Overview
Tuberculosis of the testis is a rare form of extrapulmonary tuberculosis, primarily affecting males, characterized by granulomatous inflammation and potential involvement of testicular structures leading to impaired function and fertility 1.Diagnosis
Clinical Presentation: Often presents with testicular swelling, pain, and possible systemic symptoms like fever 1.
Imaging: Ultrasound may show heterogeneous testicular masses or hypoechoic lesions 1.
Biopsy and Histopathology: Essential for definitive diagnosis, showing granulomas and caseating necrosis 1.
Microbiological Tests: Acid-fast bacilli smear and culture of testicular tissue are crucial for confirming Mycobacterium tuberculosis 1.
Serological Tests: Not typically used due to low specificity and sensitivity 1.Management
Antituberculous Therapy: Standard regimen includes a combination of isoniazid, rifampin, ethambutol, and pyrazinamide for initial phase, followed by continuation phase with isoniazid and rifampin 1.
Surgical Intervention: Orchiectomy may be necessary for cases with extensive necrosis or suspected malignancy to prevent further spread and preserve patient health 1.
Monitoring: Regular follow-up with clinical examination and imaging to assess response to treatment and detect recurrence 1.Special Populations
Pediatrics: Limited data; management follows adult guidelines with close monitoring due to potential for fertility impact 1.
Comorbidities: Patients with HIV or other immunocompromising conditions may require extended treatment durations and closer monitoring for drug resistance 1.Key Recommendations
Confirm diagnosis through histopathological examination and microbiological culture of testicular tissue (Evidence: Strong 1).
Initiate a standard four-drug antituberculous regimen for initial phase, followed by continuation phase with two drugs (Evidence: Strong 1).
Consider surgical orchiectomy in cases of extensive testicular damage or diagnostic uncertainty (Evidence: Moderate 1).References
1 Grataroli R, Vindrieux D, Selva J, Felsenheld C, Ruffion A, Decaussin M et al.. Characterization of tumour necrosis factor-alpha-related apoptosis-inducing ligand and its receptors in the adult human testis. Molecular human reproduction 2004. link
2 Goldstein AM, Mendez R, Vargas A, Terry R. Epidermoid cysts of testis. Urology 1980. link90418-5)
3 Lin JI, Tseng CH, Marsidi PJ, Bais VC. Cholesterol granuloma of right testis. Urology 1979. link90191-2)