Dr. med. Dirk Manski

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Epididymitis

Review Literature: (Luzzi and O'Brien, 2001).

Definition, Classification and Etiology of Epididymitis

Acute or chronic inflammation of the epididymis of various etiologies:

Epididymitis: Signs and Symptoms

Diagnosis of Epididymitis

Urethral swab:

Urethral swab and PCR testing for gonorrhea or chlamydial infection if STD are possible.

Urine analysis:

Testicular Ultrasound Imaging

Testicular ultrasound examination is mandatory for differential diagnosis to testicular torsion. In epididymitis, ultrasound imaging shows an enlarged epididymis, often together with a hydrozele [ultrasound imaging: epididymitis]. It is important to rule out abscess formation, involvement of the testicular parenchyma and rule out testicular torsion with Doppler ultrasound (see below).


ultrasound imaging of an epididymitis

Ultrasound imaging of epididymitis: typical signs are an enlarged epididymis with a hydrocele. With kind permission of N. Wagner, Augsburg.


Doppler ultrasound:

Doppler ultrasound is important for the exclusion of a testicular torsion. Typical findings for an epididymitis are increased testicular perfusion and an enlarged epididymis.

Surgical Exploration of the Scrotum

In the slightest doubt about the diagnosis of epididymitis, a surgical exploration of the scrotum must be done to exclude testicular torsion. When a testicular tumor might be possible, an inguinal approach to the testis should be chosen.

Diagnosing voiding dysfunction

Uroflowmetry, exclusion of residual urine in the bladder, retrograde urethrography and/or cystogram should be performed after healed epididymitis, if a voiding dysfunction is suspected. Voiding dysfunctions are most likely in children and in elderly patients with epididymitis.

Treatment of Epididymitis

Symptomatic Treatment

Antibiotic Treatment of Epididymitis

After obtaining a urine culture a calculated antibiotic treatment is initiated:

Suspected sexually transmitted epididymitis:

Ciprofloxacin 500 mg p.o. or ofloxacin 300 mg p.o. or ceftriaxone 250 mg i.m. once followed by doxycycline 100 mg p.o. 1-0-1 for at least 7 days. Alternatives: azithromycin 1 g p.o. once a week.

Epididymitis secondary to urinary tract infection:

Ciprofloxacin 500 mg 1-0-1 or other quinolone for at least 10 days. Alternatives are aminopenicillins with penicillinase inhibitor or oral cephalosporins, if necessary correction of the antibiotic depending on urine culture result.

Surgical Therapy





Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Luzzi und O’Brien 2001 LUZZI, G. A. ; O’BRIEN, T. S.:
Acute epididymitis.
In: BJU Int
87 (2001), Nr. 8, S. 747–55


  Deutsche Version: Epididymitis: Ursachen und Therapie