epididymitis

Epididymitis

 

Definition

Epididymitis is inflammation or infection of the epididymis. In this long coiled tube attached to the upper part of each testicle, sperm mature and are stored before ejaculation.

Description

Epididymitis is the most common cause of pain in the scrotum. The acute form is usually associated with the most severe pain and swelling. If symptoms last for more than six weeks after treatment begins, the condition is considered chronic.

Epididymitis can occur any time after the onset of puberty but is most common between the ages of 18 and 40. It is especially common among members of the military who exercise for extended periods without emptying their bladders.

Factors that increase the risk of developing epididymitis include:

• infection of the bladder, kidney, prostate, or urinary tract
• other recent illness
• narrowing of the urethra (the tube that drains urine from the bladder)
• use of a urethral catheter

Causes and symptoms

Although epididymitis can be caused by the same organisms that cause some sexually transmitted diseases (STDs) or occur after prostate surgery, the condition is generally due to pus-generating bacteria associated with infections in other parts of the body.

Epididymitis can also be caused by injury or infection of the scrotum or by irritation from urine that has accumulated in the vas deferens (the duct through which sperm travels after leaving the epididymis).

Epididymitis is characterized by sudden redness and swelling of the scrotum. The affected testicle is hard and sore, and the other testicle may feel tender. The patient has chills and fever and usually has acute urethritis (inflammation of the urethra).

Enlarged lymph nodes in the groin cause scrotal pain that intensifies throughout the day and may become so severe that walking normally becomes impossible.

Diagnosis

Laboratory tests used to diagnose epididymitis include:

• urinalysis and urine culture
• examination of discharges from the urethra and prostate gland
• blood tests to measure white-cell counts

Treatment

Because epididymitis that affects both testicles can make a man sterile, antibiotic therapy must be initiated as soon as symptoms appear. To prevent reinfection, medication must be taken exactly as prescribed, even if the patient's symptoms disappear or he begins to feel better. Over-the-counter anti-inflammatories can relieve pain but should not be used without the approval of a family physician or urologist.

Bed rest is recommended until symptoms subside, and patients are advised to wear athletic supporters when they resume normal activities. If pain is severe, a local anesthetic like lidocaine (Xylocaine) may be injected directly into the spermatic cord.

Self-care

A patient who has epididymitis should not drink beverages that contain caffeine. To prevent constipation, he should use stool softeners or eat plenty of fruit, nuts, whole grain cereals, and other foods with laxative properties.

An ice bag wrapped in a towel can reduce pain and swelling but should be removed from the inflamed area for a few minutes every hour to prevent burns.

Strenuous activity should be avoided until symptoms disappear. Sexual activity should not be resumed until a month after symptoms disappear.

If a second course of treatment doesn't eradicate stubborn symptoms, longterm anti-inflammatory therapy may be recommended. In rare instances, chronic symptoms require surgery.

Surgery

Each of the surgical procedures used to treat epididymitis is performed under local anesthesia on an outpatient basis. Both of them cause sterility.

Epididymectomy involves removing the inflamed section of the epididymitis through a small incision in the scrotum.

Bilateral vasectomy prevents fluid and sperm from passing through the epididymis. This procedure is usually performed on men who have chronic epididymitis or on elderly patients undergoing prostate surgery.

Prognosis

Pain generally subsides 24-72 hours after treatment begins. Complete healing may take weeks or months.

Prevention

Using condoms and not having sex with anyone who has an STD can prevent some cases of epididymitis.

