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Epididymitis

Epididymitis is a medical condition where the epididymis becomes inflamed. This condition may be mildly or very painful. Antibiotics may be needed to control a component of infection. more...

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Diagnosis

Epididymitis can be hard to distinguish from testicular torsion. Sometimes, both can occur at the same time. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain. These include: testicular cancer, enlarged scrotal veins (varicocele) or a cyst within the epididymis. As well, the nerves in the scrotal area are connected to those of the abdomen, sometimes causing pain similar to a hernia (see referred pain). Tests may also include a physical examination and ultrasound. A urologist may need to be consulted.

Chronic epididymitis is epididymitis which lasts past the first treatment. Typically, a second, longer round of treatment is used. Chronic epididymitis is characterised by inflammation even when there is no infection present. This condition can develop even without the presence of the previously described known causes. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. As a last resort, surgery may be employed.

Complications

Untreated, acute epididymitis can lead to a variety of complications. These include: chronic epididymitis, abscess, permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body.

Treatment

Treatment options include: antibiotics, elevation of the scrotum, cold compresses applied regularly to the scrotum, hospitalisation in severe cases, check-ups to ensure the infection has cleared up. Pain is frequently so severe as to require opiate analgesics such as hydrocodone.

Epidemiology

This is usually caused by a secondary bacterial infection that is brought about by a variety of underlying conditions. Some cases of epididymitis are characterised by inflammation even when there is no infection. Urinary tract infections are the most common cause. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. It can also be caused by genito-urinary surgery, including prostatectomy, urinary catheterization, congenital kidney and bladder problems, and STDs, like gonorrhoea and chlamydia.

Acute epidiymitis has a tendency to spontaneously recur months or years after a successfully treated case.

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Epididymitis
From Gale Encyclopedia of Medicine, 4/6/01 by Maureen Haggerty

Definition

Epididymitis is inflammation or infection of the epididymis. In this long coiled tube attached to the upper part of each testicle, sperm mature and are stored before ejaculation.

Description

Epididymitis is the most common cause of pain in the scrotum. The acute form is usually associated with the most severe pain and swelling. If symptoms last for more than six weeks after treatment begins, the condition is considered chronic.

Epididymitis can occur any time after the onset of puberty but is most common between the ages of 18 and 40. It is especially common among members of the military who exercise for extended periods without emptying their bladders.

Factors that increase the risk of developing epididymitis include:

  • Infection of the bladder, kidney, prostate, or urinary tract
  • Other recent illness
  • Narrowing of the urethra (the tube that drains urine from the bladder)
  • Use of a urethral catheter.

Causes & symptoms

Although epididymitis can be caused by the same organisms that cause some sexually transmitted diseases (STDs) or occur after prostate surgery, the condition is generally due to pus-generating bacteria associated with infections in other parts of the body.

Epididymitis can also be caused by injury or infection of the scrotum or by irritation from urine that has accumulated in the vas deferens (the duct through which sperm travels after leaving the epididymis).

Epididymitis is characterized by sudden redness and swelling of the scrotum. The affected testicle is hard and sore, and the other testicle may feel tender. The patient has chills and fever and usually has acute urethritis (inflammation of the urethra).

Enlarged lymph nodes in the groin cause scrotal pain that intensifies throughout the day and may become so severe that walking normally becomes impossible.

Diagnosis

Laboratory tests used to diagnose epididymitis include:

  • Urinalysis and urine culture
  • Examination of discharges from the urethra and prostate gland
  • Blood tests to measure white-cell counts.

Treatment

Because epididymitis that affects both testicles can make a man sterile, antibiotic therapy must be initiated as soon as symptoms appear. To prevent reinfection, medication must be taken exactly as prescribed, even if the patient's symptoms disappear or he begins to feel better. Over-the-counter anti-inflammatories can relieve pain but should not be used without the approval of a family physician or urologist.

Bed rest is recommended until symptoms subside, and patients are advised to wear athletic supporters when they resume normal activities. If pain is severe, a local anesthetic like lidocaine (Xylocaine) may be injected directly into the spermatic cord.

Self-care

A patient who has epididymitis should not drink beverages that contain caffeine. To prevent constipation, he should use stool softeners or eat plenty of fruit, nuts, whole grain cereals, and other foods with laxative properties.

An ice bag wrapped in a towel can reduce pain and swelling but should be removed from the inflamed area for a few minutes every hour to prevent burns.

Strenuous activity should be avoided until symptoms disappear. Sexual activity should not be resumed until a month after symptoms disappear.

If a second course of treatment doesn't eradicate stubborn symptoms, longterm anti-inflammatory therapy may be recommended. In rare instances, chronic symptoms require surgery.

Surgery

Each of the surgical procedures used to treat epididymitis is performed under local anesthesia on an outpatient basis. Both of them cause sterility.

Epididymectomy involves removing the inflamed section of the epididymitis through a small incision in the scrotum.

Bilateral vasectomy prevents fluid and sperm from passing through the epididymis. This procedure is usually performed on men who have chronic epididymitis or on elderly patients undergoing prostate surgery.

Prognosis

Pain generally subsides 24-72 hours after treatment begins. Complete healing may take weeks or months.

Prevention

Using condoms and not having sex with anyone who has an STD can prevent some cases of epididymitis.

Further Reading

For Your Information

    Books

  • Shaw, Michael, ed. Everything You Need to Know About Diseases. Springhouse, PA: Springhouse Corporation, 1996.

    Other

  • "Epididymitis." http://www.duj.com/epididymitis.html. (7 June 1998).
  • "Epididymitis." http://www.thriveonline.com/health/Library/illsymp/illness203.html. (6 June 1998).

Gale Encyclopedia of Medicine. Gale Research, 1999.

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