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]

• Chills

  Symptoms may also include redness, pain and tenderness, fever and chills, nausea, malaise and fatigue, headache, body aches, and pain and discharge with urination. [luriechildrens.org]

  Acute epididymitis typically presents with symptoms of epididymal swelling, induration, and exquisite tenderness to palpation and may also be accompanied by fever, chills, or dysuria [1]. [hindawi.com]

  Acute bacterial prostatitis S&S's - Acutely ill (fevers, chills, malaise, myalgias) - Acute UTI sx's ( Think STD = irritative voiding sx's, testicular pain) - Dribbling, LBP, Perineal or pelvic pain, Cloudy urine - VERY tender prostate - Enlarged, firm [quizlet.com]

  Symptoms may occur quite suddenly and can include: a rise in body temperature accompanied by chills a sore swelling of the epididymis hot, reddish scrotal skin occasionally, pain in the stomach accompanied by a sick feeling and vomiting. [netdoctor.co.uk]

  Symptoms of mumps orchitis may include mild to severe testicular pain, swelling, tenderness, lower abdominal pain, fever, and chills. [healthcommunities.com]

• Severe Pain

  People with severe pain in the scrotum may need a prescription pain medication. When To Call a Professional A doctor must evaluate severe pain in the scrotum or testicles. This can be a symptom of testicular torsion, as well as epididymitis. [drugs.com]

  It should be considered in all patients, is more likely in younger patients and the onset of severe pain is usually short (four hours). [hse.ie]

  pain suggesting other diagnoses (torsion, testicular infarction, abscess) unable or unlikely to comply with antimicrobial regimen high fever. [sahealth.sa.gov.au]

• Gangrene

  Fournier's gangrene can involve the perineum with gas formation but classically spares the testis and epididymis. [indianjurol.com]

  Rectal cancer and Fournier's gangrene—current knowledge and therapeutic options. World J Gastroenterol 2015; 21:9002–9020. 10. Veljkovic R, Milosevic P, Stojanovic S. Fournier's gangrene associated with carcinoma of the colon. [journals.lww.com]

  CT (Siemens SOMATOM Definition, Germany) and MRI (GE Signa HDx 1.5T MRI, USA) of the abdomen/pelvis and scrotum were obtained to confirm the diagnosis, see the extent of involvement and exclude Fournier's gangrene. [ijri.org]

  Severe pain starts on anterior abdominal wall, spreads into gluteal muscles, scrotum & penis - Edema - Blisters/bullae - Crepitus (SQ gas) - Fever - Tachycardia - Hypotension Tx for Fournier's Gangrene - Early & aggressive surgical debridement (Fatal [quizlet.com]

• Surgical Procedure

  For men over 35 years, a urine infection is a common cause, but it may also occur after surgical procedures such as a cystoscopy (a medical procedure to examine the bladder) or catheterisation (a process used to drain the bladder through a tube called [thesexualhealthhub.co.uk]

  This may also occur after surgical procedures such as cystoscopy or catheterisation. Occasionally it may be caused by a ‘gut’ bacterial infection from insertive anal intercourse. [sexualwellbeing.ie]

  In more severe cases, a person may have to stay in the hospital and may require some surgical procedures. Follow-up exams with the doctor will also be necessary to make sure the infection has cleared up. [medicalnewstoday.com]

  Endourology[edit] Endourology is the branch of urology that deals with the closed manipulation of the urinary tract.[13] It has lately grown to include all minimally invasive urologic surgical procedures. [en.wikipedia.org]

  Such reflux can also be induced iatrogenically after certain surgical procedures, such as transurethral resection of the ejaculatory ducts, resulting in epididymitis. It can also be a result of heavy physical activity such as weight lifting. [emedicine.medscape.com]

• Underweight

  Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. [en.wikipedia.org]

• Constipation

  We will ask that your child empties his bladder on a routine schedule, increase the amount of water he drinks, and monitor bowel movements for any signs of constipation Reviewed by : Division of Urology Date : April 2014 [chop.edu]