Resources

Other

"Epididymitis." Digital Urology Journal. June 7, 1998. http://www.duj.com/epididymitis.html.

epididymitis

 [ep″ĭ-did″ĭ-mi´tis]

inflammation of the epididymis. Nonspecific epididymitis may result from an infection in the urinary tract, especially in the prostate. Rarely it may be traced to an infection elsewhere in the body. Tuberculosis, mumps, and gonorrhea may be complicated by epididymitis. Symptoms include sudden severe pain in the testes followed by scrotal swelling and tenderness. Treatment is usually with antibiotics, rest in bed, and avoidance of alcoholic beverages, sexual excitement, and strenuous physical exercise until all symptoms have disappeared.

ep·i·did·y·mi·tis

(ep'i-did-i-mī'tis),

Inflammation of the epididymis.

epididymitis

/epi·did·y·mi·tis/ (-did″ĭ-mi´tis) inflammation of the epididymis.

epididymitis

[ep′idid′imī′tis]

Etymology: Gk, epi + didymos + itis, inflammation

acute or chronic inflammation of the epididymis. It may result from venereal disease, urinary tract infection, prostatitis, prostatectomy, or prolonged use of indwelling catheters. Symptoms include fever and chills; pain in the groin; and tender, swollen epididymides. Treatment includes bed rest, scrotal support, antiinflammatory medications, and antibiotics, as appropriate.

epididymitis

Urology Inflammation of the epididymis, which is the most common cause of scrotal or testicular pain in ♂ > age 18. See Blue balls, Epididymis.

ep·i·did·y·mi·tis

(ep'i-did'i-mī'tis)

Inflammation of the epididymis.

epididymitis

Inflammation of the EPIDIDYMIS from infection, usually following URETHRITIS. Epididymitis may be caused by GONORRHOEA and this may lead to sterility, but most cases are caused by other infections.

Epididymitis

DRG Category:	728
Mean LOS:	4 days
Description:	MEDICAL: Inflammation of the Male Reproductive System Without Major CC

Epididymitis is an infection or inflammation of the epididymis—a coiled duct that is responsible for nutrition and maturation of the sperm. The epididymis carries sperm from the testicle to the urethra. Epididymitis, the most common intrascrotal infection, is usually unilateral. Epididymitis needs to be differentiated from testicular torsion, tumor, and trauma. If it is left untreated, epididymitis may lead to orchitis, an infection of the testicles, which may lead to sterility. The incidence of epididymitis is less than 1 in 1,000 males each year.

Causes

Infection that results in epididymitis is usually caused by prostate obstruction, a sexually transmitted infection (STI), or another form of infection. STIs leading to epididymitis include infection by Neisseria gonorrheae, Chlamydia trachomatis, and syphilis. Epididymitis may be a complication of prostatitis or urethritis, or it may be associated with chronic urinary infection caused by Escherichia coli, Pseudomonas, or coliform pathogens. Strain or pressure during voiding may force urine that is harboring pathogens from the urethra or prostate through the vas deferens to the epididymis.

Urological abnormalities due to structural alterations are common in children, who may have an ectopic ureter, ectopic vas deferens, prostatic utricle, urethral duplication, posterior urethral valves, urethrorectal fistula, detrusor sphincter dyssynergia, or vesicoureteral reflux. Common structural abnormalities in men older than 40 years include bladder outlet obstruction or urethral stricture.

Genetic considerations

Heritable immune responses could be protective or increase susceptibility.

Gender, ethnic/racial, and life span considerations

Epididymitis commonly occurs in men ages 18 to 40 but rarely in those who have not reached puberty. In men under age 35, the most common cause is an STI. Generally, epididymitis in men over age 35 is from other bacterial causes or from obstruction. Ethnicity and race have no known effects on the risk for epididymitis.

Global health considerations

No data are available.

Assessment

History

Establish a history of sudden scrotal pain, redness, swelling, and extreme scrotal and groin tenderness. Determine if the patient has experienced fever, chills, or malaise. Ask the patient if he has experienced nausea and vomiting. Elicit a history of prostatitis, urethritis, or chronic urinary infections. Ask the patient if he has been diagnosed with tuberculosis. Determine if the patient has undergone a prostatectomy or has had a traumatic injury to the genitalia. Take a sexual history to determine if the patient has had unprotected sex with a partner who may have had an STI.

