Epididymitis

The male reproductive organs are particularly fragile and easily damaged. When the male immunity is low, a large number of pathogens will enter the epididymis through the fallopian tube, causing epididymitis. Epididymitis often occurs in young men, following urethritis and prostatitis. Epididymitis is divided into acute epididymitis and chronic epididymitis. Acute epididymitis is rapid in onset and short in course. If it is not treated thoroughly, it may turn into chronic epididymitis.

Clinical manifestations

Clinically, it is divided into two categories: acute epididymitis and chronic epididymitis.

1. Acute epididymitis

Sudden high fever, increased white blood cell count, swelling and heaviness of the scrotum on the affected side, pulling pain in the lower abdomen and groin, which worsens when standing or walking. The epididymis on the affected side is enlarged and there is obvious tenderness. When the inflammation is large, both the epididymis and testicle are swollen, and the boundary between the two is unclear, which is called epididymal orchitis. The spermatic cord on the affected side is thickened and there is also tenderness. Generally, acute symptoms can gradually subside after one week.

2. Chronic epididymitis

Chronic epididymitis is more common. Some patients become chronic because the acute phase is not completely cured, but most patients do not have a clear acute phase. Inflammation often occurs secondary to chronic prostatitis or injury. Patients often feel dull pain in the scrotum on the affected side, with a sense of bloating. The pain often extends to the lower abdomen and the ipsilateral inguinal groove, and sometimes may be accompanied by secondary hydrocele. During examination, the epididymis often enlarges and hardens to varying degrees. There is mild tenderness, and the ipsilateral vas deferens may be thickened.

treatment

1. Treatment of acute epididymitis

(1) General treatment: Rest in bed. Using a scrotal support or a homemade cushion to lift the scrotum can alleviate symptoms. Painkillers can be used for severe pain. Local heat therapy can relieve symptoms and promote the disappearance of inflammation. However, using heat therapy too early can aggravate pain and has the risk of promoting the spread of infection. Therefore, it is advisable to use ice packs for local cold compresses in the early stage. Sexual intercourse and physical labor can aggravate the infection and should be avoided.

(2) Antimicrobial drugs should be selected to be sensitive to bacteria. Usually, they are given intravenously for 1 to 2 weeks, followed by oral administration for 2 to 4 weeks to prevent the disease from turning into chronic inflammation.

(3) If antibiotic treatment is ineffective and testicular ischemia is suspected, epididymotomy should be performed to relieve pressure. Multiple longitudinal or transverse incisions should be made in the epididymal tunica vaginalis, but injury to the epididymal duct should be avoided.

2. Treatment of chronic epididymitis

Chronic epididymitis may not be cured by medication alone. In addition to the use of effective broad-spectrum antibiotics, physical therapy such as local hot compresses is also necessary. Local application of berberine or neomycin plasma ionization therapy can also be used. If there is chronic prostatitis, it must be treated at the same time. For recurrent epididymitis caused by chronic prostatitis, vasectomy can be considered before treatment. For those who have repeated episodes, epididymectomy can also be considered.