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- 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
- urinalysis and urine culture
- examination of discharges from the urethra and prostate gland
- blood tests to measure white-cell counts
epididymitisUrology Inflammation of the epididymis, which is the most common cause of scrotal or testicular pain in ♂ > age 18. See Blue balls, Epididymis.
epididymitisInflammation 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.
|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.
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.
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.
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.
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.
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.
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
DiagnosisPain (acute) related to swelling and inflammation of the scrotum
OutcomesPain level; Pain control; Pain: Disruptive effects
InterventionsAnalgesic administration; Medication administration; Heat/cold application; Positioning
Planning and implementation
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.
|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|
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.
- 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.
Patient discussion about epididymitis
Q. Can girls get infected by epididymitis?
Q. Has anyone ever had Epididymitis? I was just diagnosed with it and want to know what to expect. Thanks
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
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 :)