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Abstract: Prostatic hyperplasia is a common disease in urology and one of the main reasons for consultation in elderly men. The patient underwent transurethral plasmapheresis for urinary retention due to prostatic hyperplasia. After medication, the patient’s difficulty in urination was cured and the scrotal swelling and pain were controlled.
Basic information】Male, 75 years old
Type of disease】Epididymitis and orchitis
Hospital】Shijiazhuang People’s Hospital
Time of consultation】December 2020
Treatment plan】Intravenous infusion therapy (cefmenoxime hydrochloride for injection, piperacillin sodium tazobactam sodium for injection) + oral medication (Mai Zhi Ling tablets, cefixime capsules)
[Treatment period] 14 days of hospitalization, 1 month of outpatient follow-up
Treatment effect]: Difficulty in urination was cured, and scrotal swelling and pain were controlled.
I. Initial consultation
The patient was admitted to the hospital 10 days after prostatectomy with scrotal swelling and pain, accompanied by fever for 3 days, with a 30-year history of type 2 diabetes mellitus and unsatisfactory glycemic control. The scrotal ultrasound showed that the tail of the right epididymis was 2.2×1.8 cm in size with heterogeneous hypoechogenicity, and the CDFI was heterogeneous and hypoechoic, with abundant blood flow signal visible in it. Due to the patient’s advanced age, epididymitis requires bed rest and intravenous anti-inflammation. After communication with the patient and his family, they agreed to be hospitalized.
II. Treatment history
After the patient was admitted to hospital, he was given intravenous cefixime hydrochloride for head injection, blood culture and urine culture both indicated Escherichia coli, and piperacillin sodium sulbactam sodium for injection as intravenous anti-inflammatory treatment. After the patient’s body temperature was normalized, blood cell analysis returned to normal, and urine analysis was more or less normal, he was changed to oral cefixime capsule to continue anti-inflammatory treatment for 1-2 weeks, and in combination with the patient’s scrotal swelling and pain, he was given Mizarin tablets to reduce swelling and symptomatic treatment. At the same time, the endocrinology department was consulted to assist in glucose-lowering treatment, and the scrotal ultrasound was reviewed regularly.
Treatment effect
After 2 weeks of intravenous anti-inflammatory treatment, the patient’s scrotal swelling and pain were obviously relieved, and he could basically move to the ground without obvious swelling and discomfort, and there were no obvious symptoms of urinary frequency and urgency, and urination was smooth, and the fever symptoms also improved, and his vital signs returned to normal.
IV. Notes
I am glad that after the treatment, the patient’s difficulty in urination was cured and the scrotal distension was controlled. This patient developed acute testicular epididymitis after prostatic hyperplasia electrosurgery, which is to some extent related to retrograde urethral infection, medical urethral operation or surgery. Meanwhile, this patient has diabetes mellitus and postoperative blood glucose control is not satisfactory, therefore, after discharge, attention should be paid to blood glucose control, timely recheck urinary routine when urinary frequency, urinary urgency and other urinary tract irritation symptoms appear, and oral antibiotics such as cefixime capsule for anti-inflammatory treatment if necessary. After being discharged from hospital with acute epididymitis, it is necessary to eat a light diet, avoid eating spicy and stimulating food, refrain from drinking alcohol, be moderately active for the past 1 month, avoid straining, monitor blood sugar regularly, and continue to take oral cefixime capsules for 2 weeks. 2 weeks later, the urology clinic will recheck blood routine, urine routine and scrotal ultrasound.
V. Personal insight
The patient’s body is in recovery period after electrodesurgery for prostatic hyperplasia, due to the effect of surgery, the resistance is generally low during this time, and some patients may have combined urinary tract infection after surgery due to the trauma healing process. It is very important to drink more water at this time, pay attention to rest and ensure sufficient sleep, while blood sugar control is needed for this patient. Try not to take a bath, as retrograde infection may occur, which may lead to acute epididymitis. After going home, it is still necessary to control the amount of activity and avoid aggravating the disease with strenuous activities.