Xanthogranulomatous epididymo‑orchitis: A single‑institutional case series and systematic review

Indian Journal of Urology, 2023 · DOI: 10.4103/iju.iju_270_22 · Published: December 29, 2022

Urology Genetics Research Methodology & Design

Simple Explanation

Xanthogranulomatous inflammation (XGI) is a rare condition where tissue is damaged and replaced by foamy macrophages. This study reviews cases of XGI affecting the testicles and epididymis. The research involved a review of four cases from a single institution, along with a systematic review of medical literature, focusing on the clinical and pathological characteristics of XGEO. The primary treatment for XGEO is surgical removal, but conservative approaches may be considered in specific cases, especially in younger patients or when the disease is localized.

Study Duration

January 2000 and January 2022

Participants

Four male patients diagnosed with xanthogranulomatous epididymitis/orchitis

Evidence Level

Systematic Review and Case Series

Key Findings

1
XGEO often presents as a subacute or chronic condition, predominantly affecting men in their 50s and 60s. Symptoms include swelling, tenderness, or pain in the scrotal region.
2
Risk factors associated with XGEO include diabetes mellitus, spinal cord injury, prior prostatectomy, trauma, and transurethral resection of the prostate. These conditions may contribute to the development of the disease.
3
Microorganisms such as Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were identified in affected tissues, suggesting a potential role for bacterial infection in the pathogenesis of XGEO.

Research Summary

This study presents a case series and systematic review of xanthogranulomatous epididymo-orchitis (XGEO), a rare inflammatory condition affecting the male genital organs. The research analyzes clinical presentations, risk factors, and treatment strategies for XGEO. The findings indicate that XGEO commonly affects middle-aged to older men and is associated with conditions like diabetes mellitus and prior urological procedures. Surgical excision remains the primary treatment, although conservative management may be considered in select cases. The study emphasizes the importance of histopathological examination for accurate diagnosis and highlights the potential for misdiagnosis due to overlapping features with other conditions. Early recognition and appropriate management are crucial for optimal patient outcomes.

Practical Implications

Diagnostic Accuracy

Histopathological examination is crucial for accurate diagnosis due to overlapping features with other conditions.

Treatment Strategy

Surgical excision is the primary treatment for XGEO, but conservative management may be considered in select cases.

Risk Factor Awareness

Clinicians should be aware of associated risk factors, such as diabetes mellitus and prior urological procedures, in patients presenting with scrotal symptoms.

Study Limitations

1
Rarity of the condition limits the availability of extensive data.
2
The worldwide incidence of type 2 DM has risen and this metabolic condition poses a significant risk among males for the development of XGEO.
3
Not every patient is a candidate for orchidectomy and conservative measures can be attempted for management in selected cases.

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