Patient's question:
Medical history: Diabetes for more than 6 yearsAuxiliary tests: Color Doppler ultrasound (as shown in the figure) & Serum tests (Carcinoembryonic antigen: 6.34 g/ml, Alpha-fetoprotein: 1.90 g/ml)
Doctor's answer:
Treatment for Orchitis1. Antibacterial and anti-inflammatory therapy;
2. Bed rest, elevating the scrotum, local heat application, and physical therapy; 1% lidocaine spermatic cord block injection to alleviate pain;
3. If an abscess forms, incision and drainage should be performed. Drug principles: Early administration of sufficient, broad-spectrum antibiotics, such as azithromycin.
Supportive Examinations
1. For acute orchitis, the examination protocol primarily focuses on Box A of the diagnostic criteria.
2. For chronic orchitis or recurrent cases, the examination protocol may include Box A, B, or C.
Evaluation of Efficacy
1. Cure: Symptoms disappear, blood white blood cells return to normal, the testis shows no atrophy, and there is no hydrocele.
2. Improvement: Symptoms improve, the testis is slightly enlarged, and there is tenderness.
3. Non-resolution: Symptoms and signs do not improve, the testis is enlarged or atrophied, or an orchitis abscess and hydrocele form.
Expert Tips
Orchitis should be treated with early intravenous administration of large doses of broad-spectrum, effective antibiotics to control inflammation and reduce the risk of suppurative orchitis and orchitis abscess. Particular attention should be paid to acute mumps orchitis, as bilateral involvement can cause irreversible damage to spermatogenesis or testicular atrophy, leading to male infertility. Therefore, the key to prevention is: children under one year old who are susceptible can be vaccinated. Live attenuated mumps virus vaccine can prevent mumps and its associated orchitis. Mumps hyperimmune globulin can reduce the severity of the disease. The routine use of estrogen or adrenal glucocorticoids may have a preventive effect on orchitis in children with mumps, but this is still debated.
Common Types of Orchitis
Orchitis is primarily classified as non-specific or mumps-related. Any purulent sepsis can lead to acute purulent orchitis, even resulting in an orchitis abscess. The most common pathogens are Escherichia coli, Streptococcus, Staphylococcus, and Pseudomonas aeruginosa. In fact, the most common cause of purulent orchitis is infection spreading from epididymitis, so it should technically be referred to as epididymo-orchitis. Patients often experience testicular pain radiating to the groin, a heavy sensation, high fever, nausea, vomiting, elevated white blood cells, and significant testicular enlargement with marked tenderness and scrotal skin redness. If this occurs, medical attention should be sought promptly.
Mumps Orchitis
Mumps orchitis is caused by a viral infection. Due to the implementation of planned immunization in China, the incidence of this disease has shown a clear downward trend in recent years, as children are vaccinated with "measles," "rubella," and "mumps" vaccines during early childhood. This condition is less common before puberty, and orchitis typically occurs 4–6 days after the onset of mumps, though it may occur without mumps symptoms. Approximately 70% of cases are unilateral, and 50% of affected testes may atrophy.
Orchitis is curable. As long as it is detected early and treated systematically and effectively, testicular damage can be prevented. Men should also pay attention to reproductive health and hygiene in daily life to prevent orchitis.