UroToday - Dr. Khalid Al-Taheini, et al. from Ontario, Canada assessed the role of radiologic studies in the detection of significant urologic anomalies in boys with acute epididymitis. The group retrospectively reviewed the charts of patients with a diagnosis of acute epididymitis over a period of 15 years. The patients all presented with an acute scrotum and documented ipsilateral testicular/epididymal hyperemia on Doppler ultrasound along with a high-grade fever, leukocytosis, pyuria, and/or positive urine culture. If there was any radiologic imaging of the upper urinary tract or VCUG, they were reviewed for any anatomic abnormalities.

The group found that 16 patients were included with an age range of 3 weeks to 16 years. Of the 16 patients, 15 had upper tract imaging. Inclusively, 13 had a renal ultrasound and 2 had an intravenous pyelogram. All the upper tract imaging studies were normal. A VCUG was performed in 13 of 16 patients, and was normal in 12 of 13 patients. One patient had reflux to the right seminal vesicle, which resolved spontaneously on a follow-up study. This may have been due to dysfunctional voiding but it was not further specified in the study. The follow up ranged from 1 month to 11 years (median 2 months). None of the patients had recurrent epididymitis, except the individual who had reflux to seminal vesicle.

The group concluded that a full radiologic workup to include a renal ultrasound and VCUG should be obtained in children with acute epididymitis and a positive urine culture or recurrent epididymitis. In a child with acute epididymitis and negative urine culture, urinary tract ultrasound is adequate. The group further concludes that the yield of the VCUG is so low that its routine use should not be encouraged. It stands to reason that the child with acute epididymitis and a negative urine culture could most likely be due to dysfunctional voiding and although the study indicates that upper tract ultrasonography is adequate, it may not be indicated at all. Dysfunctional voiding as well as constipation should also be assessed in all these children to ensure there are no confounding variables that can be addressed in a less invasive fashion.

Al-Taheini KM, Pike J, Leonard M
Urology. 2008 May;71(5):826-9

Reported by UroToday Medical Editor Pasquale Casale, MD

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