RESUMO
Restless legs syndrome (RLS) is characterized by an urge to move the legs, predominantly at night. About one quarter of the patients with RLS report painful symptoms in the legs. In this case report, the patient presented at the sleep clinic with a chief complaint of insomnia and the classical symptoms of RLS. He also mentioned a chronic testicular pain (CTP). For over a year, the patient had undergone urologic investigation and empiric treatments, with only mild improvement of the testicular pain. After 3 months of therapy with pramipexole, the RLS symptoms and the CTP were no longer present. Finding an etiology for CTP can be challenging and many cases are diagnosed as idiopathic. RLS may be a forgotten and unidentified etiology for CTP in typical urological care. Considering the high prevalence of RLS and CTP, it is relevant to clarify the possible association. CITATION: Tedesco Silva LM, Lenz MCS, Martinez D. Chronic testicular pain cured by low-dose pramipexole: Is there an association with restless legs syndrome? J Clin Sleep Med. 2022;18(5):1467-1469.
Assuntos
Dor Crônica , Síndrome das Pernas Inquietas , Humanos , Masculino , Dor Crônica/tratamento farmacológico , Perna (Membro) , Pramipexol/uso terapêutico , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/tratamento farmacológicoRESUMO
In context of COVID-19 pandemic, there has been different presentations of the infection. The relationship of testicular pain with COVID-19 has not been extensively studied. We present a 31 years old male, with SARS-COV-2 infection, repeatedly consulting for intermittent bilateral testicular pain. Two months later he reported acute loss sensibility and pain in extremities, being diagnosed with axonal fine fiber polyneuropathy. Although the presence of SARS-COV-2 in testis remains controversial, there is a potential orchiepididymitis risk due to viral binding to ACE2 receptor in testicle, and also could induce systemic vasculitis as another possible cause of orchitis.
RESUMO
Objective Testicular torsion (TT) is an emergency with an incidence of 1:1,500 in patients < 18 years old. Irreversible changes in the testicular parenchyma may happen. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) questionnaire evaluates signs and symptoms to determine the risk of TT and improve the time of management. The aim of the present study was to compare the intraoperative findings of patients with TT with the result of the preoperative TWIST questionnaire. Methods A cohort of 33 pediatric patients that consulted to the emergency room was evaluated. The TWIST questionnaire was applied in the first approach. Imaging studies, time to the operating room (OR) and intraoperative findings were evaluated. Theoretical and real findings were compared. Results The median age was 13 years old (interquartile range [IQR] 1015 years old). Edema and scrotal inflammation was the most frequent finding (42.4%), followed by testicular induration (21.2%), nausea and vomiting (15.2%), and horizontal testicle and absence of cremasteric reflex (9.1%). The TWIST stratification was 3% high-risk, 18.2% intermediate-risk and 78.8% low-risk. Testicular Doppler ultrasound was performed in 93.9% of the patients: vascular congestion was found in 21.9%. A total of 30.3% of the kids were taken to surgery after 163 minutes (±116.5). Intraoperative diagnosis of TT was confirmed in the high-risk patient, in 33.3% of the intermediate-risk, and in 50% of the low-risk. The receiver operating characteristic (ROC) curve showed an accuracy of 60% (p = 0.602). Conclusions The TWIST questionnaire in the first approach allows to take the high-risk patients im
Objetivo La torsión testicular (TT) es una emergencia con incidencia de 1:1.500 en pacientes menores de 18 años. Pueden ocurrir cambios irreversibles en el parénquima testicular. El cuestionario TWIST evalúa signos y síntomas para determinar el riesgo de TT y mejorar los tiempos de atención. El objetivo de este estudio fue comparar los hallazgos intraoperatorios de los pacientes con el resultado del TWIST preoperatorio. Métodos Se evaluó una cohorte de 33 pacientes pediátricos que consultaron al Departamento de Emergencias. Se aplicó el cuestionario TWIST en la primera aproximación. Estudios imagenológicos, tiempo de entrada a salas de cirugía y hallazgos intraoperatorios también fueron evaluados. Se compararon los hallazgos teóricos y reales. Resultados La mediana de edad fue de 13 años (rango intercuartil [RIQ]: 1015). Edema e inflamación escrotal fueron los hallazgos principales, (42,4%) seguidos de induración testicular (21,2%), náusea y vómito (15,2%), y testículo horizontal y ausencia del reflejo cremastérico (9,1%). Estratificación TWIST: 3% alto riesgo, 18,2% intermedio, y 78,8% bajo. Se realizó Doppler testicular en 93,9% de los pacientes: se encontró congestión vascular en 21,9%. Se operaron 30,3% de niños tras 163 minutos (± 116,5). En el intraoperatorio se confirmó TT en el paciente de alto riesgo, en 33,3% de intermedio, y en 50% de bajo riesgo. La curva de característica operativa del receptor (COR) evidencia una exactitud de 60% (p = 0.602). Conclusiones El cuestionario TWIST en la primera aproximación es útil para operar inmediatamente pacientes de alto riesgo. Sin embargo, no ofrece un alto nivel de confianza para el diagnóstico de TT en pacientes de intermedio y bajo riesgo.