Physical examination

The most common symptom is scrotal pain. Inspect the patient’s scrotum, noting any marked edema or redness. Gently palpate the scrotum for tenderness or pain. Observe any urethral discharge. Observe the patient’s gait; patients with epididymitis often assume a characteristic waddle to protect the groin and scrotum.

Psychosocial

The patient may be concerned about his sexuality. He may be fearful of becoming sterile or impotent and anxious about whether he can continue to have sexual relationships. The patient may express anger or feelings of victimization if the condition was caused by an STI.

Diagnostic highlights

General Comments: Diagnosis is made based on visual symptoms and isolation of infective organisms.

Test	Normal Result	Abnormality With Condition	Explanation
Urinalysis	Clear, no pus	Pyuria; white blood cell count > 10,000 mm3	A urinary tract infection can contribute to epididymitis
Urine culture and sensitivity tests	< 10,000 bacteria/mL	> 10,000 bacteria/mL; pathogen is identified	A urinary tract infection can contribute to epididymitis
Cultures for STIs	Negative culture	Positive for STI	An STI can lead to epididymitis
Prehn’s sign	N/A	Pain is relieved when the scrotum is lifted onto the symphysis	Testicular torsion may be present if pain is not relieved when the scrotum is lifted onto the symphysis

Other Tests: An ultrasound is done to rule out testicular torsion, which presents with similar symptoms and is a medical emergency; white blood count; gram stain of urethral discharge

Primary nursing diagnosis

Diagnosis

Pain (acute) related to swelling and inflammation of the scrotum

Outcomes

Pain level; Pain control; Pain: Disruptive effects

Interventions

Analgesic administration; Medication administration; Heat/cold application; Positioning

Planning and implementation

Collaborative

The goal of treatment is to combat infection and reduce pain and swelling. This is usually accomplished through the use of pharmacologic agents. The patient with epididymitis is usually on bedrest with bathroom privileges. Sexual activity is prohibited during the treatment process. If epididymitis is recurrent, an epididymectomy under local anesthesia or a vasectomy may be indicated, and this will result in sterility. If orchitis develops, it is treated with diethylstilbestrol (DES), which may relieve pain, fever, and swelling. Severe cases of orchitis may require surgery to drain the hydrocele and improve testicular circulation.

Pharmacologic highlights

Medication or Drug Class	Dosage	Description	Rationale
Antibiotics	Depends on drug; usually given IV in the hospital and home	Antibiotic used is determined by its ability to eliminate the pathogen	Appropriate antibiotic is needed to eliminate infective organism
Antipyretics	Depends on drug	Preparation to reduce fever	Fever often is present with epididymitis
Analgesics	Depends on drug	Analgesic used depends on the severity of the pain	Decreases pain and discomfort

Independent

The most important interventions are pain control and emotional support. Lifting of the scrotum often relieves the pain in epididymitis; elevating the testicles on a towel eases tension on the spermatic cord and reduces pain. Ice packs to the scrotum also relieve pain, but a barrier between the scrotum and the ice pack is necessary to prevent frostbite or the ascension of the testes into the abdominal cavity. Encourage oral fluids of up to 2 to 3 L per day. As the patient heals, he can resume walking, but he should wear an athletic supporter.

Encourage the patient to verbalize his fears and concerns. Answer questions nonjudgmentally. Point out that the patient’s sexual partners are at risk if the condition was caused by an STI; urge the patient to notify his partners of his condition. The underlying STI is not restricted only to males and can be transmitted to female sexual partners. For patients who face the possibility of sterility, suggest professional counseling.

Evidence-Based Practice and Health Policy

Joo, J.M., Yang, S.H., Kang, T.W., Jung, J.H., Kim, S.J., & Kim K.J. (2013). Acute epididymitis in children: The role of the urine test. Korean Journal of Urology, 54(2), 135–138.

