Patient's question:
First supplement to the question: My problem is that sometimes I have a burning sensation, and when it hurts, it only appears on one side. There is no high fever, nor does it cause radiating pain. Sometimes it only lasts a few hours and then recovers.Doctor's answer:
Hello! First of all, I wish you a speedy recovery! I would like to discuss the issue of "epididymitis" with you. Epididymitis is the most common infectious disease in the scrotum, often occurring 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 suffers from epididymitis, it should be considered that the ureteral opening may be in 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. If both epididymides are affected, it can lead to infertility.Epididymitis can be divided into acute epididymitis and chronic epididymitis.
1) Acute Epididymitis
- Onset is sudden, with scrotal swelling and pain, which is highly sensitive to touch and radiates to the groin and lower abdomen. The size can double within a few hours, and white blood cells can increase to 20,000–30,000 per cubic millimeter. Pain worsens when standing and is often accompanied by high fever. In severe cases, the scrotal skin swells, turns red, and may form an abscess.
2) Chronic Epididymitis
- It is clinically more common and may develop from acute epididymitis that was not fully treated. However, most patients do not have a history of acute episodes and often have chronic prostatitis. Patients commonly experience pain in one side of the scrotum that radiates to the groin, with a history of intermittent swelling and pain in the epididymis. The epididymis may be slightly enlarged and hardened, with mild tenderness but rarely obvious nodules.
3) Differential Diagnosis from Epididymal Tuberculosis
- 1. The vas deferens in epididymal tuberculosis appears like a string of beads.
- 2. Epididymal tuberculosis is often adhered to the scrotal wall, even forming sinuses.
- Epididymitis does not exhibit these two characteristics.
The treatment for chronic epididymitis focuses on treating chronic prostatitis. Unless the patient has multiple acute episodes or purulent epididymitis, orchidectomy is generally not performed. If recurrent episodes form abscesses, orchidectomy may be necessary. If both epididymides are removed, fertility cannot be preserved.
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