Kim Jae Yoon, Kim Jung Yeon, Cho Dae Yeon, Yu Ji Hyeong
Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Department of Pathology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Transl Androl Urol. 2023 Jun 30;12(6):1033-1040. doi: 10.21037/tau-22-728. Epub 2023 May 22.
Epididymal tuberculosis (TB) is an uncommon form of TB, although it is known to develop frequently in the male reproductive system. Infertility is rare but important among subsequent possible complications caused by the disease, particularly in young males. Moreover, it is difficult to differentiate epididymal TB from other epididymo-testicular diseases. Herein, we report a rare case of a young patient recently diagnosed with bilateral epididymal TB causing male infertility.
We report the case of a 37-year-old patient who presented with left testicular pain and swelling lasting for about 8 months. He had no comorbidities, including pulmonary TB. Additionally, he had no children and was worried about infertility. Physical examination revealed a firm and tender mass, which was palpable in the left epididymal area, measuring 3.5 cm × 2.2 cm in diameter. Acid-fast bacilli staining and polymerase chain reaction of the urine were negative. Semen analysis showed no sperm in the semen, implying azoospermia diagnosis. Scrotal ultrasonography was suggestive of severe left epididymitis with abscess formation without abnormal appearance of the testicle. Due to persistent testicular pain, intermittent fever, and severe epididymitis with abscess formation, the patient underwent epididymectomy. Surgical exploration of the testicle revealed a severely swollen and firm epididymis with abscess materials and hard and dilated vas deferens connected to the epididymis, implying severe inflammatory reactions. The histopathological examination revealed chronic granulomatous inflammation with caseous necrosis in the epididymis tissue. According to histopathological results, the patient was treated with anti-TB pharmacological treatment. About 1 month after the surgery, he presented with pain in the right testicular area, implying bilateral TB epididymis. After completion of the pharmacological treatment, the patient had no complaints, such as pain or swelling in both testicular areas.
Physicians should consider the possibility of epididymal TB in patients with persistent testicular symptoms for early diagnosis. When a definitive diagnosis of epididymal TB is established, or clinically suspected, immediate treatment initiation, including pharmacological and, if needed, surgical treatment, should be performed to prevent subsequent complications, including abscess formation or male infertility, particularly in young males.
附睾结核是一种不常见的结核病形式，尽管已知其在男性生殖系统中经常发生。不育症在该疾病引起的后续可能并发症中较为罕见但很重要，尤其是在年轻男性中。此外，附睾结核与其他附睾 - 睾丸疾病难以区分。在此，我们报告一例罕见的年轻患者，最近被诊断为双侧附睾结核导致男性不育。
我们报告一例37岁患者，其左侧睾丸疼痛和肿胀持续约8个月。他没有包括肺结核在内的合并症。此外，他没有孩子且担心不育。体格检查发现左侧附睾区域可触及一个质地坚硬且有压痛的肿块，直径为3.5 cm×2.2 cm。尿液抗酸杆菌染色及聚合酶链反应均为阴性。精液分析显示精液中无精子，提示无精子症诊断。阴囊超声提示左侧严重附睾炎伴脓肿形成，睾丸外观无异常。由于持续的睾丸疼痛、间歇性发热以及严重的附睾炎伴脓肿形成，患者接受了附睾切除术。对睾丸进行手术探查发现附睾严重肿胀且质地坚硬，有脓肿物质，输精管坚硬且扩张并与附睾相连，提示严重炎症反应。组织病理学检查显示附睾组织有慢性肉芽肿性炎症伴干酪样坏死。根据组织病理学结果，患者接受了抗结核药物治疗。手术后约1个月，他出现右侧睾丸区域疼痛，提示双侧附睾结核。完成药物治疗后，患者无睾丸区域疼痛或肿胀等不适主诉。
对于有持续性睾丸症状的患者，医生应考虑附睾结核的可能性以进行早期诊断。当确诊或临床怀疑附睾结核时，应立即开始治疗，包括药物治疗以及必要时的手术治疗，以预防后续并发症，包括脓肿形成或男性不育，尤其是在年轻男性中。
