Login to Access Video or Poster Abstract: MP80-13
Sources of Funding: NIH Institutional Training Grant T35-HL007485-36

Introduction

Stress has been shown to exacerbate testicular pain and likely few personal situations are more stressful than incarceration. Our medical center manages all of the urologic complaints in the state prison population and we have anecdotally noted a large number of incarcerated men reporting genital pain and pathology (GPP). Iowa prisoners with non-emergent urologic complaints are initially evaluated with telemedicine (TM) before an in-person clinic visit. The objective of the study was to evaluate trends in urologic complaints in our male prisoner population and to determine the incidence, management, and outcomes of GPP.

Methods

We retrospectively reviewed the medical records of all prisoners in our state who were initially evaluated by TM from Jan 2007 – Jul 2014 after obtaining IRB approval. Patient records were evaluated for urologic complaints, diagnoses, initial tests and treatments, outcomes, and eventual need for surgical treatment. GPP was defined as a primary diagnosis at the initial TM encounter of benign testicular lesion, testicular pain, or epididymitis. To determine the incidence of GPP, we queried the Iowa prison database for average numbers of male inmates per year during the study dates and compared to the frequency of prisoner visits for urologic complaints.

Results

There were 376 prisoners with urologic complaints during the study period (incidence 7 per 1000 prisoner years), of which 29% (n=110) were for GPP. Tests were ordered in 78% of men presenting with GPP on the TM encounter (73% US/radiology, 15% labs, 6% other) and medication was prescribed in 25%. Clinic visits followed TM 49% of the time. In these visits, the TM diagnosis was confirmed in 98%. Follow-up revealed that <1% had worsening of their GPP and only 9 patients (8%) ultimately required surgery (4 hydrocelectomy, 2 varicocelectomy, 1 spermatocelectomy, 1 spermatic cord block, 1 scrotal exploration). No patients were found to have testicular cancer or acute testicular torsion.

Conclusions

GPP represented nearly a third of all urologic complaints in our male prison population. Most of the GPP resolved with time and few required surgery. For this access-poor population, it appears that TM, combined with local ultrasound, may represent an ideal way to manage the majority of these complaints safely and more cost-effectively.

Funding

NIH Institutional Training Grant T35-HL007485-36