Mistakes in the diagnosis of tuberculous orchiepididymitis.

Introduction. Everywhere there is a weighting of the structure of urogenital tuberculosis. Tuberculosis of the testis and its epididymis is difficult to diagnose because it does not have pathognomonic symptoms; the diagnosis cannot be verified microbiologically in the study of ejaculate or prostate secretion, however, it is possible to detect a pathogen in biopsy specimens or surgical material. Materials and methods. Search results were analyzed in the scientific databases eLibrary, PubMed, Web of Science, Embase, Cochrane Library and PEDro, Wang-fang and Cnki, Edline for the queries «urogenital tuberculosis», «tuberculosis of the male genital organs», «tuberculosis testicles», «tuberculosis of the epididymis», «tuberculous epididymitis», «tuberculous orchiepididymitis», «diagnosis». Results. An isolated lesion of the scrotum is observed with testicular neoplasms, bacterial epididymo-orchitis, genitourinary sarcoidosis, inguinal-scrotal hernia, and hydrocele. Since oncological diseases cause the greatest concern, misinterpretation of clinical and laboratory data and neglect of the epidemic history can lead to an erroneous diagnosis and unnecessary orchiectomy. At best, the patient is initially diagnosed with bacterial epididymo-orchitis and given antibiotic therapy. At the same time, the wrong choice of antibiotic can subsequently make it impossible to identify the pathogen and distort the pathomorphological picture. Description of the clinical case. The article presents a case of incorrect tactics in the treatment of a patient with tuberculous epididymitis, erroneously diagnosed as an «epididymal cyst». Neglect of microbiological data led to the formation of a fistulous form of orchiepididymitis. Conclusions. The diagnosis of tuberculous orchiepididymitis is difficult. With the help of radiation diagnostic methods, tuberculosis of the testicle and apidymis can be suspected; to confirm the diagnosis, identification of the pathogen or the presence of specific pathological signs is required. High vigilance is required for tuberculosis when examining a patient with complaints of enlargement and tenderness of the scrotum.