Download MBBS Urology Presentations 8 Epididymoorchitis Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Urology 8 Epididymoorchitis PPT-Powerpoint Presentations and lecture notes

Epididymoorchitis : spectrum and


Department of Urology

Learning Objectives

? Describe the clinical manifestations,

methods of identification, CDC treatment

guidelines, prevention and follow up for


Anatomy review


Seminal vesicle

Vas deferens



Anatomy review

A: Caput or head of

the epididymis

B: Corpus or body of

the epididymis

C: Cauda or tail of the

D: Vas deferens
E: Testicle

Cleveland Clinic Center for Medical Art and Photography ? 2009

Risk Factors

? Sexual intercourse with more than one

partner and not using condoms

? Being uncircumcised
? Recent surgery or a history of structural

problems in the urinary tract

? Regular use of a urethral catheter
Causes of acute epididymitis

? Among sexually active men aged <35 years

? C. trachomatis or N. gonorrhoeae

? Men who are the insertive partner during anal


? Escherichia coli and Pseudomonas spp

? Men aged >35 years

? Sexual y transmitted epididymitis is uncommon
? Bacteriuria secondary to obstructive urinary

disease is more common

Causes of chronic epididymitis

? Inadequate treatment of acute epididymitis
? Recurrent epididymitis
? Granulomatous reaction

? Mycobacterium tuberculosis (TB) is the most

common granulomatous disease affecting the


? Chronic disease

? Epididymitis is most common in young men

ages 19 ? 35

? ~1 in 1000 men develop epididymitis


? Acute epididymitis accounts for >600,000

medical visits per year in the U.S.

? Patients with epididymitis secondary to a STI

have 2-5 times the risk of acquiring and

transmitting HIV

Acute Epididymitis

? Discomfort and/or pain in the scrotum,

testicle, or epididymis lasts <6 week

? Usually caused by a bacterial infection

Chronic Epididymitis

? Discomfort and/or pain in the scrotum,

testicle, or epididymis lasting >6 weeks

? Pain may be constant or waxing and


? Scrotum is not usually swollen but may be

indurated in long-standing cases

Mumps Orchitis

? Fever, malaise &


? Parotiditis typically

preceding onset of

orchitis by 3-5 days

? Subclinical


Epididymitis ? signs/symptoms

? Heavy sensation in the

testicle area

? Painful scrotal swelling
? Fever
? Chills
? Testicle pain gets

worse with pressure

? Lump in the testicle

Epididymitis ? signs/symptoms

? Blood in the semen
? Discharge from the


? Pain or burning during

urination or ejaculation

? Discomfort in the lower

abdomen or pelvis

? Urine R/M

? Urine C/S

? Urethral swab

? intracellular gram-negative diplococci, -N.


? only WBCs - C. trachomatis

? Scrotal USG( rule out testicular torsion)

Epididymitis ? diagnosis

? Gram stain of urethral secretions

demonstrating 5 WBC per oil immersion


? Positive leukocyte esterase test on first-

void urine

? Culture, nucleic acid hybridization tests,

and NAATs are available for the detection

of both N. gonorrhoeae and C. trachomatis
Epididymitis ? diagnosis

? Physical exam
? Additional tests:

? Complete blood count
? Doppler ultrasound
? Testicular scan (nuclear medicine scan)
? Urinalysis and culture

Acute Epididymitis vs Testicular Torsion

Acute Epididymitis

Testicular Torsion

? Gradual onset of scrotal pain ? Sudden onset of scrotal pain



? Normal cremasteric reflex

? Abnormal cremasteric reflex

? Usually no nausea & vomiting ? Nausea & vomiting common
? More common in sexually

? More common in adolescents

active men

and in men without evidence of

inflammation or infection

? HPI & exam support a

? HPI & exam do not support a

diagnosis of urethritis or

diagnosis of urethritis or UTI

urinary-tract infection

? Surgical emergency

? Empiric treatment & follow-up
Epididymitis ? treatment

? Empiric treatment is indicated before

laboratory results are available

? Goals of treatment of acute epididymitis

caused by C. trachomatis or N.


? Microbiological cure of infection

? Improvement of signs & symptoms

? Prevent transmission to others

? Reduce potential complications

Epididymitis ? treatment

? Recommended Regimens:

? Ceftriaxone 250mg IM in a single dose PLUS
? Doxycycline 100mg PO BID x 10 days

For acute epididymitis most likely caused by enteric


? Levofloxacin 500mg PO once daily x 10 days

? Ofloxacin 300mg PO BID x 10 days

Source: Centers for Disease Control and Prevention (CDC). Epididymitis. In: Sexual y transmitted diseases treatment

guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59(RR-12):67-9.
Epididymitis ? follow up

? Pain improves within 1-3 days
? Induration can last a few weeks-months to


? Swelling and tenderness that persists after

completion of treatment should be evaluated


? Evaluate for formation of an epididymal

abscess or a testicular abscess

Epididymitis ? complications

Complications of epididymitis:
? Abscess in the scrotum
? Chronic epididymitis
? Fistula on the skin of the scrotum

(cutaneous scrotal fistula)

? Death of testicular tissue due to lack of

blood (testicular infarction)

? Sepsis & infertility
Epididymitis ? prevention

? Practicing safe sex
? Treating sexual partners as a contact to


? Repeat screening for STI ~ 2 months after

initial testing for re-infection

? Abstain from sex until the individual & sex

partners have completed treatment


? Centers for Disease Control and Prevention (CDC). Epididymitis. In:

Sexual y transmitted diseases treatment guidelines, 2010. MMWR

Recomm Rep. 2010 Dec 17;59(RR-12):67-9.

? Nickel JC. Inflammatory Conditions of the Male GenitourinaryTract:

Prostatitis, and Related Conditions, Orchitis, Epididymitis. In: Wein AJ,

ed. Campbel -Walsh Urology. 10th ed. Philadelphia, Pa: Saunders

Elsevier; 2011:chap 11.

? Trojian TH, Lishnak TS, Heiman D. American Family Physician. 2009

Apr 1;79(7):583-7. Epididymitis and orchitis: an overview.

? Walker NA, Chal acombe B. Practitioner. 2013 Apr;257(1760):21-5, 2-3.

Managing epididymo-orchitis in general practice.

This post was last modified on 08 April 2022