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07-SEPTEMBER-2008 03:17:44 - Epididymitis Epididymitis Classification and external resources 1: Epididymis 2: Head of epididymis 3: Lobules of epididymis 4: Body of epididymis 5: Tail of epididymis 6: Duct of epididymis 7: Deferent duct ductus deferens or vas deferens ICD-10 N45.0 ICD-9 604 DiseasesDB 4342 eMedicine med/704 radio/261 emerg/166 MeSH D004823 Epididymitis is a medical condition in which there is inflammation of the epididymis a curved structure at the back of the testicle in which sperm matures and is stored. This condition may be mildly to very painful, and the scrotum sac containing the testicles may become red, warm and swollen. It may be acute of sudden onset or rarely chronic. Epididymitis is the most frequent cause of sudden scrotal pain. In contrast with men who have testicular torsion, the cremaster reflex elevation of the testicle in response to stroking the upper inner thigh is not altered. If the diagnosis is not entirely clear from the patient's history and physical examination, a Doppler ultrasound scan can confirm increased flow of blood to the affected epididymis. Infection is the most common cause. In sexually active men, Chlamydia trachomatis is the most frequent causative microbe, followed by E. coli and Neisseria gonorrhoeae. In children, it may follow an infection in another part of the body for example, a viral illness, or there may be an associated urinary tract anomaly. Another cause is sterile reflux of urine through the ejaculatory ducts. Antibiotics may be needed to control a component of infection. Treatment otherwise comprises pain killers or anti-inflammatory drugs and bed rest if necessary, and symptom control by resting the scrotum in a supported position. Contents 1 Diagnosis 2 Causes 3 Complications 4 Treatment 5 Epidemiology 6 Chronic epididymitis 7 Epididymitis in bulls 8 References 9 Further reading 10 External links Diagnosis Epididymitis can be hard to distinguish from testicular torsion. Both can occur at the same time. A urologist may need to be consulted. Epididymitis usually has a gradual onset. On physical examination, the testicle is usually found to be in its normal vertical position, of equal size compared to its counterpart, and not high-riding. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle this is the normal position of the epididymis relative to the testicle. The cremasteric reflex if it was normal before remains normal. This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called Prehn's sign, which is however non-specific. Analysis of the urine may or may not be normal. Before the advent of sophisticated medical imaging techniques, surgical exploration was the standard of care. Nowadays, color Doppler ultrasound is the preferred test. It can demonstrated increased blood flow also compared to the normal side, as opposed to testicular torsion. Nuclear testicular blood flow testing is rarely used. Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for sexually transmitted diseases may be done. These may include microscopy and culture of a first void urine sample, Gram stain and culture of fluid or a swab from the urethra, nuclear acid amplification tests to amplify and detect microbial DNA or other nucleic acids or tests for syphillis and HIV. Causes Infection is the most common cause of epididymitis. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. There can be associated urethritis inflammation of the urethra. Rarely, the infection reaches the epididymis via the bloodstream. In sexually active men, Chlamydia trachomatis is responsible for two-thirds of cases, followed by Neisseria gonorrhoeae and E. coli or other bacteria that cause urinary tract infection. Less common microbes include Ureaplasma, Mycobacterium, and cytomegalovirus, or Cryptococcus in patients with HIV infection. E. coli is more common in boys before puberty, the elderly and homosexual men. Non-infectious causes are also possible. Reflux of sterile urine urine without bacteria through the ejaculatory ducts may cause inflammation with obstruction. In children, it may be a response following an infection with enterovirus, adenovirus or Mycoplasma pneumoniae. Epididymitis can also be caused by genito-urinary surgery, including prostatectomy and urinary catheterization. Congestive epididymitis is a long-term complication of vasectomy.12 Chemical epididymitis may also result from drugs such as amiodarone.3 Complications Most cases with adequate treatment develop no complications and don't result in infertility. 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 Antibiotics are used if an infection is suspected. Fluoroquinolones are an option, although resistance of N. gonorrhoeae may limit their use. A cephalosporin such as ceftriaxone combined with doxycycline is an alternative. Azithromycin can be used for susceptible strains. In children, quinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children, co-trimoxazole or suited penicillins for example, cephalexin can be used. If there is a sexually transmitted disease, the partner should also be treated. Household remedies such as elevation of the scrotum and cold compresses applied regularly to the scrotum may relieve the pain. Painkillers or anti-inflammatory drugs are often necessary. Hospitalisation is indicated for severe cases, and check-ups can ensure the infection has cleared up. Surgery is rarely necessary, for example in those rare instances where an abscess forms. Epidemiology Please help improve this section by expanding it. Further information might be found on the talk page or at requests for expansion. June 2008 Chronic epididymitis Chronic epididymitis is epididymitis which ensues for more than six weeks. Chronic epididymitis is characterised by inflammation even when there is no infection present. 