Paediatric recurrent epididymitis is frequently observed in several urogenital conditions, and may result in deterioration of long-term fertility. The management of recurrent epididymitis is still a therapeutic challenge for paediatric urologists, and as yet there is no consensus for treatment. In this paper, the authors evaluate the results of endoscopic transurethral injection of dextranomer / hyaluronic acid around the ejaculatory ducts at the verumontanum in 11 boys who were referred with recurrent epididymitis in a context of urogenital malformations which included two (18%) bladder exstrophy, three (27%) anorectal malformation, two (18%) peno-scrotal hypospadias, two (18%) posterior urethral valves, one (9%) seminal vesicle cyst, and one (9%) urethral stricture. The median age at injection was 3.75 years (range 8 months – 14.7 years). Endoscopic injection effectively prevented recurrence in eight patients (73%) with a mean follow-up of three years (range 6 months – 8.8 years). The mean injected volume was 0.7ml/session. No perioperative complications were recorded. Vas clipping was performed in three patients after unsuccessful injections. Most discussions on management of recurrent epididymitis is based on vas clipping. The authors of this paper conclude that endoscopic injection of the verumontanum could offer several potential advantages over vas clipping and can be easily performed by a urologist who is acquainted with endourological approaches. Endoscopic injection of the verumontanum is a safe and effective treatment in almost 73% of children with recurrent epididymitis with no perioperative complications. 

Endoscopic injection of bulking agent around the ejaculatory ducts at the verumontanum for recurrent paediatric epididymitis.
Faure A, Haddad FM, Hery G, et al.
2018; [Epub ahead of print].
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Ravindar Anbarasan

Southampton Children’s Hospital.

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