What is the cause of epididymitis? Here is the doctor's answer!

If a man suffers from epididymitis, he must receive correct treatment and usually rest in bed. If the pain is unbearable, he can use painkillers or local hot compresses to relieve the pain. Because the disease may be caused by bacterial infection, some antibacterial drugs can be used, such as antibiotics for treatment, but all drugs must be used according to the doctor's advice.

1. Causes

Acute epididymitis is mostly caused by urinary tract infection spreading along the vas deferens to the epididymis. Transurethral instrumentation, frequent catheterization, and indwelling urinary catheter after prostatectomy are all factors that cause epididymitis. Acute epididymitis can turn into chronic epididymitis if it is not treated thoroughly. Common pathogens are Escherichia coli, followed by Proteus, Staphylococcus, Enterococcus, and Pseudomonas aeruginosa. Chlamydia trachomatis can also cause acute epididymitis. Pathogenic bacteria often enter the epididymis retrogradely through the vas deferens. In addition, bacteria invading the epididymis can also cause epididymitis through lymphatic vessels or bloodstream infection, but this is rare.

Since the ejaculatory duct opens into the prostatic fossa, urethral pressure during urination can cause urine to flow back into the ejaculatory duct.

2. 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.

3. Inspection

1. Laboratory inspection

The peripheral blood leukocyte count can reach (2-3)×109/L. Urinary secretions can be examined by staining or non-staining. Urinalysis is also an important examination method.

2. Ultrasound examination

The extent of swelling and inflammation of the epididymis and testicles can be shown.

3. Magnetic resonance imaging

Epididymitis may be diffuse or focal, and the epididymal signal on T2-weighted images may be the same as or higher than the testicular signal.