  Hernia LEFT: herniated bowel in preterm.RIGHT: left-sided hernia in constipated child due to intermitted herniation of sigmoid. Hernias in children are common especially in premature infants. [radiologyassistant.nl]

  To prevent constipation, he should use stool softeners or eat plenty of fruit, nuts, whole grain cereals, and other foods with laxative properties. [medical-dictionary.thefreedictionary.com]

• Tachycardia

  Examination revealed a temperature of 39.6 ° C and sinus tachycardia. Otorhinopharyngeal, parotid and abdominal examinations were normal. [mja.com.au]

  His vital parameters showed tachycardia, normal blood pressure, and temperature of 100°F. Clinical examination of the scrotum showed inflamed left scrotum and tender and enlarged left testis and epididymis. [indianjurol.com]

  General physical examination demonstrated an elevated temperature of 101°F and tachycardia. Blood pressure and other vital signs were normal. [ijri.org]

  Levofloxacin (Levaquin) 500 mg PO qd x 10 d Necrotizing fasciitis of perineum S&S of Fournier's Gangrene - Severe pain starts on anterior abdominal wall, spreads into gluteal muscles, scrotum & penis - Edema - Blisters/bullae - Crepitus (SQ gas) - Fever - Tachycardia [quizlet.com]

  Patients with epididymitis and orchitis often have tachycardia or fever. Patients may also be uncomfortable while seated, but this is also common with testicular torsion. [aafp.org]

• Erythema

  There may be erythema overlying the area of swelling. Pain should improve within 72 hours after treatment, although inflammation may persist for a few weeks. [visualdx.com]

  Definition Epididymitis can be defined as inflammation of the epididymis manifested by a gradual onset of unilateral testicular pain (sometimes bilateral pain) and swelling often with tenderness of the epididymis and vas deferens and occasionally with erythema [canada.ca]

  […] bacteriuria and subsequent retrograde ascent of pathogen Prognosis resolves with antibiotics Presentation Symptoms testicular pain and often unilateral lower abdominal pain urinary frequency or urgency urinary dysuria Physical exam fever testicular erythema [medbullets.com]

  • Tenderness and induration occurring first in the epididymal tail and then spreading • Elevation of the affected hemiscrotum • Normal cremasteric reflex • Erythema and mild scrotal cellulitis • Reactive hydrocele (in patients with advanced epididymo-orchitis [de.slideshare.net]

  Other signs and symptoms such as discharge, dysuria, frequency, urgency, erythema of the scrotal skin, and fever may be present also. [academic.oup.com]

• Blister

  Other complications are also rare but can include: chronic inflammation of the epididymis an abscess or blister within the scrotum shrinking of the affected testicle the death of testicular tissue Some cases of orchitis cannot be prevented. [healthline.com]

  Ciprofloxacin (Cipro) 500 mg PO bid x 10 d OR Levofloxacin (Levaquin) 500 mg PO qd x 10 d Necrotizing fasciitis of perineum S&S of Fournier's Gangrene - Severe pain starts on anterior abdominal wall, spreads into gluteal muscles, scrotum & penis - Edema - Blisters [quizlet.com]

• Suggestibility

  Taking history Onset: insidious presentation suggests infection. [bmj.com]

  The series by Mittemeyer et al. of 610 cases suggested a rate of ~3–5% [ 2 ] and another paper by Fernández-Pérez quoted a figure of 3.5% [ 3 ]. [ncbi.nlm.nih.gov]

  USG of the scrotum revealed enlarged, ill-defined, hypoechoic right testis and epididymis with multiple linear and punctate bright, highly reflective hyperechoic foci suggestive of gas shadows [Figure 1]. [ijri.org]

  In patients presenting with scrotal swelling, the sonographic detection of epididymal abnormalities, skin thickening, and hydrocele are suggestive of infection rather than testicular tumor. [ajronline.org]

