Epididymitis

Epididymitis is an inflammation of the epididymis. Share of non-specific epididymitis caused by staphylococci or streptococci, and specific epididymitis: tuberculosis, gonorrhea, brucellosis, syphilis. Pathogens penetrate into the epididymis directly on semyavynosyaschego the channel, for example, when instrumental interventions - catheterization bladder, birovni, cystoscopy, or hematogenous route with influenza, angina, brucellosis, pneumonia , and so on
The clinical course there are, acute and chronic epididymitis. Acute epididymitis is developing rapidly: pain in the affected part of the scrotum, radiating to the groin and Ilium, the body temperature rises up to 39-40 degrees, the epididymis is sharply increased in size, it becomes dense, sharply painful to palpation, corresponding to half of the scrotum is increased, the skin loses its normal folding, becomes smooth, hyperemic, hot to the touch. Sometimes increases the testis due to accumulation of serous fluid between the shells, the so - called reactive hydrocele (see Hydrocele). If a timely started treatment temperature is normal within 4-7 days, the pain decreased. Infiltrate lasts up to two months. Chronic nonspecific epididymitis may recur, and the infiltration of the epididymis, sometimes not fully resolved; periodically comes aggravation of the process with the clinical picture of acute epididymitis, but usually pain and temperature reaction is less pronounced.
The most common among specific tuberculosis epididymitis often begins acutely has a protracted course, leads to the formation of a cavity in the appendage; may arise fistula scrotum with purulent discharge.
Brucellosis epididymitis begins with egg, and then the process moves to the epididymis. First - clinic of acute epididymitis, 15-20 days epididymitis takes chronic.
Gonorrheal epididymitis is a complication gonorrheal urethritis. Proceeds by type of acute nonspecific epididymitis. Testicle in the process is not involved.
Syphilis epididymitis occurs in the transition process from egg. Is rare.
Complication of epididymitis is often infertility: after bilateral epididymitis - 80-90%, after the unilateral - 4-5% of cases.
Diagnosis of epididymitis established on the basis described the clinical picture, anamnesis and laboratory analyses of the patient.
Epididymitis should be differentiated from strangulated inguinal-scrotal hernia, orchitis, testicular torsion. Pain, sometimes spreading with right-hand epididymitis in iliac region, suggest an attack of acute appendicitis or renal colic, however, the typical local changes of the epididymis, no symptoms of peritoneal irritation and pain effleurage in the lumbar area allow you to make a correct diagnosis.
Acute nonspecific epididymitis with timely and proper treatment can be cured and rarely takes chronic relapsing course.
The main method of treatment for epididymitis - antibiotics: penicillin - 300 000 UNITS, 2 times a day and streptomycin - 0,25 - 0,5 g 2 times a day intramuscularly within 7-10 days. Favorable effect on the course of acute epididymitis has novocaine blockade of the spermatic cord (60 ml of 0.25% solution novokaina, 500 000 UNITS of penicillin and 0.5 g streptomycin).
When epididymitis appoint bed decide immobilization scrotum - jockstrap (see), which you can replace the T-shaped gauze. In acute epididymitis in the first two days of applied locally cold (an ice pack); in subsequent heat compresses, warmers, physiotherapeutic procedures. When tuberculosis epididymitis the application of heat treatments are contraindicated. If acute epididymitis flows with a high fever, symptoms of intoxication, shown inpatient treatment.
Treatment of tuberculosis, brucellosis, gonorrhea, syphilis epididymitis - specific (see Tuberculosis, Brucellosis, Gonorrhea, Syphilis).
Surgical treatment - see Epididymectomy.

