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 want to discuss the issue of "epididymitis" with you. Epididymitis is the most common infectious disease in the scrotum and is more common in 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 frequently experiences epididymitis, it should be considered that the ureteral opening may be into the seminal vesicle. Common bacteria that cause epididymitis include Escherichia coli and Staphylococcus, as well as Mycobacterium tuberculosis, Neisseria gonorrhoeae, and Chlamydia, which also frequently cause epididymitis. Since the epididymis is the site where sperm mature and are stored, it plays a crucial role in fertility. Bilateral epididymal disease can lead to infertility. Epididymitis can be divided into acute epididymitis and chronic epididymitis.1) Etiology
Acute epididymitis is often caused by the spread of infections from the urinary system, prostatitis, or seminal vesiculitis along the vas deferens to the epididymis, with hematogenous infection being less common. Procedures such as urethral instrumentation, frequent catheterization, and indwelling catheters after prostatectomy can easily lead to epididymitis. If acute epididymitis is not treated thoroughly, it can progress to chronic epididymitis.
2) Symptoms
1. Clinical manifestations of acute epididymitis: Acute epididymitis develops rapidly, with scrotal swelling and pain, high sensitivity to touch, and radiation to the groin and lower abdomen. The size can double within a few hours, and white blood cell counts can rise to 20,000–30,000/cubic millimeter. 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. When inflammation is extensive, both the epididymis and testis may swell, turn red, and form abscesses. The boundaries between them become indistinct, a condition known as epididymitis orchitis. The spermatic cord on the affected side may also thicken and become tender. Generally, acute symptoms gradually subside after one week.
2. Clinical manifestations of chronic epididymitis: Chronic epididymitis is more common clinically. Some patients develop it from acute episodes that were not fully treated, 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 the same side of the groin. Secondary hydrocele may also occur. Examination may reveal 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 does not have these two characteristics.
4) Examination
1. Acute epididymitis: The diagnosis is usually straightforward based on medical 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: Chronic epididymitis is often characterized by uniform enlargement, hardness, and tenderness of the epididymis.
5) Treatment
To maximize the preservation of fertility, treatment must be thorough. Antibiotics that easily diffuse into the male reproductive tract, such as erythromycin, doxycycline, and clindamycin, should be used. After acute symptoms subside, medication should continue for 4–5 days, and in chronic cases, treatment should extend for 2–4 weeks to consolidate the effect. Effective measures include elevating the scrotum, local cold compresses, abstinence from sexual activity, avoiding smoking, alcohol, and spicy foods to prevent congestion. The prognosis is better than that of epididymitis tuberculosis, but if not treated thoroughly, it can persist for a long time. Ultimately, scar formation may block the ducts, leading to infertility. If recurrent abscesses form, epididymectomy may be performed. If both epididymides are removed, fertility cannot be preserved.
1. Treatment for acute epididymitis: Patients with acute epididymitis should rest appropriately and receive antibiotics and general analgesics. Local heat therapy, physical therapy, and scrotal support can be applied. If an abscess forms, drainage may be necessary. The underlying cause should also be addressed actively.
2. Treatment for chronic epididymitis: Chronic epididymitis often coexists with chronic prostatitis, so treatment measures are similar to those for chronic prostatitis. Treating prostatitis can alleviate symptoms of chronic epididymitis. After healing, residual epididymal nodules may sometimes cause psychological burdens. Surgical removal does not always relieve symptoms, so orchidectomy is generally not performed. For male infertility caused by bilateral epididymitis and obstruction of sperm output, anastomosis at the proximal obstruction site of the vas deferens and epididymis may partially address sperm drainage issues, but postoperative pregnancy rates remain low.
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