Inflammation of the gonad in prepubertal healthy children. Epidemiology, etiology, and management.

The prevalence, etiology, and proper management of acute gonadal inflammation in prepubertal children are still controversial, with some reports defining it as rare, while others have found it more prevalent. So far, there is no consensus on imaging studies or standard follow-up procedures. In the minority of the children, the inflammation is related to congenital genitourinary malformation and bacterial infection. The majority of children with gonadal inflammation are healthy and do not have any underlying malformations; in this group, the etiology is related to viral infection or torsion of the gonad appendix. Management is directed towards the etiology. Hence, when bacterial inflammation is suspected, antibiotics should be given and full evaluation of the urinary tract system should be performed. For patients with negative medical history, absence of fever, and normal urinalysis, the diagnosis of bacterial inflammation is very unlikely, and there is neither justification for antimicrobial antibiotic therapy nor for any further urinary tract imaging. Caution should be taken with nonverbal children and infants, or patients with any abnormal parameter. For these patients, we recommend initial management as for bacterial urinary tract infection, until urine cultures results are obtained. This paper provides a comprehensive review with the related medical literature.