Epididymitis

Epididymitis is a medical condition in which the epididymis becomes inflamed. This condition may be mildly to very painful. Antibiotics may be needed to control a component of infection.

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Diagnosis

Epididymitis can be hard to distinguish from testicular torsion. Sometimes, both can occur at the same time. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain. These include: testicular cancer, enlarged scrotal veins (varicocele) or a cyst within the epididymis. As well, the nerves in the scrotal area are connected to those of the abdomen, sometimes causing pain similar to a hernia (see referred pain). Tests may also include a physical examination and ultrasound. A urologist may need to be consulted.

Chronic epididymitis is epididymitis which lasts past the first treatment. Typically, a second, longer round of treatment is used. Chronic epididymitis is characterised by inflammation even when there is no infection present. This condition can develop even without the presence of the previously described known causes. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. As a last resort, surgery may be employed.

Complications

Untreated, acute epididymitis can lead to a variety of complications. These include: chronic epididymitis, abscess, permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body.

Treatment

Treatment options include: antibiotics Doxycycline is one example of the antibiotics that are possibly used, elevation of the scrotum, cold compresses applied regularly to the scrotum, hospitalisation in severe cases, check-ups to ensure the infection has cleared up. Pain is frequently so severe as to require opiate analgesics such as hydrocodone. If traditional treatment options have been exhausted, then a procedure called a cord block would be done. This consists of an injection into the nerve that traces along the epididymis. The injection is a compound of several medications including a steroid, pain killers, and a high dose of an anti-inflammatory. This treatment usually quells the pain for 2-3 months in ideal conditions. Some patients may only experience an even shorter duration of 2-3 days, while the fortunate ones in rare occasions are never bothered again. This procedure would of course have to be repeated when necessary, until the problem goes away completely, or until the routine is simply too bothersome. In that case, a patient may then decide to have the epididymis completely removed, thus rendering all pain obsolete. In the case of a scrotal abscess, this may have to be done long before other treatment options are considered.

Epidemiology

This is usually caused by a secondary bacterial infection that is brought about by a variety of underlying conditions. Some cases of epididymitis are characterised by inflammation even when there is no infection. Urinary tract infections are the most common cause (e.g E. coli). It may also be caused by STDs, chlamydia (responsible for nearly 50-60% of cases) and gonorrhea. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. It can also be caused by genito-urinary surgery, including prostatectomy, urinary catheterization, or congenital kidney and bladder problems.

A reflux of sterile urine through the vas deferens can cause chemical epididymitis. Physical stress, such as heavy lifting, may cause such a reflux. Chemical epididymitis may also result from drugs such as amiodarone.

Acute epididymitis has a tendency to spontaneously recur months or years after a successfully treated case.

Congestive epididymitis is a long-term complication of vasectomy.^[1][2]

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References

1. ^ Schwingl PJ, Guess HA (2000). "Safety and effectiveness of vasectomy". Fertil. Steril. 73 (5): 923–36. PMID 10785217.
2. ^ Raspa RF (1993). "Complications of vasectomy". American family physician 48 (7): 1264–8. PMID 8237740.