Metastatic Urothelialcarcinoma to the Testis Presenting as Epididymo-Orchitis

Case Report

Austin J Urol. 2015;2(2): 1022.

Metastatic Urothelialcarcinoma to the Testis Presenting as Epididymo-Orchitis

Fuller TW, Ristau BT, Bandari and Benoit RM*

Department of Urology, University of Pittsburgh Medical Center, USA

*Corresponding author: Benoit RM, Department of Urology, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA 15219

Received: February 06, 2015; Accepted: February 25, 2015; Published: February 26, 2015


A 70 year-old male with a complicated past urologic history including right testicular abscess requiring orchiectomy, prostate cancer, non-muscle invasive Urothelial Carcinoma (UC) of the bladder, and distal ureteral UC presented with signs and symptoms consistent with epididymo-orchitis. It was refractory to multiple prolonged courses of parenteral antibiotics as well as surgical drainage of a paratesticular fluid collection. Ultimately, orchiectomy was performed and pathologic evaluation of the testis revealed metastatic urothelial carcinoma. The testes represent a very rare metastatic location for urothelial carcinoma when there is no other evidence of systemic disease.

Keywords: Urothelial carcinoma; Metastasis; Testis; Epididymo-orchitis; Orchiectomy


UC: Urothelial Carcinoma; TUIP: Transurethral Incision of the Prostate; TURP: Transuretheral Resection of the Rostate


We present a case of metastatic urothelial carcinoma to the testis in the absence of other identifiable metastatic disease. The most common sites of metastatic bladder UC in order of decreasing frequency are regional lymph nodes, bone, lung, liver, and peritoneum [1,2]. The testis represent an especially unusual site of metastasis due to the postulated limited metastatic access conferred by the bloodtestis barrier [3].

Case Report

A 70-year-old male with an extensive urologic history developed urinary retention several years after undergoing prostate brachytherapy. After medical therapy failed to resolve his retention, he elected to proceed with surgical intervention in hopes of obviating the need for intermittent catheterization. Given the significant risk of urinary incontinence resulting from surgical intervention to the prostate after pelvic radiotherapy, he initially underwent a Transurethral Incision of the Prostate (TUIP). This procedure failed to resolve his urinary retention and he was subsequently scheduled for Transurethral Resection of the Prostate (TURP). On preoperative examination the patient had a swollen, tender, erythematous, left hemiscrotum. He had a leukocytosis of 32,200. He was admitted for treatment of presumed epididymo-orchitis.

In addition to prostate cancer, he had a history of urothelial carcinoma involving both his upper urinary tract and bladder. He had undergone multiple trans-urethral resections of the bladder for superficial disease, including high grade disease invading the lamina propria (HGT1). Restaging transurethral resection of his bladder tumorat that time had confirmed the lack of muscle invasion. He had also undergone a distal ureterectomy for a 2.8 cm low grade tumor with focal invasion into muscle (T2N0MX). His distal ureterectomy occurred approximately 18 months prior to his episode of presumed epididymo-orchitis, while his last bladder tumor was resected approximately 12 months prior to this presentation.

On admission the patient was started on intravenous antibiotics and a urine culture was sent. His exam failed to improve, and his WBC did not decrease despite antimicrobial therapy and negative urine cultures. A scrotal ultrasound demonstrated a complex extratesticular fluid collection and a reactive hydrocele (Figure 1). Surgical intervention was considered as he failed to improve with more conservative therapy, but since the patient was hemodynamically stable, afebrile, and nontoxic in appearance; the patient elected to continue IV antibiotics rather than proceed with surgery. He was also reluctant to accept the risk of a left orchiectomy as he had a prior right orchiectomy for testicular abscess many years earlier.

Citation: Fuller TW, Ristau BT, Bandari and Benoit RM. Metastatic Urothelialcarcinoma to the Testis Presenting as Epididymo-Orchitis. Austin J Urol. 2015;2(2): 1022. ISSN:2472-3606