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. This condition can develop even without the presence of the previously described known causes. Typically, a second, longer round of treatment is used. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. A procedure called a cord block is a last measure. 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 can quell 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. As a last resort, a patient may then decide to have the epididymis completely removed. Epididymitis in bulls Epididymitis can be a concern in cattle herds. Bulls with epididymitis can spread bacteria to other cattle when they mount them. The cattle with epididymitis can often be detected early by the presence of white blood cells in their semen. In later stages, it can be detected by the swelling and hardening of the epididymis of the bull. References ^ Schwingl PJ, Guess HA 2000. Safety and effectiveness of vasectomy. Fertil. Steril. 73 5: 923-36. doi:10.1016/S0015-02820000482-9. PMID 10785217. ^ Raspa RF 1993. Complications of vasectomy. American family physician 48 7: 1264-8. PMID 8237740. ^ Ibsen HH, Frandsen F, Brandrup F, Møller M August 1989. Epididymitis caused by treatment with amiodarone. Genitourin Med 65 4: 257-8. PMID 2807285. Further reading Galejs LE February 1999. Diagnosis and treatment of the acute scrotum. Am Fam Physician 59 4: 817-24. PMID 10068706. Nickel JC 2003. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. Rev Urol 5 4: 209-15. PMID 16985840. External links Epididymitis at the Open Directory Project v d e Diseases of the pelvis and genitals N40-N99, 600-629 Female Adnexa Ovary Oophoritis · Ovarian cyst · Ovarian hyperstimulation syndrome · Anovulation · Mittelschmerz Fallopian tube Salpingitis · Hydrosalpinx · Hematosalpinx Parametrium Parametritis Uterus Endometrium: Endometriosis Adenomyosis · Endometrial polyp menstruation Amenorrhoea, Anovulation, Hypomenorrhea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea Hematometra · Retroverted uterus · Asherman's syndrome Cervix Cervicitis - Cervical polyp - Nabothian cyst Vagina Vaginitis Bacterial vaginosis, Atrophic vaginitis · Leukorrhea · Hematocolpos/Hydrocolpos intercourse Dyspareunia, Vaginismus Prolapse Cystocele, Rectocele, Urethrocele · Fistulae Vesicovaginal, Rectovaginal Vulva Vulvitis · Bartholin's cyst Other/general Pelvic inflammatory disease · Female infertility Habitual abortion Male Testicular Orchitis · Hydrocele testis · Testicular torsion · Male infertility Azoospermia, Oligospermia Epididymis Epididymitis · Spermatocele · Hematocele Prostate Prostatitis · Benign prostatic hyperplasia Penis Balanoposthitis/Balanitis · Phimosis · Priapism · Sexual dysfunction Erectile dysfunction · Peyronie's disease Other Hematospermia · Retrograde ejaculation See also congenital, neoplasia v d e Inflammation Acute Plasma derived mediators Bradykinin - complement C3, C5a, MAC - coagulation Factor XII, Plasmin, Thrombin Cell derived mediators preformed: Lysosome granules - vasoactive amines Histamine, Serotonin synthesized on demand: cytokines IFN-γ, IL-8, TNF-α, IL-1 - eicosanoids Leukotriene B4, Prostaglandins - Nitric oxide - Kinins Chronic Macrophage - Epithelioid cell - Giant cell - Granuloma Processes Traditional: Rubor - Calor - Tumor - Dolor pain - Functio laesa Modern: Acute-phase reaction/Fever - Vasodilation - Increased vascular permeability - Exudate - Leukocyte extravasation - Chemotaxis Specific types Cardiovascular Endocarditis - Myocarditis - Pericarditis - Vasculitis Arteritis, Phlebitis Digestive mouth Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis - tract Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis - accessory Hepatitis, Cholangitis, Cholecystitis, Pancreatitis - Peritonitis Musculoskeletal Arthritis - Dermatomyositis - soft tissue Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis - Osteochondritis Osteitis, Chondritis Integumentary Dermatitis Folliculitis - Hidradenitis - Mastitis Nervous Encephalitis - Meningitis - Myelitis - Neuritis - Otitis - eye Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis Respiratory upper Sinusitis, Rhinitis, Pharyngitis, Laryngitis - lower Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis Reproductive female: Oophoritis - Salpingitis - Endometritis - Parametritis - Cervicitis - Vaginitis - Vulvitis male: Orchitis - Epididymitis - Prostatitis - Balanitis - Balanoposthitis pregnancy/newborn: Chorioamnionitis - Omphalitis Urinary Nephritis Glomerulonephritis, Pyelonephritis - Ureteritis - Cystitis - Urethritis Retrieved from http://en..org/wiki/Epididymitis Categories: Andrology | Urology | InflammationsHidden categories: Articles to be expanded since June 2008 | All articles to be expanded Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Français Italiano Nederlands Português Simple English Svenska This page was last modified on 17 August 2008, at 03:03
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