Objectives: The aim of this study was to determine the epidemiological-clinical profile of patients with scrotal infectious pathology in Abidjan and describe the ultrasound features of this scrotal infectious pathology. Methods: This was a prospective study of 80 cases of scrotal infectious pathology objectified by ultrasound at Yopougon University Hospital from 1 January 2015 to 31 December 2015. Ultrasounds were performed using a high-frequency linear probe in B and Color Doppler modes by senior radiologists. The epidemiological-clinical data were recorded from the ultrasound request form and the interrogation of the patient. Results: The average age was 23 years with extreme ranging from 16 to 40 years. Soldiers were the most concerned (40%) followed by students (30%). The painful large bursa was the quasi constant presenting feature (95% of cases) and fever was associated in less than half of the cases (45% of cases). The scrotal involvement was most often unilateral (85% of cases) and the left side was involved in 70% of the cases. Epididymitis was the most frequent pathology (60%) followed by orchiepididymitis (30%) and orchitis (10%). The most commonly encountered accompanying ultrasound findings were envelope thickening (100%), intravaginal fluid effusion (60%), and Doppler Hypervascularization (30%). Conclusion: In Abidjan Scrotal infectious pathology is most often encountered among young soldiers or students most often with a ± febrile large bursa. The most common pathology is left unilateral epididymitis.
Scrotal pathology is common in both children and adults. It concerns nearly 200 reasons for consultation in Switzerland [
The diagnosis of scrotal infectious pathology requires in an unavoidable way medical imaging represented by Doppler ultrasound and magnetic resonance imaging [
It is in this context that our study proposes to determine the epidemiological and clinical profile of patients with scrotal infectious pathology and to describe the ultrasound features of the scrotal infectious pathology in Abidjan.
This is a prospective study that was carried out over a twelve-month period from 1 January 2015 to 31 December 2015 at Yopougon University Hospital. It involved all patients in whom a scrotal infectious pathology was discovered on the ultrasound scan. Ultrasounds were performed using a high frequency linear probe in B and color Doppler modes by senior radiologists. The epidemiological data were recorded from the ultrasound request form and the interrogation of the patient. The variables sought were age, occupation, previous history of sexually transmitted infections (STI) or urinary tract infection, notion of fever, direct and indirect ultrasound findings. The interpretation of the ultrasound findings was based on measuring the size of testes, epididymises and envelopes. It is also necessary to assess the echostructure of the different intra-scrotal structures, to seek intravaginal fluid effusion. We also assessed the vascularization of the different intra scrotal components without performing a thorough spectral analysis. Eight patients underwent urinary sampling, 5 sperm culture and 1 cytobacteriological examination of the urine. Data were processed by Statistical Package for the Social Sciences (SPSS) software version 16.0.
All of our results are summarized in Tables 1-6.
A total of 80 patients were involved in our study. The average age of patients was 23 years with extremes of 16 to 40 years. Soldiers were the most concerned
AGE (year) | EFFECTIVE | PERCENTAGE % |
---|---|---|
16 - 20 | 18 | 22.5 |
21 - 25 | 41 | 51.3 |
26 - 30 | 6 | 7.5 |
31 - 35 | 8 | 10 |
36 - 40 | 7 | 8.7 |
TOTAL | 80 | 100 |
The mean age was 23 years with a predominance of the age group between 21 and 25 years. No case was found before 15 years.
OCCUPATION | EFFECTIVE | PERCENTAGE % |
---|---|---|
Soldiers | 32 | 40 |
Students | 24 | 30 |
Mechanics | 5 | 6.3 |
Tradespeople | 7 | 8.7 |
Drivers | 8 | 10 |
Other | 4 | 5 |
TOTAL | 80 | 100 |
Soldiers were the most concerned (40%) followed by students (30%).
INDICATION | EFFECTIVE | PERCENTAGE % |
---|---|---|
Painful swelling | 76 | 95 |
Isolated scrotal pain | 3 | 3.7 |
Isolated swelling | 1 | 1.3 |
TOTAL | 80 | 100 |
Painful swelling was the major indication in nearly half of the cases (95%).
PATHOLOGY | EFFECTIVE | PERCENTAGE % |
---|---|---|
Orchi-epididymitis | 24 | 30 |
Epididymitis | 48 | 60 |
Orchitis | 8 | 10 |
TOTAL | 65 | 100 |
Epididymitis was the most common pathology (60%).
(40%) followed by students (30%). The large painful bursa was the almost constant presenting features (95% of cases) and fever was associated in less than half of the cases (45% of cases). Scrotal involvement was mostly unilateral (85% of cases) and the left side was involved in 70% of cases. Epididymitis (
Anatomical Structure | Ultrasound sign | Effective | Percentage % |
---|---|---|---|
Epididymis | - Homogeneous thickening Heterogeneous thickening | - 36 - 36 | - 50 - 50 |
Testicle | - Homogeneous hypertrophy Heterogeneous hypertrophy | - 24 - 8 | - 75 - 25 |
Vaginal | - Hydrocele - No effusion | - 48 - 32 | - 60 - 40 |
Envelopes | - Thickened - Normal | - 80 - 0 | - 100 - 0 |
Vessels | - Hyper vascularization - Normal | - 24 - 56 | - 30 - 70 |
Epididymis was thickened in 100% of cases. There was an increase in the size of the testis in 75% of cases and a heterogeneous appearance was either localized or focal in 25% of cases.
