Epididymitis
Epididymitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
This infection of the epididymis, the testicle’s cordlike excretory duct, is one of the most common infections of the male reproductive tract. It usually affects adults and is rare before puberty. Epididymitis may spread to the testicle itself, causing orchitis; bilateral epididymitis may cause sterility. (See Orchitis.)
Causes and incidence
Epididymitis is usually a complication of pyogenic bacterial infection of the urinary tract (urethritis or prostatitis). The pyogenic organisms, such as staphylococci, Escherichia coli, streptococci, Chlamydia trachomatis, and Neisseria gonorrhoeae, reach the epididymis through the lumen of the vas deferens. Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis, that spreads through the lymphatics or, less commonly, the bloodstream. Other causes include trauma, gonorrhea, syphilis, or a chlamydial infection. Trauma may reactivate a dormant infection or initiate a new one. Epididymitis may be a complication of prostatectomy and may also result from chemical irritation by extravasation of urine through the vas deferens. The incidence is about 600,000 cases per year, with the highest prevalence in young males ages 19 to 35.
Signs and symptoms
The key symptoms are pain, extreme tenderness, and swelling in the groin and scrotum with erythema, high fever, malaise, and a characteristic waddle — an attempt to protect the groin and scrotum during walking. An acute hydrocele may also result from inflammation.
Diagnosis
Clinical features suggest epididymitis but diagnosis is actually made with the aid of laboratory tests:
❑ urinalysis: increased white blood cell (WBC) count indicates infection
❑ urine culture and sensitivity tests: may identify causative organism
❑ serum WBC count: more than 10,000/µl in infection.
Alert Scrotal ultrasonography may help differentiate acute epididymitis from other conditions, such as testicular torsion, which is a surgical emergency.
Testicular scan (nuclear medicine scan) may be done to rule out torsion. In epididymitis, increased blood flow is also demonstrated.
Treatment
The goal of treatment is to reduce pain and swelling and combat infection. Therapy must begin immediately, particularly in the patient with bilateral epididymitis because sterility is always a threat. During the acute phase, treatment consists of bed rest, scrotal elevation with towel rolls or adhesive strapping, broad-spectrum antibiotics, and analgesics. An ice bag applied to the area may reduce swelling and relieve pain (heat is contraindicated because it may damage germinal cells, which are viable only at or below normal body temperature). When pain and swelling subside and allow walking, an athletic supporter may prevent pain. Occasionally, corticosteroids may be prescribed to help counteract inflammation but their use is controversial.
ELDER TIP In the older patient undergoing open prostatectomy, bilateral vasectomy may be necessary to prevent epididymitis as a postoperative complication; however, antibiotic therapy alone may prevent it. When epididymitis is refractory to antibiotic therapy, epididymectomy under local anesthetic is necessary.
Special considerations
Patient care includes support and monitoring for worsening of symptoms.
❑ Watch closely for abscess formation (localized, hot, red, tender area) or extension of infection into the testes. Closely monitor temperature, and ensure adequate fluid intake.
❑ Because the patient is usually very uncomfortable, administer analgesics as necessary. During bed rest, check often for proper scrotum elevation.
❑ Before discharge, emphasize the importance of completing the prescribed antibiotic therapy, even after symptoms subside. Educate the patient regarding preventing the transmission of sexually transmitted diseases, as appropriate.
❑ If the patient faces the possibility of sterility, suggest supportive counseling as necessary.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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