Epididymitis (epididymitis; from the Greek. epididymis - epididymis - is an inflammation of the epididymis.
Epididymitis in most cases is a complication of urethritis (see), less common infectious and viral diseases (influenza, fever, sepsis, brucellosis). In the first case, the pathogen penetrates into an appendage of the urethra intracanalicular or lymphogenous. Epididymitis may also occur after trauma to the scrotum. There are nonspecific and specific epididymitis.
Nonspecific epididymitis is caused by various organisms, most often Staphylococcus.
For nonspecific epididymitis can be acute or chronic. Acute epididymitis usually begins with a sudden fever, pain in the testicle and swelling of the epididymis, which grow rapidly. The appendage tight, painful, covers an egg in the form of the helmet on the rear surface, top and bottom. Inflammatory exudate in the membranes of the egg (priorit) tousewives border between the testis and epididymis and they palpable as General conglomerate. The acute period of the disease is usually 1-1,5 weeks, then inflammation gradually fades. Infiltration in the epididymis is gradually absorbed, sometimes there is a small scar seal in the tail of the epididymis. Less trouble from the very beginning, is sluggish, chronically. Pain is a small, swelling growing slowly, normal or subfebrile temperature.
Traumatic epididymitis develops directly after the trauma of the epididymis. Formed hematoma, appendage swells. Traumatic epididymitis is slow.
Diagnosis of acute epididymitis simple. If effusion in the membranes of the egg is hard to probe increased, filled appendage and differentiate epididymitis with orchitis or orhoepididimit. At last the clinical picture is stronger.
Treatment. In acute epididymitis shown in bed. Used jockstrap for protection of inflamed appendage shaking, and minor injuries and heat in the form of a warm compress or heating pad. Very effective introduction to seed cord 20 ml of 1 % solution novokaina with 200 000 or 300 000 UNITS of penicillin procaine blockade). Depending on the sensitivity of flora isolated from urine or urethral discharge, apply different antibiotics.
After acute nephritis phenomena prescribed drugs iodine, and locally - diathermy or UHF, mud tampons.
Due to previous epididymitis tubules of the epididymis and adjacent segment essentially duct in most cases become impassable for sperm.

Specific epididymitis, mainly tuberculosis, gonorrhea, and very rarely syphilis and brucellosis.
Tuberculosis epididymitisusually accompanied by TB, prostate gland, seminal vesicles. Infection occurs hematogenous, lymphogenous or urinogenny way. In the latter case the infection from the urine containing M. tuberculosis (tuberculosis of the kidneys), falls into the epididymis of the posterior urethra on semyavynosyaschego channel.
There are two clinical forms of tuberculosis epididymitis - chronic and acute. At first - the most common tuberculosis epididymitis begins quietly; when light pain or a feeling of heaviness in the scrotum, in appendage already found various sizes thick lumpy infiltrate or site.

Tuberculosis of the epididymis: 1 egg is not affected; 2 - tuberculous process in the epididymis moved to the testis.


The ductus deferens is thickened, sclerotic (fibrous), malevolent as an appendage; in the course of its defined celabrate thickening.
Approximately 20% of cases of tuberculosis epididymitis begins rapidly, by type of acute nonspecific epididymitis. The acute period usually lasts 10-15 days. The pain gradually subside, sizes swelling decreases, and the disease takes chronic. Remains tight, cartilage consistency, little or painless infiltrate (Fig.). With the transition process on the egg is formed General conglomerate. TB granulomas are melting; filled with cheesy decay cavities are opened in the subcutaneous tissue, forming wandering ulcer, which then breaks through the skin of the scrotum several fistula.
The diagnosis of tuberculous epididymitis is based on the sluggish current, painlessness, bumpy and cartilage consistency node in the epididymis and the prostate gland, sklerozirovanie, celabration semyavynosyaschego duct. In the early stages of the disease, these signs are absent and diagnostics then difficult. Especially convincing cold fluktuiruyushchimi abscesses scrotum and outgoing from the epididymis fistulas on the skin of the scrotum. With significant Jurii need to install if there simultaneously tuberculosis of the kidneys, concomitant tuberculosis epididymitis in 50% of cases. The differential diagnosis spend with syphilis and malignant neoplasms of the epididymis: when they process starts with eggs, not in the epididymis, rarely fistulas appear. From gonorrhea, epididymitis, differentiated by history (recently transferred urethritis), acute beginning, the presence of a discharge from the urethra, a positive serological reactions.
TB chemotherapy ineffective treatment of tuberculosis epididymitis mainly operational. Operation of choice is epididymectomy. It has a beneficial effect on the course of the concomitant tuberculosis in the prostate gland and seminal vesicles. If during operation the Department of the epididymis, it appears that TB infiltrate or disruption has moved to the testicles removed along with the epididymis and adjacent edge of the egg (if the deleted area is less than 2 cm in diameter). More extensive resection leads to necrosis of the remaining part of the testis.
When more extensive or diffuse lesions of the testicle should resort to orchidectomy (see Testis). For prevention of TB lesions another appendage is used vasectomy on the opposite side. When bilateral tuberculosis epididymitis limited palliative surgery: a scraping TB foci of necrosis, cavernoma, etc. with further use of anti-tuberculosis chemotherapy.
Anti-TB chemotherapy is a mandatory addition of surgical intervention.
Gonorrheal epididymitis is a complication gonorrheal urethritis, now rarely occurs. Proceeds rapidly on the type of acute nonspecific epididymitis. The testicle is usually century, the process is not involved. Treatment, as when nonspecific epididymitis, in combination with protivoavarijnoj therapy (see Gonorrhea).
Brucellosis epididymitis begins with egg, then ill appendage. The disease first occurs as an acute epididymitis; 10-15 days it takes chronic. The diagnosis is found out by means of reaction Wright and Heddson. The specific treatment (see Brucellosis).
Syphilis epididymitis is rare. Is a result of the transition process from egg. The diagnosis is based on medical history and a positive reaction Wasserman. Treatment protevoepilepticescoe (see Syphilis).

