Presentation
Idiopathic scrotal oedema usually presents in childhood with bilateral oedema and bruising over the scrotal skin. The testes should not be tender on examination. Taking history Onset: insidious presentation suggests infection. [bmj.com]
He was discharged from hospital nine days after presentation on a two-week course of oral amoxycillin and made a full recovery. Discussion Epididymo-orchitis can result from bacterial or viral infections. [mja.com.au]
The testicular involvement may be diffuse or focal; if the latter it may present as patchy hypoechoic lesions in the testis. [sonoworld.com]
We present a case of a 37-year-old man presented to the Emergency department with a 3-day history of progressive left testicular pain. [ncbi.nlm.nih.gov]
Clinical presentation Acute onset of pain and swelling to testis Urinary symptoms of dysuria, frequency and haematuria Symptoms of urethritis such as, urethral discharge and penile irritation Most important differential diagnosis is testicular torsion [aci.health.nsw.gov.au]
Entire Body System
- Asymptomatic
Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19 M. Gandhi et al. Transforming ORs into ICUs A.W. Peters et al. Rural Matters — Coronavirus and the Navajo Nation H. [nejm.org]
Sometimes a prostate infection remains asymptomatic until it spreads to the epididymis. 3 Other possible causes of epididymitis are: Trauma : an injury to the groin or scrotum. [soc.ucsb.edu]
In sexually transmitted epididymitis, symptoms of urethritis or a urethral discharge may be present, however urethritis is often asymptomatic. [canada.ca]
The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely positive results. [en.wikipedia.org]
The background 'noise' should just be visible in the asymptomatic testis. Once you have a good image of the normal side, don't touch any of the settings' and go to the symptomatic side. [radiologyassistant.nl]
- Constitutional Symptom
Symptoms include scrotal pain and enlargement with or without constitutional symptoms (fever, night sweats, etc.). Histology: Caseating and noncaseating granulomas (image A) & (image B). [auanet.org]
Musculoskeletal
- Costovertebral Angle Tenderness
It is important to check for costovertebral angle tenderness, a sign of concomitant pyelonephritis, and for signs of cystitis by palpating the suprapubic region. [aafp.org]
- Muscle Spasm
If the tone was high, spasm was diagnosed. Results of VCUG were also checked for any sign of bladder trabeculation as an indicator of spastic bladder. These patients also showed some lower skeletal muscle spasm at the time of the test. [nature.com]
Urogenital
- Scrotal Pain
Epididymo-orchitis is the commonest cause of acute scrotal pain and refers to inflammation of the epididymis and testis. [bmj.com]
Among these cases, epididymitis or epididymo-orchitis were diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis. [trdizin.gov.tr]
Gradual onset of mild to moderate testicular or scrotal pain, usually unilateral Progressive scrotal swelling Dysuria (30%): Recent UTI History of abnormal bladder funct... [5minuteconsult.com]
pain and swelling;, which develops over several days and radiates to the ipsilateral flank Positive Prehn sign: reduced pain when the affected hemiscrotum is elevated Scrotal skin overlying the epididymis may appear red, shiny, and edematous. [amboss.com]
History: 5 year old boy with left scrotal pain. Epididymitis Orchitis : Grayscale ultrasound through the scrotum reveals asymmetric swelling and hypoechogenicity of the left testicle and epididymis. [radiologypics.com]
- Testicular Pain
Day 1 post-operatively the patient continued to have left sided testicular pain, now associated with lower abdominal pain. A KUB ultrasound and a repeat scrotal ultrasound were performed. [ncbi.nlm.nih.gov]
The testicular pain and swelling will last much longer. Untreated infection is more likely to lead to complications such as chronic testicular pain an abscess rarely testicular atrophy and loss of fertility More information www.bashh.org.uk [sexualhealthkingston.co.uk]
