- • Scrotal pain and swelling is typically unilateral
- • 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
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. |Favorite Table|Download (.pdf)
Table 6–1. Etiology of Epididymitis.
|Associated with urethritis|
|Associated with bacteriuria|
|Coliform bacteria (eg, Escherichia
|Associated with funguria|
|Associated with systemic infection|
|Mycobacterium other than M tuberculosis (MOTT)|
|Associated with drugs|
|Associated with systemic vasculitis|
|Associated with postinfectious etiology|
|Upper respiratory tract infections|
|Associated with trauma|
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 ...