Inflammation of the epididymis (epididymitis)

Epididymitis (epididymitis) in most cases is a complication of urethritis. Less epididymitis occurs hematogenous route as a complication of General communicable diseases, influenza, typhoid, brucellosis.
Distribution urethral infection by semyavynosyaschego the channel is not per continuitatem, and by flooding the microorganisms antiperistaltic movements essentially duct during sexual excitation, unusual physical stress or when introduced into the urethra tools.
Filled appendage increased, compacted, larger than the size of an egg. The ductus deferens first remains unchanged, but in the future, involved in the inflammatory process. He felt in the form of a thick cord, sometimes reaching the thickness of a pencil, sensitive when zatragivanija (acute differentit). If the process involves fiber, seed cord sharply thickens, separate element you to probe fails (acute funicula). In the membranes of the egg is celebrated reactive effusion, corresponding to half of the scrotum noticeably increased, her skin redness and edema.
In most cases, epididymitis begins acutely. Sudden high fever and pain in the testicle, radiating along the spermatic cord in the groin. Then increases the epididymis. It is dense, painful and covers an egg behind, above and below in the form of the helmet. Due to accumulation of inflammatory exudate in the membranes (priorit, symptomatic of a hydrocele) the testis and epididymis are of common conglomerate, sometimes reaching the size of a fist, in which the egg from the epididymis clearly distinguish failed! The temperature of the high - 39-40 degrees.
In other cases, the epididymis is increasing slowly, pains are moderate, low-grade temperature, effusion shells no, there is a clear boundary between the inflamed appendage and unaltered testicle.
Acute phenomena in 5-7 days subside. With proper treatment comes resorption infiltrate in the appendage; sometimes there is a small seal that leaves a scar.
Inflammation of the epididymis in most cases leads to obstruction of its channel, and the nearest area VAS flow of sperm. Unilaterally epididymitis there is a decline in the number of sperm (oligospermia); for two-sided - the complete absence of them in the sperm (azoospermia).
Diagnosis is simple. If effusion shells may be suspected orchitis. As treatment in the resorption process of infiltration in the epididymis and fluid in the membranes of the egg clearly defined filled appendage. A special kind of aseptic inflammation of the epididymis is epididymitis erotica, after a severe sexual arousal (prolonged erections, not ending ejaculation) appendage swell up and becomes painful. The swelling lasts 2-3 days and passes without treatment.
Treatment. In the first days, while the temperature is raised and kept severe pain, shown in bed. Using jockstrap scrotum tightened up and locked in this position. It protects filled appendage shaking, and minor injuries and facilitate the outflow of blood from him, which reduces pain. In the following days, apply heat in the form of a warm compress on the scrotum, fixed jockstrap. Of painkillers is recommended candles with injected or pantopoda, injection into seed cord 20 ml of 1 % solution novokaina with 200 000 UNITS of penicillin procaine blockade).
Antibiotics are appointed in the same doses as prostatitis, cystitis.
After the acute effects subside for resorption infiltrate appoint 3% solution of potassium iodide (1 tablespoon 3-4 times a day), on the area of the epididymis - diathermy or UHF therapy, mud tampons.