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Epididymitis is an inflammatory lesion of a special formation that looks like a narrow tube located above and behind the testicle and serves to promote and ripen spermatozoa – the epididymis (epididymis).
The most common epididymitis in men aged 19 – 35 years. Pathology at this age is a common cause of hospitalization. Somewhat less often, the disease is recorded in the elderly, and epididymitis almost never occurs in children.
Types and causes of epididymitis
The disease can have many different causes, both infectious (due to the pathogenic effects of viruses, bacteria, fungi), and non-infectious. Bacterial epididymitis is the most common. It is believed that in young people (15 – 35 years), the disease is usually provoked by sexually transmitted infections (STIs), such as chlamydia, gonorrhea, etc. In the elderly and children, the problem is associated with microorganisms that usually cause diseases of the urinary system (for example, enterobacteria). The cause of epididymitis can also be specific pathologies, such as tuberculosis (tuberculous epididymitis), etc.
Sometimes a conditionally pathogenic (constantly present in the body, but not normally leading to a disease) fungus of the genus Candida becomes the causative agent of the pathology, then they speak of candidal epididymitis. In this case, the irrational use of antibiotics, a decrease in immunity, can provoke the development of the disease.
Perhaps the occurrence of a pathological process in the epididymis against the background of: • mumps (“mumps”) – inflammation of the parotid glands; • angina; • influenza; • pneumonia; • especially often infections of nearby organs – urethritis (inflammatory pathology of the urinary canal), vesiculitis (seminal vesicles), prostatitis (prostate gland), etc.
Sometimes the infection also penetrates into the appendage as a result of certain manipulations: endoscopy, catheterization, bougienage of the urethra (a diagnostic procedure carried out by introducing a special instrument – a bougie).
Non-infectious epididymitis, for example, can occur: • when treated with a drug such as Amiodarone for arrhythmias; • after sterilization by removal/ligation of the vas deferens (due to the accumulation of unresorbed spermatozoa) – granulomatous epididymitis.
There are acute (the duration of the disease does not exceed 6 weeks) and chronic epididymitis, which is characterized by a predominant lesion of both appendages, often develops with tuberculous lesions, syphilis (duration over six months).
Depending on the severity of manifestations, mild, moderate and severe epididymitis is distinguished.
Risk Factors
Since epididymitis is most often a consequence of STIs, the main risk factor for the development of pathology is unprotected sex. Other provocative moments: • injuries of the pelvis, perineum, scrotum, including as a result of surgery (adenomectomy, etc.); • anomalies in the development of the urogenital system; • structural disorders of the urinary tract (tumors, prostate hyperplasia, etc.); • recent surgical interventions on the urinary organs; • medical manipulations – electrical stimulation (when multidirectional contractions of the vas deferens occur, which can provoke “sucking” of microbes from the urethra), infusion of drugs into the urethra, catheterization, massages, etc.; • prostate hyperplasia; • haemorrhoids; • lifting weights, physical stress; • frequent coitus interruptus, erections without intercourse; • decrease in the body’s defenses as a result of a serious pathology (diabetes, AIDS, etc.), hypothermia, overheating, etc.
Symptoms of epididymitis
The onset of the disease manifests itself as severe symptoms, which, in the absence of adequate therapy, tend to worsen. With epididymitis, there may be: • dull pain on one side of the scrotum / in the testicle with possible irradiation to the groin, sacrum, perineum, lower back; • sharp pain in the affected area; • pelvic pain; • redness, increased local temperature of the scrotum; • swelling/increase in size, induration of the appendage; • tumor-like formation in the scrotum; • chills and fever (up to 39 degrees); • general deterioration of health (weakness, loss of appetite, headaches); • increase in inguinal lymph nodes; • pain during urination, defecation; • increased urination, sudden urge; • pain during intercourse and ejaculation; • the appearance of blood in the semen; • discharge from the penis.
A specific diagnostic sign is that scrotal elevation may lead to symptomatic relief (positive Pren’s sign).
In the chronic course of the disease, the signs of the problem may be less pronounced, but soreness and enlargement of the scrotum, and often also frequent urination, persist.
Important! Acute pain in the testicles is an indication for immediate medical attention!
Methods for diagnosing and detecting a disease
The first diagnostic measure in making a diagnosis is a doctor’s examination of the affected side of the testicle, the lymph nodes in the groin. If epididymitis due to prostate enlargement is suspected, a rectal examination is performed.
Further, laboratory methods are used: • smear from the urethra for microscopic analysis and isolation of the causative agent of STIs; • PCR diagnostics (detection of the pathogen by polymerase chain reaction); • clinical and biochemical analysis of blood; • urinalysis (general, “3-cup test” with consecutive urination in 3 cups, cultural study, etc.); • analysis of seminal fluid.
