitourinary Tuberculosis in Pediatric Surgical Practice,” Journal of Pediatric Surgery, Vol. 32, No. 9, 1997, pp. 1283-1286.

[17]   D. A. Cabral, H. W. Johnson, G. U. Coleman, M. Nigro and D. P. Speert, “Tuberculous Epididymitis As a Cause of Testicular Pseudomalignancy in Two Young Children,” Pediatric Infectious Disease Journal, Vol. 4, No. 1, 1985, pp. 59-62.

[18]   L. Mbala, N. Ilunga and K. Kadinekene, “A 3-Year-Old Boy with Tuberculous Epididymo-Orchitis,” Tropical Doctor, Vol. 27, No. 1, 1997, pp. 50-51.

[19]   Z. Mor, G. Pinsker, N. Cedar, M. Lidji and I. Grotto, “Adult Tuberculosis in Israel and Migration: Trends and Challenges between 1999 and 2010,” International Journal of Tuberculosis and Lung Disease, Vol. 16, No. 12, 2012, pp. 1613-1618.

[20]   M. A. Tasar, I. Bostanci, B. Karabulut and Y. Dallar, “A Rare Extrahepatic Syndrome Related to Acute Hepatitis Type B: Epididymitis in an Adolescent,” Acta Gastro— Enterologica Belgica, Vol. 68, No. 2, 2005, pp. 270-271.

[21]   A. E. Barskey, C. Schulte, J. B. Rosen, E. F. Handschur, E. Rausch-Phung, M. K. Doll, K. P. Cummings, E. O. Alleyne, P. High, J. Lawler, A. Apostolou, D. Blog, C. M. Zimmerman, B. Montana, R. Harpaz, C. J. Hickman, P. A. Rota, J. S. Rota, W. J. Bellini and K. M. Gallagher, “Mumps Outbreak in Orthodox Jewish Communities in the United States,” New England Journal of Medicine, Vol. 367, No. 18, 2012, pp. 1704-1713.

[22]   L. E. Galejs and E. J. Kass, “Color Doppler Ultrasound Evaluation of the Acute Scrotum,” Techniques in Urology, Vol. 4, No. 4, 1998, pp. 182-184.

[23]   S. Strauss, R. Faingold and H. Manor, “Torsion of the Testicular Appendages: Sonographic Appearance,” Journal of Ultrasound in Medicine, Vol. 16, No. 3, 1997, pp. 189-192.

[24]   P. K. Hegarty, E. Walsh and M. O. Corcoran, “Exploration of the Acute Scrotum: A Retrospective Analysis of 100 Consecutive Cases,” Irish Journal of Medical Sciences, Vol. 170, No. 3, 2001, pp. 181-182.

[25]   M. Blaivas, P. Sierzenski and M. Lambert, “Emergency Evaluation of Patients Presenting With Acute Scrotum Using Bedside Ultrasonography,” Academic Emergency Medicine, Vol. 8, No. 1, 2001, pp. 90-93.

[26]   M. Blaivas and P. Sierzenski, “Emergency Ultrasonography in the Evaluation of the Acute Scrotum,” Academic Emergency Medicine, Vol. 8, No. 1, 2001, pp. 85-89.

[27]   M. Blaivas and L. Brannam, “Testicular Ultrasound,” Emergency Medicine Clinics of North America, Vol. 22, No. 3, 2004, pp. 723-748.

[28]   E. J. Kass, K. T. Stone, A. A. Cacciarelli and B. Mitchell, “Do All Children With an Acute Scrotum Require Exploration?” The Journal of Urology, Vol. 150, No. 2, 1993, pp. 667-669.

[29]   G. Liguori, S. Bucci, A. Zordani, S. Benvenuto, G. Ollandini, G. Mazzon, M. Bertolotto, F. Cacciato, S. Siracusano and C. Trombetta, “Role of US in Acute Scrotal Pain,” World Journal of Urology , Vol. 29, No. 5, 2011, pp. 639-643.

[30]   K. A. Johnson and K. C. Dewbury, “Ultrasound Imaging of the Appendix Testis and Appendix Epididymis,” Clinical Radiology, Vol. 51, No. 5, 1996, pp. 335-337.

[31]   M. Baldisserotto, J. C. de Souza, A. P. Pertence and M. D. Dora, “Color Doppler Sonography of Normal and Torsed Testicular Appendages in Children,” American Journal of Roentgenology, Vol. 184, No. 4, 2005, pp. 1287-1292.

[32]   S. J. Park, H. L. Kim and B. H. Yi, “Sonography of Intrascrotal Appendage Torsion: Varying Echogenicity of the Torsed Appendage according to the Time from Onset,” Journal of Ultrasound in Medicine, Vol. 30, No. 10, 2011, pp. 1391-1396.

[33]   O. Cappele, A. Liard, E. Barret, B. Bachy and P. Mitrofanoff, “Epididymitis in Children: Is Further Investigation Necessary after the First Episode?” European Urology, Vol. 38, No. 5, 2000, pp. 627-630.

[34]   L. A. Graumann, H. G. Dietz and M. Stehr, “Urinalysis in Children with Epididymitis,” European Journal of Pediatric Surgery, Vol. 20, No. 4, 2010, pp. 247-249.