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cumstances, such as a cluster of cases in a family or commu-nity, or complicated cases.
Our results indicate that epididymitis in boys is not a rareillness. Clinical and laboratory finding suggest an inflamma-tory phenomenon (presumably post-infectious) with a benigncourse. The treatment of these patients is basically withanalgesics and nonsteroidal anti-inflammatory drugs with alittle role for antibiotics. However, it should be emphasizedthat ruling out testicular torsion is the most important stepin the evaluation of the patient with epididymitis.
1. Bukowski, T. P., Lewis, A. G., Reeves, D., Wacksman, J. andSheldon, C. A.: Epididymitis in older boys: dysfunctional void-ing as an etiology. J Urol, 154: 762, 1995
2. Richman, M. N. and Bukowski, T. P.: Pediatric epididymitis:pathophysiology, diagnosis and management. Infect Urol, 14:31, 2001
3. Cappele, O., Liard, A., Barret, E., Bachy, B. and Mitrofanoff, P.:Epididymitis in children: is further investigation necessaryafter the first episode? Eur Urol, 38: 627, 2000
4. Merlini, E., Rotundi, F., Seymandi, P. L. and Canning, D. A.:Acute epididymitis and urinary tract anomalies in children.Scand J Urol Nephrol, 32: 273, 1998
5. Lau, P., Anderson, P. A., Giacomantonio, J. M. and Schwarz,R. D.: Acute epididymitis in boys: are antibiotics indicated?Br J Urol, 79: 797, 1997
6. Gislason, T., Noronha, R. F. X. and Gregory, J. G.: Acute epidid-ymitis in boys: a 5-year retrospective study. J Urol, 124: 533,1980
7. Lewis, A. G., Bukowski, T. P., Jarvis, P. D., Wacksman, J. andSheldon, C. A.: Evaluation of acute scrotum in the emergencydepartment. J Pediatr Surg, 30: 277, 1995
8. Klin, B., Zlotkevich, L., Horne, T., Efrati, Y., Serour, F. andLotan, G.: Epididymitis in childhood: a clinical retrospectivestudy over 5 years. Isr Med Assoc J, 3: 833, 2001
9. Elder, J. S.: Urologic disorders in infants and children. Disordersand anomalies of the scrotal contents. In: Nelson Textbook ofPediatrics, 16th ed. Edited by R. E. Behrman, R. M. Kliegmanand H. B. Jenson. Phiadelphia: W. B. Saunders Co., pp. 1652–1653, 2000
10. Sidler, D., Brown, R. A., Millar, A. J., Rode, H. and Cywes, S.: A25-year review of the acute scrotum in children. S Afr Med J,
87: 1696, 199711. Hutcheson, J., Peters, C. A. and Diamond, D. A.: Amiodarone
induced epididymitis in children. J Urol, 160: 515, 199812. Cassidy, T. S. and Petty, R. E.: Arthritis related to infection. In:
Textbook of Pediatric Rheumatology, 3rd ed. Edited by T. S.Cassidy and R. E. Petty. Philadelphia: W. B. Saunders Co., pp.487–530, 1995
13. Morag, A. and Ogra, P. L.: Enteroviruses. In: Nelson Textbook ofPediatrics, 16th ed. Edited by R. E. Behrman, R. M. Kliegmanand H. B. Jenson. Philadelphia: W. B. Saunders Co., pp. 956–964, 2000
The authors reported novel and intriguing information regardingelevated viral titers in prepubertal boys presenting with acute scro-tal swelling and pain who were thought to have acute epididymitis.The diagnosis of acute epididymitis was based on physical findingsand sonographic evidence of a congested epididymitis with increasedblood flow. Using these criteria 71% of the patients presenting totheir emergency department with acute scrotal swelling were as-signed this diagnosis.
Although this article raises interesting questions regarding theetiology of acute epididymitis, one must recognize the limited abilityof sonography to differentiate acute epididymitis from torsion of theappendix testis. The 2 conditions can cause congestion of the epidid-ymal tissue with increased blood flow, tenderness and scrotal swell-ing secondary to the inflammatory response. At our institution tor-sion of the appendix testis is thought to occur much more commonlythan acute epididymitis in the prepubertal male and yet the authorsapparently made this diagnosis in only a small minority of theirpatients (11%, presumably the 7 with sonographic evidence of in-creased blood flow without epididymal enlargement). Furthermore,of the 44 patients diagnosed with acute epididymitis only a smallminority (16%) had fever. Urinalysis was normal in almost all casesand the mean serum white blood count in this group was normal. Allof these findings call into question the accuracy of the diagnosis ofacute epididymitis in many of these patients. However, we wouldagree with the author recommendations that antibiotic therapy isunnecessary. In fact, almost all of these boys can be treated asoutpatients with ibuprofen and limited activity restriction.
H. Gil RushtonDivision of Pediatric UrologyChildren’s National Medical CenterUrology and PediatricsGeorge Washington University School of MedicineWashington, D. C.
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