TUBERCULOUS EPIDIDYMO-ORCHITIS

• The infection reaches the epididymis via:

• The blood stream (rare): Here the lesion occupies the head of epididymis.

• More frequently the infection is retrograde from a tuberculous focus in the seminal vesicle or prostate. The lesion occurs in the globus minor (tail). The vas is beaded due its involvement by multiple subepithelial tubercles or by

CLINICAL PICTURE

– There is a firm or hard discrete swelling of epididymis in the head (rare) or tail as mentioned above. It is slightly painful.

– The disease progresses until the whole epididymis is firm and craggy behind a normal feeling testis.

– There may be a small secondary hydrocelse in one third of cases.

– The vas is beaded.

– PR examination: The seminal vesicle feels indurated and swollen; there may be a hard craggy nodule in the prostate.

– In neglected cases, a tuberculous ‘cold’ abscess forms which may discharge through a posteriorly placed sinus. In two-thirds of cases there is evidence of renal tuberculosis or previous disease. The other patients appear healthy.