ACUTE EPIDIDYMO-ORCHITIS

1st lesson

•Mode of infection:

Ascending Infection

Infection reaches the globus minus of the epididymis (tail) via the lumen of the vas from a primary infection of the urethra, prostate or seminal vesicles; both sexually transmitted (e.g. gonococci, Chlamydia) and non sexually transmitted.

Urinary infection, especially if associated with outflow obstruction causes reflux of infected urine up the vas to infect the epididymis.

A non-infective epididymitis sometimes arises from a similar cause when unusual exertion or violent strain when the bladder is full causes injection of urine into the vasa under pressure.

Urethral instrumentation and indwelling catheters. Post-operative epididymitis may occur after prostatectomy or other operations in the lower urinary tract especially if the urine was infected or catheters were used.

Blood borne infection: the infection starts in the globus major (head).

CLINICAL PICTURE

Symptoms of the causative factor, e.g. acute prostatitis, urethritis, urethral discharge may precede or coexist with the scrotal complaints..

Fever.

Severe scrotal pain (and tenderness), which can radiate to the inguinal canal and even to the flank.

Swelling of the scrotum, which can reach a large size, associated with redness and edema of the overlying skin.

Resolution may take 6—8 weeks to complete.

COMPLICATIONS

• ABSCESS

• CHRONICITY

INVESTIGATIONS

Culture and sensitivity of urethral discharge, urine and prostatic fluid.

CBC shows leucocytosis.

Duplex scan shows increased vascularity in the testis and epididymis.

US shows the details of the swelling and the presence of secondary hydrocele.

TREATMENT

• Broad spectrum antibiotics.

• Analgesics and antipyretics and anti-inflammatory drugs (as alpha chymotrypsin)

• Scrotal support.