• Irritability

  Epididymitis is inflammation (swelling and irritation) of this tube. Orchitis occurs when the inflammation spreads to the testicle. Normal flow of sperm and urine Sperm are made in the testicles. [veteranshealthlibrary.va.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]

  Doctors think this may be caused by some urine flowing backward and causing irritation. [merckmanuals.com]

  Acute bacterial prostatitis S&S's - Acutely ill (fevers, chills, malaise, myalgias) - Acute UTI sx's ( Think STD = irritative voiding sx's, testicular pain) - Dribbling, LBP, Perineal or pelvic pain, Cloudy urine - VERY tender prostate - Enlarged, firm [quizlet.com]

• Stroke

  Adjacent scrotal and testicular inflammation may occur with Testicular Torsion or infection Orchitis and Testicular Torsion both cause Testicular Swelling, scrotal erythema, reactive Hydrocele Cremasteric Reflex present in both Orchitis and Epididymitis Stroking [fpnotebook.com]

  In contrast with men who have testicular torsion, the cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) is not altered. [ipfs.io]

  Neurological diseases and disorders such as a stroke, multiple sclerosis, Parkinson's disease, and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence, detrusor overactivity, urinary retention, [en.wikipedia.org]

  The cremasteric reflex, elicited by stroking the skin of the upper medial thigh, should always be evaluated. [aafp.org]

• 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]

• Urethral Discharge

  Urethral discharge may also be noted. [aci.health.nsw.gov.au]

  Likely sexually transmitted pathogens including gonorrhoea The following factors may be associated with the presence of a sexually transmitted pathogen younger age high risk sexual history urethral discharge present no previous urological procedure or [sahealth.sa.gov.au]

  E. coli and Chlamydia in patients with a history of urethral discharge are the organisms most frequently cultured bacterial infections are the most common aetiology for epididymitis in men <= 35 years of age, ascending infection from the urethra by sexually [gpnotebook.com]

  Urethral swab if discharge. If age <35 years, sexually active or urethral discharge, refer to GUM (see Appendix 6 under Sandyford for contact details). [handbook.ggcmedicines.org.uk]

• 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]

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]

• Pyuria

  Rarely, it may also be associated with dysuria, or pyuria with urethral discharge. [ijri.org]

  (Urgency, frequency, nocturia & Painful perineum, low abdomen, testicles, penis, ejaculation) - +/- bloody ejaculate, Possibly enlarged prostate - Non-tender or mildly tender prostate - Firm prostate Dx studies for Acute Bacterial prostatitis - U/A: Pyuria [quizlet.com]

  […] urethritis (urethral discharge) Chronic epididymitis Recurrent bouts of scrotal pain Swelling is minimal when compared to acute epididymitis Thickened epididymis References:[1][2] Diagnostics Primarily a clinical diagnosis Laboratory findings Urinalysis (pyuria [amboss.com]

  The diagnosis of Orchitis and Epididymo-Orchitis may involve the following tests and procedures: Complete evaluation of medical history along with a thorough physical exam Urinalysis for pyuria (the presence of pus cells) or bacteriuria (the presence [dovemed.com]

• Pseudomonas

  Epididymo-orchitis can occur with Neisseria and Chlamydial infections, which are sexually transmitted and can also occur with E.coli or Pseudomonas. [sonoworld.com]

  If the epididymo-orchitis is caused by an enteric bacterial pathogen (including Pseudomonas aeruginosa), a urine culture should be obtained and used to guide antimicrobial therapy. [visualdx.com]

  It occurs most commonly as a complication of a urethral infection caused by sexually transmitted pathogens (Chlamydia trachomatis, Neisseria gonorrhoea) in sexually active men, or a urinary tract infection caused by enteric Gram-negative bacteria (Pseudomonas [mshc.org.au]

  Therefore, the most common pathogens are E. coli, Proteus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa. [teachmesurgery.com]

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]

Treatment and prognosis The vast majority of patients are managed with simple analgesia and oral antibiotics. [radiopaedia.org]

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]

[…] 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]

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]

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]