Patient's question:
BR>Current general situation: Testicular swelling, slightly heavy and distending sensation Medical history: Occasionally experienced this condition five or six years ago, now the symptoms have been lasting for a long time Is it epididymitis?Doctor's answer:
Hello! First of all, I wish you a speedy recovery! I'd like to discuss the issue of "epididymitis" with you. Epididymitis is the most common infectious disease in the scrotum, primarily affecting young and middle-aged adults. Bacteria usually spread from infected urine, the prostate, the posterior urethra, or the seminal vesicles through the vas deferens to the epididymis. Patients who have undergone prostate surgery or have indwelling catheters are also prone to epididymitis. Urine reflux into the vas deferens during urination can also lead to epididymitis. If a child experiences recurrent epididymitis, it may indicate that the ureter opens into the seminal vesicle. Common bacteria that cause epididymitis include Escherichia coli and Staphylococcus, as well as Mycobacterium tuberculosis, Neisseria gonorrhoeae, and Chlamydia. Since the epididymis is the site where sperm mature and are stored, it plays a crucial role in fertility. Bilateral epididymal involvement can result in infertility. Epididymitis can be classified into acute and chronic forms.1) Etiology
Acute epididymitis is most commonly caused by the spread of infection from the urinary system, prostatitis, or seminal vesiculitis along the vas deferens to the epididymis. Hematogenous infection is less common. Procedures such as urethral instrumentation, frequent catheterization, and post-prostatectomy indwelling catheters can easily lead to epididymitis. If acute epididymitis is not treated thoroughly, it may progress to chronic epididymitis.
2) Symptoms
1. Acute Epididymitis
- Clinical Presentation: Acute epididymitis develops rapidly, with scrotal swelling and pain that is highly sensitive to touch, radiating to the groin and lower abdomen. The size may double within hours, and white blood cell counts can rise to 20,000–30,000/cu mm. Pain worsens when standing and is often accompanied by high fever. The affected scrotum feels swollen, heavy, and aching, with pulling pain in the lower abdomen and groin, which intensifies when standing or walking. The affected epididymis is enlarged and tender to palpation. If the inflammation is extensive, both the epididymis and testis may swell, redden, and form abscesses. The boundaries between them become indistinct, a condition known as epididymo-orchitis. The spermatic cord on the affected side may also thicken and become tender. Generally, acute symptoms gradually subside within a week.
2. Chronic Epididymitis
- Clinical Presentation: Chronic epididymitis is more common clinically. Some patients develop it from unresolved acute episodes, but most do not have a clear acute phase, with inflammation often secondary to chronic prostatitis or injury. Patients often experience dull pain, heaviness, or aching in the affected scrotum, which may radiate to the lower abdomen and ipsilateral groin. Secondary hydrocele may also occur. Examination reveals varying degrees of enlargement and hardness of the epididymis with mild tenderness, and the ipsilateral vas deferens may be thickened.
3) Differential Diagnosis
1. The vas deferens in epididymitis tuberculosis appears as a string of beads.
2. Epididymitis tuberculosis is often adhered to the scrotal wall, even forming sinuses. Epididymitis lacks these two characteristics.
4) Examinations
1. Acute Epididymitis: Diagnosis is usually straightforward based on history and physical examination, but it must be differentiated from testicular torsion. Testicular torsion occurs suddenly, with an enlarged, fixed testis that cannot move within the scrotum, and elevating the scrotum does not relieve local pain.
2. Chronic Epididymitis: The epididymis in chronic epididymitis is uniformly enlarged, hard, and tender.
5) Treatment
To maximize preservation of fertility, treatment must be thorough. Antibiotics that easily diffuse into the male reproductive tract, such as erythromycin, doxycycline, and clindamycin, should be selected. After acute symptoms subside, medication should continue for an additional 4–5 days. In chronic cases, treatment should extend for 2–4 weeks to consolidate the effect. Effective measures include elevating the scrotum, local cold compresses, abstaining from sexual activity, avoiding smoking, alcohol, and spicy foods to prevent congestion. The prognosis is better than that of epididymitis tuberculosis, but incomplete treatment can lead to prolonged recovery. Ultimately, scar formation may block the ducts, resulting in infertility. If recurrent abscesses form, epididymectomy may be necessary. If both epididymides are removed, fertility cannot be preserved.
1. Treatment for Acute Epididymitis: Adequate rest, antibiotics, and analgesics should be provided. Local heat, physical therapy, and scrotal support may be applied. If an abscess forms, drainage is required. The underlying cause should also be addressed.
2. Treatment for Chronic Epididymitis: Chronic epididymitis often coexists with chronic prostatitis, so treatment is similar to that for chronic prostatitis. Treating prostatitis can alleviate epididymitis symptoms. After healing, residual epididymal nodules may cause psychological distress. Surgical removal does not always relieve symptoms, so orchiectomy is generally not performed. For male infertility due to bilateral epididymitis and obstruction of sperm output, anastomosis at the proximal obstruction site of the vas deferens can partially address sperm drainage issues, but postoperative pregnancy rates remain low.
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