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Epididymitis

Causes

Epididymitis usually results from pyogenic organisms, such as Enterobacteriaceae and Pseudomonas. Epididymitis can result from an existing urinary tract infection or prostatitis and reach the epididymis through the lumen of the vas deferens.

Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis, that spreads through the lymphatics or, less commonly, the bloodstream.

Other causes include trauma, gonorrhea, syphilis, and a chlamydial infection. Trauma may reactivate a dormant infection or initiate a new one. Epididymitis is a complication of prostatectomy and may also result from chemical irritation by extravasation of urine through the vas deferens.

Signs and symptoms

The symptoms of epididymitis include:

• Slight fever
• Chills
• A sensation of heaviness in the affected testicle
• The testicle becomes sensitive to touch or pressure
• Enlargement of the testicle
• Abdominal pain
• Pelvic pain
• Frequent urge to urinate
• A burning sensation on urination
• Discharge from the penis
• Blood in the urine
• Painful ejaculation.

Diagnosis

Epididymitis can be hard to distinguish from testicular torsion, particularly in younger men. Testicular torsion means the testicle has twisted and choked off its supply of blood. Sometimes, epididymitis and testicular torsion can occur at the same time. Epididymitis is diagnosed using a number of tests, including:

• Physical examination
• Medical history
• Urine tests
• STI tests
• Blood tests
• If necessary, further tests to distinguish epididymitis from testicular torsion, such as an ultrasound scan.

Treatment

The goal of treatment is to reduce pain and swelling and combat infection. Therapy must begin immediately, particularly in the patient with bilateral epididymitis, because sterility is always a threat.

During the acute phase

Treatment consists of bed rest, scrotal elevation with towel rolls or adhesive strapping, broad-spectrum antibiotics, and analgesics.

An ice bag applied to the area may reduce swelling and relieve pain. (Heat is contraindicated because it may damage germinal cells, which are viable only at or below normal body temperature.) When pain and swelling subside and allow walking, an athletic supporter may prevent pain.

Prevention

Safer sexual practices, such as monogamous sex and condom use, help protect against STDs. If you have recurrent urninary tract infections or other risk factors for epididymitis, your doctor may discuss with you other ways to prevent recurrent episodes of epididymitis.

In the older patient undergoing open prostatectomy, bilateral vasectomy may be necessary to prevent epididymitis as a postoperative complication; however, antibiotic therapy alone may prevent it. When epididymitis is refractory to antibiotic therapy, epididymectomy under local anesthetic is necessary.