Epididymitis
Epididymitis | |
---|---|
Other names | Inflammation of the epididymis |
Frequency | 600,000 per year (age 15-35, US)[2] |
Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle.[1] Onset of pain is typically over a day or two.[1] The pain may improve with raising the testicle.[1] Other symptoms may include swelling of the testicle, burning with urination, or frequent urination.[1] Inflammation of the testicle is commonly also present.[1]
In those who are young and sexually active,
Treatment may include
Signs and symptoms
Those aged 15 to 35 are most commonly affected.[2] The acute form usually develops over the course of several days, with pain and swelling frequently in only one testis, which will hang low in the scrotum.[3] There will often be a recent history of dysuria or urethral discharge.[3] Fever is also a common symptom. In the chronic version, the patient may have painful point tenderness but may or may not have an irregular epididymis upon palpation, though palpation may reveal an indurated epididymis. A scrotal ultrasound may reveal problems with the epididymis, but such an ultrasound may also show nothing unusual. The majority of patients who present with chronic epididymitis have had symptoms for over five years.[4]: p.311
Complications
Untreated, acute epididymitis's major complications are
Causes
Though urinary tract infections in men are rare, bacterial infection is the most common cause of acute epididymitis.
In sexually active men,
Non-infectious causes are also possible. Reflux of sterile urine (urine without bacteria) through the
Any form of epididymitis can be caused by genito-urinary
Diagnosis
Diagnosis is typically based on symptoms.
Epididymitis usually has a gradual onset. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) remains normal.[1] This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called Prehn's sign, which is, however, non-specific and is not useful for diagnosis.[13] Before the advent of sophisticated
Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for
Classification
Epididymitis can be classified as acute, subacute, and chronic, depending on the duration of symptoms.[6]
Chronic epididymitis
Chronic epididymitis is epididymitis that is present for more than 3 months. Chronic epididymitis is characterized by inflammation even when there is no infection present. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain including testicular cancer (though this is often painless), enlarged scrotal veins (varicocele), calcifications,[15] and a possible cyst within the epididymis. Some research has found that as much as 80% of visits to a urologist for scrotal pain are for chronic epididymitis.[4]: p.311 As a further complication, the nerves in the scrotal area are closely connected to those of the abdomen, sometimes causing abdominal pain similar to a hernia (see referred pain).
Chronic epididymitis is most commonly associated with lower back pain, and the onset of pain often co-occurs with activity that stresses the low back (i.e., heavy lifting, long periods of car driving, poor posture while sitting, or any other activity that interferes with the normal curve of the
Treatment
In both the acute and chronic forms,
For cases caused by enteric organisms (such as E. coli), ofloxacin or levofloxacin are recommended.[8]
In children, fluoroquinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children,
Household remedies such as elevation of the
It is generally believed that most cases of chronic epididymitis will eventually "burn out" of patient's system if left untreated, though this might take years or even decades.[5] However, some prostate-related medications have proven effective in treating chronic epididymitis, including doxazosin.[16]
Epidemiology
Epididymitis makes up 1 in 144 visits for medical care (0.69 percent) in men 18 to 50 years old or 600,000 cases in males between 18 and 35 in the United States.[6]
It occurs primarily in those 16 to 30 years of age and 51 to 70 years.
References
- ^ PMID 27929243.
- ^ PMID 19378875.
- ^ ISBN 978-0-19-518924-7.
- ^ ISBN 978-1-84882-033-3.
- ^ ISBN 978-0-7817-9307-0.
- ^ PMID 19378875.
- ^ "Epididymitis and Orchitis". The Lecturio Medical Concept Library. Retrieved 19 July 2021.
- ^ a b c d Smith DM (September 1, 2008). "A Really Big Pain: Acute Epididymitis". The AIDS Reader.
- ISBN 9780801886591.
- PMID 10785217.
- PMID 8237740.
- PMID 2807285.
- ^ "Diagnosis and Treatment of the Acute Scrotum - February 15, 1999 - American Academy of Family Physicians". Archived from the original on June 6, 2011. Retrieved May 19, 2008.
- ^ ISBN 978-0849399329.
- ^ Matt A. Morgan and Yuranga Weerakkody. "Epididymal calcification". Radiopaedia. Retrieved 2018-05-21.
- from the original on 2013-07-31.
Further reading
- Galejs LE (February 1999). "Diagnosis and treatment of the acute scrotum". Am Fam Physician. 59 (4): 817–24. PMID 10068706. Archived from the originalon 2011-06-06. Retrieved 2008-05-19.
- Nickel JC (2003). "Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma". Rev Urol. 5 (4): 209–15. PMID 16985840.
External links
- Epididymitis at Curlie