Epididymitis Disease

BASICS

DESCRIPTION

Inflammation of the epididymis resulting in scrotal pain, swelling and induration of the posterior-lying epididymis, and eventual scrotal wall edema, involvement of the adjacent testicle, and hydrocele formation

System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA: Common
Predominant age: Usually younger sexually active men or older men with urinary infection, but may also rarely occur in prepubertal boys
Predominant sex: Male only

SIGNS AND SYMPTOMS

Scrotal pain, sometimes extending to the groin region, may begin relatively acutely over several hours
Urethral discharge or symptoms of urinary tract infection, such as frequency of urination, dysuria, cloudy urine, or hematuria
Initially, only the posterior-lying epididymis, usually the lowermost tail section, will be very tender and indurated
Elevation of the testes/epididymis improves the discomfort
Entire hemiscrotum becomes swollen, the testis becomes indistinguishable from the epididymis, the scrotal wall becomes thick and indurated, and reactive hydrocele may occur
Fever and chills occur with severe infection and abscess formation

CAUSES

Younger than age 35
- Usually Chlamydia or Neisseria gonorrhea
- Look for serous urethral discharge (chlamydia) or purulent discharge (gonorrhea)
Older than age 35
- Coliform bacteria usually, but sometimes Staphylococcus aureus or epidermidis
- Often associated with distal urinary tract obstruction
- Tuberculosis, if sterile pyuria and nodularity of vas deferens
- Sterile urine reflux after transurethral prostatectomy
- Granulomatous reaction following bacillus Calmette-Guerin (BCG) intravesical therapy for superficial bladder cancer
Prepubertal boys
- Usually coliform bacteria
- Evaluate for underlying congenital abnormalities, such as vesicoureteral reflux or ectopic ureter
At any age
- Amiodarone, an antiarrhythmic agent, may cause a non-infectious epididymitis, that resolves with decreasing the drug dose

RISK FACTORS

Urinary tract infection, particularly prostatitis
Indwelling urethral catheter
Urethral instrumentation or transurethral surgery
Urethral stricture

DIAGNOSIS

LABORATORY

Pyuria on urinalysis, leukocytosis, gram stain urethral discharge

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Gross and microabscesses
Organisms reach the epididymis through the lumen of the vas deferens
Interstitial congestion
Fibrous scarring

SPECIAL TESTS

N/A

IMAGING

Ultrasound of scrotum, radionuclide scan

DIAGNOSTIC PROCEDURES

Scrotal exploration or aspiration of epididymis (rarely performed)

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient, usually
Inpatient, if septic or if surgery is scheduled

GENERAL MEASURES

Scrotal elevation
Ice pack
Spermatic cord block with local anesthesia in severe cases

SURGICAL MEASURES

Aspiration of hydrocele to assist examination of scrotal contents and relieve discomfort
Vasostomy to drain infected material
Scrotal exploration, if uncertain whether this is epididymitis or testicular torsion
Drainage of abscesses, epididymectomy, or epididymo-orchiectomy in severe cases not responding to antibiotics

ACTIVITY

Bedrest for minimum of 1-2 days

DIET

No restrictions, but force fluids

PATIENT EDUCATION

Limit activity, immobilize scrotal contents
Stress completing course of antibiotics, even when asymptomatic

FOLLOW UP

PREVENTION/AVOIDANCE

Vasectomy or vasoligation during transurethral surgery
Antibiotic prophylaxis for urethral manipulation
Early treatment of prostatitis
Avoid vigorous rectal examination with acute prostatitis

POSSIBLE COMPLICATIONS

Recurrent epididymitis
Infertility
Fournier's gangrene (necrotizing synergistic infection)

EXPECTED COURSE AND PROGNOSIS

Pain improves within 1-3 days, but induration may take several weeks/months to completely resolve
If bilateral involvement, sterility may result

MISCELLANEOUS

ASSOCIATED CONDITIONS

Prostatitis
Urethritis

AGE-RELATED FACTORS

Pediatric:

Bacteremia from Haemophilus influenzae infection may produce acute epididymitis
In adolescent males, must rule out acute testicular torsion

Geriatric: Diabetic patients with sensory neuropathy may have little pain despite severe infection/abscess
Others: N/A

PREGNANCY

N/A

OTHER NOTES

Syphilis, brucellosis, blastomycosis, coccidioidomycosis, and cryptococcosis are rare causes of epididymitis
Nonbacterial epididymitis and epididymo-orchitis are not rare. Cause is not clear, but may be secondary to retrograde extravasation.

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.