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  • • Scrotal pain and swelling is typically unilateral in epididymitis.
  • • Epididymitis is typically characterized by the presence of urethritis or bacteriuria.
  • • An abnormally high position of the testicle may indicate testicular torsion.
  • • Have a low threshold to obtain a doppler ultrasound or radionuclide scanning to rule out testicular torsion in adolescents or young adults, because prompt surgical intervention is essential to save the involved testicle.

Epididymitis, an inflammatory process involving the epididymis, is one of the primary etiologies of the acute scrotum syndrome. Epididymitis is common and can cause substantial short-term morbidity (eg, suffering and loss of time from work) and long-term complications (eg, infertility, chronic epididymitis, etc). The incidence of epididymitis may range from 1 to 4 per 1000 men per year. The inflammatory process causes a gradual onset of scrotal pain and swelling that is characteristically unilateral.

With the improved understanding of the etiology of epididymitis, the diagnosis and management of this condition is becoming more rational, leading to decreased morbidity and, possibly, to prevention of recurrences. Epididymitis usually results from infection. There are two main infectious causes: (1) urethral infection with Neisseria gonorrhoeae or Chlamydia trachomatis, and (2) genitourinary tract infection with coliform bacteria or Pseudomonas aeruginosa (see Table 6–1). Age is an important predictor of the etiology, with heterosexual men younger than 35 years of age more likely to have a sexually transmitted pathogen, and older individuals more likely to have a pathogen associated with bacteriuria. In rare cases, epididymitis may occur as a complication of systemic infection with various bacterial, fungal, viral, or parasitic pathogens, or may be due to noninfectious causes (see Table 6–1). In prepubertal boys, epididymitis may be related to concomitant presence of structural, functional, or neurologic abnormalities of the genitourinary tract. Men who have sex with men and who practice insertive anal intercourse are at greater risk for epididymitis caused by coliform bacteria. Cases for which no etiologic agent can be determined after thorough investigation are referred to as idiopathic.

Table 6–1. Etiology of Epididymitis.

The epididymis is a sausage-shaped structure positioned on the posterior aspect of the testicle. It consists of a single, delicate convoluted tubule 12–15 feet long. During passage through the epididymis, sperm become motile and achieve the potential to fertilize an ovum. Hence, inflammation and fibrosis from epididymitis can impair the passage ...

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