M.

Durai Raj K umar

definition Inflammation of epididymis is epididymitis € Inflammation of testis is called orchitis € € Inflammation confined to the epididymus. the condition is called EPIDIDYMOORCHITIS .but when the infection spreads to the body of testis.

CAUSATIVE : A complication from a urine infection € Sexually transmitted infection € The mumps virus € An operation to the prostate or urethra € Uncommon causes € .

coli Primary infection of urethra Outflow obstruction Results in Secondary urinary infection.a high pressure in the prostatic urethra cause reflux of infected urine up into the vasa € € € .complication from a urine infection € Urinary tract pathogens like E.

€ € .Sexually transmitted infection € chlamydia and gonorrhoea Both are associated with urethritis the infection can track down the vas deferens to the epididymis and testis.

.The mumps virus € € common cause mumps in boys also causes epididymoorchitis in about 1 in 5 cases € The virus gets to the testes via the bloodstream € now uncommon since the MMR immunisation is now routinely given to children.

€ .operation to the prostate or urethra Epididymo-orchitis used to be a common complication after prostatectomy (removal of the prostate) € This may allow bacteria into the urethra which may track down to the testes € This is now rare due to better surgical techniques.

€ Injury to the scrotum can cause inflammation of the epididymis and testis.Uncommon causes Infection from other parts of the body rarely. travel in the blood to the testes € TB (tuberculosis) and brucellosis. € when unusual exertion or violent strain when the bladder is full causes injection of urine into the vasa under pressure € .

6-8 weeks € . fever € The epididymis and testis swell rapidly and become exquisitely painful € scrotal wall which is at first red. oedematous and shiny may become adherent to the epididymis € Resolution.Clinical features initial symptoms are those of acute prostatitis € ache in the groin.

usually¶ as the parotid swelling is waning € .Acute tuberculous epididymitis vas is thickened there is little response to the usual antibiotics € Acute epididymo-orchitis of mumps 18 percent of males suffering from mumps.

testicular atrophy which may cause infertility Partial atrophy .infants € .€ main complication is testicular atrophy bilateral(not usual) .persistent testicular pain absence of parotitis .

this simplifies the choice of antibiotic should rest in bed while the acute symptoms persist Doxycvcline (100 mg daily) . . The inflamed organ rests on a pad of cotton wool placed on the sling.Treatment € € € € organism is isolated from the urine.treatment of choice for chlamydial infection The scrotum is supported on a sling made of broad adhesive tape attached between the thighs.

€ .Treatment patient should be warned that the testis may atrophy. € If suppuration occurs. drainage is necessary. € Antibiotic treatment should continue for 2 weeks or until the inflammation has subsided.

Chronic tuberculous epididymoorchitis € € € Insidious onset infection is retrograde from a tuberculous focus in the seminal vesicles. Clinical features firm discrete swelling of the Iower pole of the epididvmis which aches a little a characteristic beading of the vas is apparent due to subepithelial tubercles seminal vesicle feels indurated and swollen .

urine and semen should be examined repeatedly for tubercle bacilli Intravenous urographv and chest radiography should be performed. .Chronic tuberculous epididymoorchitis € € € € € in neglected cases. a tuberculous µcold¶ abscess forms which may discharge body of the testis may be uninvolved for years but the contralateral epididymis often becomes diseased.

epididymectomy / orchidectomy is advisable € full course of antituberculous chemotherapy should be completed even if there is no evidence of disease elsewhere. € .Treatment Treatment with antituberculous drugs € If resolution does not occur within 2 months.

Chronic nontuberculous epididymitis failure of an acute attack to resolve fully € difficult to distinguish from tuberculosis but the swelling may be larger and smoother € Should exclude urethral stricture.sarcoidosis € Epididymectomy / orchidectomv should be considered if there is no resolution after 4²6 weeks of conservative treatment. € .

Complications € € € € An abscess (a collection of pus due to infection) occasionally develops in the scrotum. serious damage to the testis may occur and result in gangrene (dead tissue) in the testis that needs to be surgically removed. . Reduced fertility in the affected testis. Rarely. An ongoing (chronic) inflammation occasionally develops. This may need a small operation to drain the pus. especially in cases caused by the mumps virus.