GERM | EFFECTIVE | PERCENTAGE % |
---|---|---|
Chlamydiae trachomatis | 3 | 21.5 |
Neisseria gonorrhae | 6 | 42.9 |
Salmonella | 1 | 7.1 |
E. Coli | 1 | 7.1 |
Staphylococcus aureus | 2 | 14.3 |
No germ | 1 | 7.1 |
TOTAL | 14 | 100 |
Neisseria gonorrhae (42.9%) and Chlamidya trachomatis (21.5%) were the most commonly encountered germs.
(30%) and orchitis (10%). Semeiologically, the epididymis was thickened in 100% of cases. This thickening involved the whole epididymis in 60% of cases, the head in 30% of cases and the tail in 10% of cases. The appearance was heterogeneous with the presence of abscess in 30% of cases and 20% of cyst. In 50% of cases the thickening was homogeneous. Regarding orchitis (
The most common accompanying ultrasound findings were envelope thickening (100%), intravaginal fluid effusion (60%), and Doppler hyper-vasculariza- tion (30%). Biological examinations revealed in 6 cases Neisseriae Gonorrhae and 3 cases of Chlamydiae Trachomatis, 2 cases of Staphylococcus aureus, 1 case of Salmonella and 1 case of E. Coli. In 1 case no germ was found.
Our study reveals that scrotal infectious pathology in Abidjan concerns young subjects with an average age of 23 years and a predominance of the age group ranging between 20 and 30 years. Our results agree with those of Mittmeyer [
According to the literature, this is an affection related to sexually active subjects, thus explaining the extreme youth of the population but also the most exposed profession. In our work, soldiers were the most represented, followed by students. According to Ryan P. Smith [
first urological affection observed during the military service and the consequence of this, a 3 week-hospitalization and a reduction of the time of the military service. Kouassi in Abidjan found 50% of students in his population.
Presenting features of scrotal infectious pathology were dominated by the large painful bursa in our study associated with fever in 46% of cases. Hence the notion of Aubert’s large hot bursa [
The left bursa was the most concerned at 70%. This predominance of the left scrotal involvement was demonstrated by Kouassi in 100% of cases. The only case of tuberculousorchitis described by Agoda et al. was lateralized to the left. We are in contradiction with Luizzi et al. who consider that acute epididymitis involves the right and left sides with equal frequency.
Pathologically, our study showed that epididymitis was the most common pathology (60%) followed by orchiepididymitis (30%) and orchitis (10%). We agree with the literature that demonstrates primary epididymal involvement before secondary orchid contamination. According to Roy, primary infectious testicular involvement is right away bilateral and of viral origin (Mumps Orchitis), which is the prerogative of children, although in a small proportion the adult could be affected. Ouattara et al. demonstrated 100% of orchiepididymitis (
would have first developed epididymitis and consulted traditional healers before going to hospital in the orchiepididymitis stage.
Radiologically, scrotal analysis was performed in B mode and in Doppler mode using an 11 MHz probe. According to ROY, scrotal analysis must be done in high resolution with spectral studies associated. Contrast ultrasound is used by other authors in this pathology in order to make the difference between a tumor nodule and a pseudo-tumor orchitis [
Semeiologically, we have demonstrated direct signs and signs of accompaniment. Concerning epididymitis, the thickening was demonstrated in 100% of cases. This thickening involved the whole epididymis in 60% of cases, the head in 30% of cases and the tail in 10% of cases. The appearance was heterogeneous with the presence of abscess in 30% of cases and 20% of cyst. In 50% of cases the thickening was homogeneous.
Regarding orchitis, there was an increase in the size of the gland in 75% of cases and a heterogeneous appearance either localized or focal in 25% of cases.
The most commonly encountered ultrasound accompanying findings, whether epididymitis, orchitis or the combination of both were envelope thickening (100%), intravaginal fluid effusion (60%) and Doppler Hypervascularization (30%).
Our results agree with those of Pilatz et al. [
These ultrasound findings have also been described by Roy et al. to whom epididymitis appears as hypoechoic hypertrophy of the epididymis with envelope thickening and marked Doppler Hypervascularization.
For Gonzalez et al. [
The heterogeneous appearance of the testis was found by Agoda et al. [
Considered as a common pathology, scrotal infections are widely explored on ultrasound worldwide. The technique that consists in using a high frequency probe associated with the color Doppler helps make positive diagnosis, look for complications and eliminate the other noninfectious pathologies. Our study showed that scrotal infectious pathology in Abidjan was most often encountered among young soldiers or students most often presenting a ± febrile painful large bursa. This pathology is most often represented by total epididymal hypertrophy associated with Doppler Hypervascularization and accompanied by complications such as abscesses and hydrocele. Sexually transmitted germs were the predominant etiologies. Sexual education of young people, the fight against STIs could help prevent scrotal infectious pathology in sub-Saharan Africa.
None.
Kouame, N., Manewa, F.S., Kouame, A.M.-F., N’goan- Domoua, A.-M. and N’gbesso, R.-D. (2017) Infectious Pathology of the Scrotum in Abidjan: Ultrasound Features of 80 Cases. Open Journal of Radiology, 7, 103-111. https://doi.org/10.4236/ojrad.2017.72012