• The characteristics of epididymitis vary by age, which may contribute to difficult diagnosis and treatment in children, especially because occurrence in children is rare.
• Investigators conducted a retrospective study among 139 patients diagnosed with acute epididymitis and compared children under age 18 (76 patients) with adults ages 18 to 35 (19 patients) and adults over age 35 (44 patients).
• More than 96% of cases in the children under age 18 were idiopathic, whereas only 8% were idiopathic in the adult group above age 35. A greater proportion of the adults had bilateral epididymitis compared to the children under age 18 (21.1% to 22.7% versus 3.9%; p = 0.005).
• Children also had significantly lower white blood cell counts and C-reactive protein levels (p < 0.001) as well as symptom duration (p = 0.003) compared to adults over age 35.

Documentation guidelines

• Physical findings: Swelling, redness, and tenderness of the scrotum; urethral discharge
• Color, odor, and consistency of urine
• Activity tolerance during ambulation
• Response to antibiotic therapy, analgesics, and other treatments
• Acceptance and understanding of sterility as a result of infection or epididymectomy

Discharge and home healthcare guidelines

prevention.

Teach the patient to use a condom and spermicide for sexual encounters to prevent STIs. Encourage the patient to continue to increase fluid intake and to empty the bladder frequently.

postoperative teaching.

If the patient had an epididymectomy, teach him to report incisional bleeding, unusual difficulty in starting the urine stream, blood in the urine, or increasing pain and swelling. Remind him of his postoperative appointment and that sexual activity is prohibited until after the postoperative checkup. Suggest the patient use an ice pack and athletic supporter to relieve minor discomfort from the surgery. Tepid sitz baths may also help relieve pain. Remind the patient to avoid strenuous activity and heavy lifting until he is seen by his physician.

complications.

Teach the patient to report problems of impotence to his physician immediately.

medications.

Be sure the patient understands any medication prescribed, including dosage, route, action, and side effects. Emphasize the need to complete the course of antibiotic medications even if symptoms have diminished.

epididymitis

inflammation of the epididymis. Nonspecific epididymitis may result from an infection in the urinary tract, especially in the prostate. Rarely it may be traced to an infection elsewhere in the body. Specific epididymitides are those caused by Actinobacillus seminis and by Brucella ovis, both in rams, by B. canis in dogs, and the virus of epivag, bovine viral epididymitis and vaginitis in bulls.

Patient discussion about epididymitis

Q. Can girls get infected by epididymitis?

A. no,females dont get epiddy,because of the lack of having no testicals,but can get vaginal infections.

Q. Has anyone ever had Epididymitis? I was just diagnosed with it and want to know what to expect. Thanks

A. i had an ultrasound done once before,it revealed nothing was wrong,then i had a lower gi,it also showed nothing,at the present moment,my testicules are swollen a little,
slight pain,tenderness,problems with urination,and not
urinating very often,feel as if i"m not completing my
urination,feels like i have a bladder infection,with
an epididymis infection,this makes the 7th time i"ve
had this,i"d like to know why i keep getting it??? and
will it ever stay away??? is there a complete cure?
would a vasecemy cure it???

Q. epididymis i have epididymitus,have had it 7 times, but this time its different,im having more bladder like problems, im not urinating very often,about every 8 to 10 hours and having to force it out or to start the urination process, after i start im fine? drinking plenty of liquids,feels like my bladder is always hurting,i know i have a epididymis infection,seeing the dr, end of the week,which is 3 long days from now,lol,could it be more than the epididymis infection, or what?and it hurts to ejaculate during sex

A. i'll answer this one as well :)- infection comes when from some reason a bacteria/virus succeeded in entering your body first defenses and sitting in the epididymis. usually the best way to get there is.. well.. ahh,you know...
it's probably infected your bladder or urethra too. just get an answer from the Dr. what bacteria did it- he'll probably need to take a sample and run tests. in the mean while i recommend cranberry juice. it's a natural and very affective way to fight infections in the urinary tracts. works like a charm..believe me :)