Epididymo-orchitis is a combined inflammation of the testicle and its appendage of various etiologies. The acute form is characterized by a rise in body temperature to 40 °, chills, a local inflammatory reaction on the side of the lesion with redness, swelling, an increase in the size of the scrotum, a sharp pain syndrome with irradiation in the groin. Compaction of the testicle, its lack of mobility indicates the formation of infiltrate and possible accumulation of fluid (pus). Disease is diagnosed based on symptoms, urine test, blood test, urethral smear, STD test, ultrasound. Treatment: suspension, antibiotics, anti-inflammatory drugs (in hospital or outpatient). Abscessing is the reason for the operation.
Epididymo-orchitis (orchoepididymitis) is one of the most common inflammatory processes of the scrotal organs that occurs as an independent disease or against the background of another pathology. From an anatomical point of view, the combined inflammation in the testicle and appendage is due to the close connection of these organs. Sperm and testosterone are produced in the testicles, while appendages are necessary for the ripening of the seed.
Epididymo-orchitis has been known since the V century BC. thanks to the writings of Hippocrates about epidemic mumps (inflammation of the testicle and appendage can be a complication of this disease). In 1790, Hamilton finally linked this pathology with the lesion of the genital glands. The triggers of the pathological process are most often prostatitis and urethritis, so the disease is usually diagnosed by urologists, less often by andrologists or venereologists. According to statistics, pathology is most common among men aged 20 to 40 years, has no pronounced seasonality, endemicity, racial priorities. The urgency of the problem is due to complications of epididymo-orchitis, one of which is male infertility.
There are independent epididymo-orchitis that occurs as a result of temperature changes, wearing tight underwear, twisting of the testicle and its appendages, decreased immunity, and inflammation of the testicle and appendage as a complication of another disease: urethritis, prostatitis, local infections (including sexually transmitted infections), inflammatory processes in the pelvis (varicose veins, hemorrhoids, paraproctitis), sore throats, etc. Contact epididymo-orchitis can develop due to scrotal trauma, complications after prostate surgery, endoscopic intervention, catheterization, prolonged sexual arousal with an erection, but without ejaculation, incorrect therapy of pathology of the genitourinary organs.
In modern andrology, according to the nature of the course, epididymo-orchitis is divided into acute (developing in the first hours after exposure to an etiological factor), subacute (occurring during the first week) and chronic. Chronic processes, as a rule, are masked by symptoms of another disease, which lengthens the time of inflammation development by weeks or even months.
Etiologically, there are specific and nonspecific epididymo-orchitis.
- Specific inflammation of the scrotum organs includes tuberculosis, syphilitic and brucellosis pathological process, which arise under the influence of specific pathogens and are characterized by certain morphological signs.
- Nonspecific epididymo-orchitis occurs against the background of infection with fungi, protozoa (trichomonas), bacteria (cocci, mycoplasmas, chlamydia, E. coli, proteus, klebsiella), influenza viruses, rubella and mumps, enteroviruses.
There is also a division of epididymo-orchitis in accordance with the pathways of infection into the testicle and appendage. There are hematogenic (with blood flow), lymphogenic (through the lymphatic pathways) and retrograde (from the urethra through the vas deferens to the cord and appendage of the testicle) infection. The mechanism of tuberculosis bacilli entering the scrotum cavity is not completely clear, lymphogenic and hematogenic penetration is most likely. STDs are characterized by a retrograde path of infection. For non–specific microflora such as viruses, fungi, most bacteria – hematogenic.
Acute epididymo-orchitis is manifested by high fever (up to 40 °) and sharp pain, which radiates into the lower back and lower abdomen, increases when walking. Due to the pronounced symptoms of the disease, patients very quickly turn to a doctor. Concomitant manifestations of pathology are weakness, bruising, myalgia, signs of local inflammation, discharge from the urethra with an unpleasant odor and pain when urinating.
With a weakening of immunity or a massive attack of microbes, it is possible to transform the acute form of the disease into purulent epididymo-orchitis, in which there is pronounced general intoxication and damage to other organs of the genitourinary system. Sepsis, testicular infarction is possible. The danger of the progression of epididymo-orchitis lies in the occurrence of a bilateral process.
With subacute epididymo-orchitis, all symptoms are less intense. The chronic variant of the disease is characterized by prodroma, moderate soreness of the scrotum, which increases with movement and palpation, high testicular density, decreased libido, changes in the composition of sperm due to impurities of pus and erythrocytes, an unpleasant odor of secretions.
The slow progression of pathology makes it possible to prescribe adequate therapy in time and avoid serious complications. However, subacute or chronic epididymo-orchitis can be complicated by the formation of scrotal fistulas, fibrosis of the testicle and appendage with the development of infertility (with bilateral lesions), malignancy. A bilateral lesion entails a decrease in libido and erectile dysfunction.
Usually, a clinical diagnosis is made by a urologist or andrologist based on anamnesis, data from an objective examination of the scrotum organs and additional research methods. Examination for epididymo-orchitis includes:
- Urine test, blood test;
- bacteriological examination of urine;
- urethral smear (often with inoculation for antibiotic sensitivity);
- PCR diagnostics;
- examination of sperm and prostate juice (general and bacteriological);
- blood test for PSA;
- Ultrasound of the scrotum.
When diagnosing epididymo-orchitis, there is a rule of mandatory examination of the sexual partner for the presence of sexual infections.
Treatment of epididymo-orchitis should begin immediately after diagnosis. Therapy is usually carried out in a hospital, only exacerbation of the chronic process is stopped on an outpatient basis. The complex of therapeutic measures for epididymo-orchitis includes bed or semi-bed rest, wearing a suspension, a diet with a restriction of sweet, spicy, salty and a predominance of animal proteins.
Drug therapy of epididymo-orchitis consists in the appointment of broad-spectrum antibiotics for a period of 7-10 days with a control sowing of microflora from the urethra. You can adjust the treatment after receiving the results of a bacteriological examination (urine, semen, prostate secret). In addition to antibiotics, anti-inflammatory drugs, regeneration stimulants and immunomodulators are indicated.
Severe pain in epididymo-orchitis is relieved by novocaine blockades of the spermatic cord. It is also used in the treatment of physiotherapy: UHF scrotum, magnetic procedures, paraffin applications, iodine electrophoresis against the background of the subsiding of the inflammatory process. With suppuration, infarction, testicular fistulas and twisting of the rope, surgical intervention is indicated. When an STD is detected, preventive treatment of the partner is carried out.
Prognosis and prevention
Prevention of epididymo-orchitis includes the absence of casual sexual relations, the use of condoms. It is recommended to avoid hypothermia and overheating, wear underwear made of natural fabrics. In case of injuries to the groin area, you should contact a specialist. It is necessary to sanitize the foci of infections in time, do not neglect the rules of personal hygiene. The prognosis in case of timely adequate treatment is favorable. In advanced cases, infertility, testicular necrosis or malignant degeneration of tissues in the affected area is possible.