• Clinical science

Epididymitis

Abstract

Epididymitis is an inflammation of the epididymis that is commonly associated with genitourinary tract infections. The typical presentation involves gradual onset of pain and swelling of the affected side of the scrotum as well as a positive Prehn sign. Epididymitis is a clinical diagnosis, but testicular torsion should be excluded by ultrasound because it has a similar presentation and is a surgical emergency. Treatment involves prompt empiric antibiotic therapy, scrotal elevation, and nonsteroidal anti‑inflammatory therapy to prevent abscess formation and possible infertility.

Etiology

References:[1]

Clinical features

  • Unilateral scrotal pain and swelling; , which develops over several days and radiates to the ipsilateral flank
  • Positive Prehn sign: reduced pain when the affected hemiscrotum is elevated
  • Scrotal skin overlying the epididymis may appear red, shiny, and edematous.
  • Low-grade fever (especially among children)
  • Symptoms of lower urinary tract infection (e.g., dysuria, frequency, urgency), including urethritis (urethral discharge)
  • Chronic epididymitis
    • Recurrent bouts of scrotal pain
    • Swelling is minimal when compared to acute epididymitis
    • Thickened epididymis
  • Tuberculous epididymitis
    • Beading of the vas deferens
    • A secondary hydrocele may occur (30% of cases).
    • A cold abscess on the posterior surface of the scrotum
    • Manifestations of renal tuberculosis (60% of cases) and/or pulmonary tuberculosis (50% of cases)

References:[1][2]

Diagnostics

  • Primarily a clinical diagnosis
  • Laboratory findings
  • Scrotal ultrasound
    • Indicated
      • To rule out testicular torsion if this is not possible based on history and physical exam
      • If an abscess is suspected
    • Findings in epididymitis: enlarged epididymis, increased blood flow
  • The following tests should be performed to rule out tuberculosis:
    • Mantoux test
    • Microscopic examination of urine and semen for TB bacilli
    • Chest x-ray

Rule out other conditions requiring urgent intervention before diagnosing epididymitis!

References:[1][3][4]

Differential diagnoses

References:[1]

The differential diagnoses listed here are not exhaustive.

Treatment

References:[1]

Complications

References:[5]

We list the most important complications. The selection is not exhaustive.