If you do not get treatment, the testicular pain and swelling will last much longer. An untreated infection is more likely to lead to complications such as long-term testicular pain or an abscess. [sexualwellbeing.ie]
If it is left untreated, it could lead to chronic epididymo-orchitis, where persistent testicular inflammation leads to recurring testicular pain. It can also lead to testicular shrinkage or testicular abscess (pus collection within the testicle). [leedssexualhealth.com]
- Swelling of the Scrotum
This is pain and swelling of the scrotum (sac round balls). It is usually caused by an infection in the epididymis, testicle or tubes. What might I notice? Pain, redness or swelling in the scrotum. [sexualhealth.cht.nhs.uk]
A man’s two testicles sit inside the scrotum. One epididymis sits behind each testicle. Epididymitis is inflammation (swelling and irritation) of this tube. Orchitis occurs when the inflammation spreads to the testicle. [veteranshealthlibrary.va.gov]
Epididymo-orchitis is a condition characterised by pain and swelling in the scrotum. It is caused by infection and inflammation in the epididymis and/or testicle. Epididymitis means inflammation of the epididymis. [sexualhealthdorset.org]
Symptoms Symptoms of epididymitis and orchitis can include: Pain, swelling and tenderness in your scrotum. Only one side of the scrotum is affected. Pain that at first is most intense at the back of one testicle. [drugs.com]
The primary complaint is swelling of the scrotum associated with pain. Urethral discharge is common. Fever may or may not be present. On palpation, swelling in the posterior scrotum localized over the involved epididymis can be appreciated. [visualdx.com]
- Testicular Mass
normal cremasteric reflex Testicular masses or swollen testicles with hypoechoic and hypervascular areas Testicular torsion Acute onset of pain, usually severe High-riding transversely oriented testis; abnormal cremasteric reflex; pain with testicular [aafp.org]
At USG, testicular tumors usually appear as discrete masses, or the entire testis may be involved. They may be diffusely or heterogeneously hypoechoic. [wajradiology.org]
- Scrotal Mass
Clinically, patients present with a painless or slightly painful scrotal mass. The differential diagnosis of such a scrotal mass includes testicular tumor, acute infection, infarction, and granulomatous infection [3, 4]. [ajronline.org]
Anorchia (Medical Encyclopedia) Hydrocele (Medical Encyclopedia) Hydrocele repair (Medical Encyclopedia) Hypogonadotropic hypogonadism (Medical Encyclopedia) Orchitis (Medical Encyclopedia) Scrotal masses (Medical Encyclopedia) Testicle lump (Medical [icdlist.com]
“Scrotal Masses. General Characteristics” Image created by Lecturio Testicular torsion is the most serious condition that presents with an acute scrotum. Up to 25 % of the cases of the acute scrotum are caused by testicular torsion. [lecturio.com]
Evaluation of scrotal masses. Am Fam Physician. 2014 May 1. 89(9):723-7. [Medline]. Altinkilic B, Pilatz A, Weidner W. [medscape.com]
Workup
Surgical indications present Older age group if it is the only way to ensure appropriate workup: Many will have underlying urologic pathology. Systemically ill, fev... Testicular torsion should be ruled out in all cases of new-onset testicular pain. [5minuteconsult.com]
Diagnostic Workup for Testicular Torsion The main diagnostic tool for the evaluation of a suspected case of testicular torsion is history and physical examination. [lecturio.com]
Treatment
Table 1 Staging of acute epididymo-orchitis and its treatment STAGE Palpation SUI TREATMENT Efficacy of conservative treatment E/T Malacia Hydrocele Abscess I + – – No Conservative 100% II + – + None, one, or a few abscesses up to 0.5 cm in greatest dimension [ncbi.nlm.nih.gov]
Partner treatment All partners of men with epididymo-orchitis not secondary to an enteric pathogen should be tested and managed accordingly. Disclaimer The content of these treatment guidelines is for information purposes only. [mshc.org.au]