Instrumental diagnostics involves the following: • Ultrasound of the scrotum to determine the lesions, stage of inflammation, tumor processes, assessment of blood flow velocity (Doppler study); • nuclear scanning, in which a small amount of a radioactive substance is injected and blood flow in the testicles is monitored using special equipment (allows diagnosing epididymitis, testicular torsion); • cystourethroscopy – the introduction through the urethra of an optical instrument, a cystoscope, to examine the internal surfaces of the organ.
Computed tomography and magnetic resonance imaging are less commonly used.
Treatment of epididymitis
Treatment of epididymitis is carried out strictly under the supervision of a specialist – a urologist. After the examination, the identification of the pathogen, a rather long, up to a month or more, course of antibiotic therapy is prescribed.
Preparations are selected taking into account the sensitivity of the pathogenic microorganism, if the type of pathogen cannot be established, then a broad-spectrum antibacterial agent is used. The main drugs of choice for epididymitis, especially in the presence of other pathologies from the urogenital system and in young people, are antibiotics of the fluoroquinolone group. Tetracyclines, penicillins, macrolides, cephalosporins, sulfa drugs may also be prescribed. In a situation where the disease is caused by an STI, the simultaneous passage of therapy by the patient’s sexual partner is required.
Also, to relieve the inflammatory process and pain relief, the doctor recommends non-steroidal anti-inflammatory drugs (such as indomethacin, nimesil, diclofenac, etc.), with severe pain, a novocaine blockade of the spermatic cord is performed. May be additionally recommended: • taking vitamins; • physiotherapy; • enzymatic, absorbable (lidase) and other preparations.
With a mild course of the disease, hospitalization is not required, but if the condition worsens (temperature rises above 39 degrees, general intoxication manifestations, a significant increase in the appendage), the patient is sent to the hospital. If there is no effect, a different antibiotic may be required. If the disease is persistent, especially with bilateral lesions, there is a suspicion of the tuberculous nature of the pathology. In such a situation, consultation with a phthisiourologist is required and, upon confirmation of the diagnosis, the appointment of specific anti-tuberculosis drugs.
Treatment of the chronic form is carried out in a similar way, but takes longer.
In addition to taking medication, the patient must adhere to the following rules: • observe bed rest; • to provide an elevated position of the scrotum, for example, by means of a towel twisted into a roller; • exclude heavy lifting; • strictly observe absolute sexual rest; • exclude the consumption of spicy, fatty foods; • ensure adequate fluid intake; • apply cool compresses/ice to the scrotum to relieve inflammation; • wear a suspensorium – a special bandage supporting the scrotum, which ensures the rest of the scrotum, prevents it from shaking when walking; • wear tight elastic shorts, swimming trunks (can be used until the pain symptoms disappear).
As the condition improves, light habitual physical activity is allowed: walking, running, with the exception of cycling. It is important to avoid general and local hypothermia during the treatment phase and at the end of it.
After completing the course of antibiotic therapy, after about 3 weeks, you should consult a doctor for re-testing (urine, ejaculate) in order to confirm the complete elimination of the infection.
Traditional medicine can only be used as an additional to the main therapeutic course and only after the permission of the attending physician. Traditional healers with epididymitis recommend using decoctions from: • lingonberry leaf, tansy flowers, horsetail; • nettle leaves, mint, linden blossom and other herbal preparations.
With the development of such a complication as a purulent abscess, a surgical opening of suppuration is performed. In severe situations, it may be necessary to remove part or all of the affected appendage. In addition, the operation is resorted to: • to correct physical anomalies that cause the development of epididymitis; • in case of suspected testicular torsion/attachment (hydatids) of the epididymis; • in some situations with tuberculous epididymitis.
Complications
As a rule, epididymitis is well treated with antibacterial drugs. However, in the absence of adequate therapy, the following complications may develop: • transition of the pathology to a chronic form; • the occurrence of a bilateral lesion; • orchiepididymitis – the spread of the inflammatory process to the testicle; • testicular abscess (purulent, limited inflammation of the tissues of the organ); • development of adhesions between the testicle and scrotum; • testicular infarction (tissue necrosis) as a result of impaired blood supply; • atrophy (decrease in volumetric dimensions, followed by a violation of sperm production and a decrease in testosterone production) of the testicles; • formation of fistulas (narrow pathological canals with purulent discharge) in the scrotum; • Infertility is a consequence of both a decrease in sperm production and the formation of obstacles to the normal progress of the latter.
Prevention of epididymitis
The main measures to prevent epididymitis include: • a healthy lifestyle; • safe sex; • ordered sexual life; • timely detection and elimination of recurrent urinary tract infections; • prevention of injury to the testicles (wearing protective equipment when practicing traumatic sports); • observance of requirements of personal hygiene; • exclusion of overheating, hypothermia; • prevention/adequate therapy of infectious diseases (including vaccination against mumps), etc.