Patient's question:

Testis feels cold, with a sense of heat, the area around the waist feels cold, the area around the Dantian feels cold, and the lower abdomen feels bloated. What is the cause and what methods need to be taken? This episode and its duration: About a week. Current general condition: Mainly, but the penis can still erect. Medical history: It has been two years, with intermittent episodes.

Doctor's answer:

Hello: Epididymitis is more common in middle-aged and young adults and can be classified into acute epididymitis and chronic epididymitis based on the course of the disease. Etiology Acute epididymitis is often caused by the spread of urinary system infections, prostatitis, or seminal vesiculitis along the vas deferens to the epididymis, with hematogenous infection being less common. through the urethra, frequent catheterization, and indwelling urethral catheters after prostatectomy are all predisposing factors for epididymitis. If acute epididymitis is not treated thoroughly, it can progress to chronic epididymitis. Symptoms 1. Clinical manifestations of acute epididymitis: Onset is sudden, with high fever, elevated white blood cell count, swelling and pain in the affected scrotum, a heavy sensation, and radiating pain in the lower abdomen and inguinal region, which worsens when standing or walking. The affected epididymis is swollen and tender to touch. When the inflammation is extensive, both the epididymis and testis may be swollen, making it difficult to distinguish between them, a condition known as epididymitis orchitis. The spermatic cord on the affected side may also be thickened and tender. Generally, acute symptoms gradually subside within one week. 2. Clinical manifestations of chronic epididymitis: Chronic epididymitis is more common and may develop from incomplete healing during the acute phase, though many cases have no clear acute phase and are secondary to chronic prostatitis or injury. Patients often experience a dull ache or heavy sensation in the affected scrotum, with pain radiating to the lower abdomen and the same inguinal region. Secondary hydrocele may also be present. On examination, the epididymis is often moderately enlarged and hardened with mild tenderness, and the ipsilateral vas deferens may be thickened. Examination 1. Acute epididymitis: Diagnosis is usually straightforward based on history and physical examination, but it must be differentiated from testicular torsion. Testicular torsion is characterized by sudden onset, testicular swelling and fixation, inability to move within the scrotum, and relief of pain when the scrotum is elevated. 2. Chronic epididymitis: In chronic epididymitis, the epididymis is uniformly enlarged and hardened with tenderness. Treatment 1. Treatment of acute epididymitis: Acute epididymitis should be treated with adequate rest, antibiotics, and general analgesics. Local heat, physical therapy, and scrotal support may be applied. If an abscess forms, drainage is necessary. The underlying cause should also be addressed. 2. Treatment of 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 hardening may persist, sometimes causing psychological distress. Surgical orchiectomy may not always relieve symptoms, so it is generally not performed. In cases of male infertility due to bilateral epididymitis causing obstructed sperm output, anastomosis of the vas deferens at the proximal obstruction site can partially address sperm drainage issues, but postoperative pregnancy rates remain low.