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
management
Department of Urology
Learning Objectives
? Describe the clinical manifestations,
methods of identification, CDC treatment
guidelines, prevention and follow up for
epididymoorchitis.
Anatomy review
Bladder
Seminal vesicle
Vas deferens
Epididymis
Testis
Anatomy review
A: Caput or head of
the epididymis
B: Corpus or body of
the epididymis
C: Cauda or tail of the
epididymis
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
intercourse:
? 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
epididymis
? Chronic disease
Incidence
? Epididymitis is most common in young men
ages 19 ? 35
? ~1 in 1000 men develop epididymitis
annually
? 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
waning
? Scrotum is not usually swollen but may be
indurated in long-standing cases
Mumps Orchitis
? Fever, malaise &
myalgia
? Parotiditis typically
preceding onset of
orchitis by 3-5 days
? Subclinical
infections
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
urethra
? Pain or burning during
urination or ejaculation
? Discomfort in the lower
abdomen or pelvis
Diagnosis
? Urine R/M
? Urine C/S
? Urethral swab
? intracellular gram-negative diplococci, -N.
gonorrhoeae
? only WBCs - C. trachomatis
? Scrotal USG( rule out testicular torsion)
Epididymitis ? diagnosis
? Gram stain of urethral secretions
demonstrating 5 WBC per oil immersion
field
? 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
(days)
(hours)
? 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.
gonorrhoeae:
? 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
organisms:
? Levofloxacin 500mg PO once daily x 10 days
OR
? 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
resolve
? Swelling and tenderness that persists after
completion of treatment should be evaluated
comprehensively
? 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
epididymitis
? Repeat screening for STI ~ 2 months after
initial testing for re-infection
? Abstain from sex until the individual & sex
partners have completed treatment
References
? 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