Treatment includes medicine to get rid of the infection. It also includes medicine and other methods to relieve symptoms. Possible treatments Antibiotics. Acute epididymitis is most often treated with oral antibiotics. [saintlukeskc.org]
Prognosis
Treatment and prognosis The vast majority of patients are managed with simple analgesia and oral antibiotics. [radiopaedia.org]
Etiology
Microbial etiology and predisposing factors in acute epididymitisFootnote 3 Age group Etiology and predisposing factors Prepubertal children Usual etiology: coliforms, P. aeruginosa Unusual etiology: hematogenous spread from primary infected site Predisposing [canada.ca]
Lymph nodes are more likely involved in tuberculous etiology. [wajradiology.org]
Definition, Classification and Etiology of Epididymitis Acute or chronic inflammation of the epididymis of various etiologies: Bacterial epididymitis Epididymitis secondary to urinary tract infection : E. coli, Proteus, Klebsiella, Pseudomonas, Staphylococci [urology-textbook.com]
In children, infection is less common an etiology. [emedicine.medscape.com]
Epidemiology
[…] if symptoms don’t settle with empiric treatment Useful resources: British Association of Sexual Health and HIV guidelines Hepatitis C Screening National Clinical Guideline British Association of Sexual Health and HIV statement on partner notification Epidemiological [hse.ie]
The authors conclude that further studies on the epidemiology, etiology and pathogenesis of this condition are needed. References [canada.ca]
Introduction Clinical definition inflammation of epididymis with symptoms of < 6 weeks Epidemiology incidence 25 per 100,000 persons demographics men 18-35 years old risk factors sexual activity bladder outlet obstruction Etiology pathogens from sexually [medbullets.com]
Summary Epidemiology The overall prevalence and incidence of these conditions is difficult to estimate but autosomal recessive malignant osteopetrosis (ARO; see this term) has an incidence of 1/ 250,000 births, and autosomal dominant osteopetrosis (ADO [orpha.net]
Epidemiology Incidence (U.S.): 1 per 1000 Boys (up to age 13 years old) Prepubertal Epididymitis is much less common than Testicular Torsion in this age group Mean age of onset 11 years old Five year recurrence rate: 25% Men: Acute Epididymitis Ages 20 [fpnotebook.com]
Pathophysiology
1 – The structure of the testis and epididymis Classically, these two conditions are thought to occur together (termed epididymo-orchitis), however most cases are solely epididymitis, whilst a sole orchitis is very rare and is mostly of viral origin Pathophysiology [teachmesurgery.com]
Table 2 Multifactorial comparisons Discussion The pathophysiology of epididymitis remains unclear. 4 In a study of 22 men with Escherichia coli or idiopathic acute epididymitis, and nine controls, urethrovasal reflux secondary to high voiding pressures [nature.com]
Pathophysiology Ascending infection via vas deferens from prostatic Urethra IV. [fpnotebook.com]
Prevention
How do I prevent epididymo-orchitis? When you are sexually active, the best way to prevent epididymo-orchitis is to use condoms for oral, vaginal, and anal sex. [myhealth.alberta.ca]
Prevention To help reduce your chance of orchitis: Get vaccinated with the MMR vaccine. Practice safe sex, including wearing a latex condom to prevent STIs. Get prompt treatment for any infections. [winchesterhospital.org]
Centers for Disease Control and prevention (CDC). Update: mumps outbreak – New York and New Jersey, June 2009-January 2010. MMWR Morb Mortal Wkly Rep. 2010;59(5):125–129. Centers for Disease Control and Prevention (CDC). [cambridge.org]
There also is no recommended method to prevent varicoceles, hydroceles, or testicular torsion. Epididymitis can sometimes be prevented by practicing safe sex and avoiding heavy lifting or straining with a full bladder. [webmd.com]
[…] can be prevented by proper sexual hygiene and sterile precautions during any transurethral procedures. [dovemed.com]