Epididymitis
- Acute epididymitis is an infection of the epididymis.
- Pain in the scrotum usually develops quite quickly.
- The patient may notice a rapid swelling of the affected hemiscrotum.
- Irritative voiding symptoms and fever may also be present.
On exam the hemiscrotum is usually visibly enlarged and the overlying
skin reddened. The affected epididymis is quite tender. At first the
indurated epididymis may be distinguishable from the testicle but as
the inflammatory process continues the epididymis and testicle become
one inflammatory mass. A reactive hydrocoele may also develop. Rectal
exam should be done to rule out prostatitis as the source of infection.
The patient may have an elevated white count and positive urinalysis
but this is not always the case. Urine should be routinely sent for
culture and sensitivity.
The diagnosis is often difficult to make because of the similar presentation
of testicular torsion. If there is any possibility that torsion
exists then a urologist should be consulted. A doppler ultrasound
or testicular flow scan can sometimes be helpful in distinguishing the
two conditions but imaging studies should not be done if they will delay
surgical treatment.
In a young man a sexual transmitted organism is the
most likely cause.
Contents by Dr Íomhar O' Sullivan 19/05/2005. Reviewed by Dr ÍOS 26/05/2006. Next review 26/05/2007.
