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Diagnosis and treatment of acute and chronic epididymitis in men

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The problem of male reproductive health is very acute. The organism of a modern man is influenced by many negative factors: poor ecology, constant stress, unhealthy diet, sedentary lifestyle, and a whole range of diverse sexually transmitted infections. As a result, doctors observe a steady increase in diseases of the male genital sphere, including inflammatory processes of the external genital organs.

What is epididymitis

Epididymitis is the inflammatory process in the epididymis. Men of all ages suffer from this unpleasant disease, but it is most often observed in the age group of 20-40 years old - during the period of the greatest sexual activity.

The testicles and their appendages are located in the scrotum and belong to the male external genitals

The male testicles are paired genital glands, which are located in the scrotum. Each of them adjoins an appendage on the side, a dense cord that resembles a spiral tube. It serves for the maturation and advancement of sperm. At the lower pole of the testicle, the appendage continues into the vas deferens, which, passing through the prostate gland, merges with the urethra.

The testicles can be easily felt through the scrotum wall, normally these are rounded elastic formations. The appendages are felt in the form of rollers on the lateral surfaces of the genital glands.

Due to the fact that the appendage is directly adjacent to the testicle, epididymitis often provokes inflammation - orchitis. In this case, the disease is called orchiepididymitis.

Inflammation of the appendages is accompanied by severe swelling of the scrotum.

Types and forms of the disease

Depending on the cause of the disease, there are several types of epididymitis:

  • infectious (specific, non-specific);
  • necrotic-infectious (due to torsion and dying of testicular tissue);

  • granulomatous (provoked by seed granuloma);

  • post-traumatic.

About 80% of cases of epididymitis and orchepididymitis are caused by infection.

These may be non-specific agents:

  • bacteria (including E. coli);
  • viruses;
  • fungi;
  • chlamydia;
  • mycoplasma.

For nonspecific infections are common manifestations of the disease. The particular difficulty is that the causative agent of the disease cannot be determined without special bacterioscopic examination.

Specific infections have characteristic manifestations that facilitate diagnosis. The reason for the development of pathology can be:

  • tuberculosis bacillus;
  • gonococcus;
  • trichomonas;
  • the causative agent of syphilis (very rarely causes epididymitis).

In males of 20–40 years, the main cause of inflammation is STIs - sexually transmitted infections (gonorrhea, trichomoniasis). Whereas in the age group older than 40 years, most often the development of the disease is provoked by E. coli.

Of particular concern is ochroepididymitis, which develops in children and adolescents as a complication of mumps (mumps). In 20-40% of cases, this disease leads to testicular atrophy and infertility.

The cause of infectious-necrotic epididymitis becomes testicular torsion. The addition of a bacterial agent aggravates the course of the disease. Granulomatous inflammation occurs when sperm is embedded in the epididymis tissue.

Often, inflammation of the appendage occurs after trauma to the male genital organs. Traumatic epididymitis is divided into:

  • postoperative (if the infection was brought in during the operation);
  • post-instrumental (infection occurred during medical procedures);
  • actually traumatic (after injury of the scrotum).

Post-traumatic inflammation is fixed in approximately 9% of patients.

By the nature of the course of epididymitis is:

  • acute;
  • chronic.

These forms are significantly different in symptoms and require a different approach to treatment.

The acute process develops rapidly, usually starts from one side. Most often on the right, as the right testicle in men is located just above the left. Sometimes inflammation engulfs the testicle, causing its dropsy.

The first bright symptom of trouble becomes pain. There are many receptors in the scrotum, so the discomfort during inflammation is very intense. They are the reason for going to the doctor.

The main symptom of inflammation of the epididymis is severe pain in the scrotum.

With adequate treatment, the acute manifestations of epididymitis disappear within a week, but the seal in the scrotum lasts much longer - up to two months.

Acute epididymitis can be serous or purulent. For a serous form, edema and induration in the area of ​​the affected appendage is characteristic. Purulent process is a serious disease in which inflammation foci are formed, followed by purulent fusion of tissues.

With the wrong treatment, the disease becomes chronic, hidden form. At the same time, the process threatens to drag on for a long time, and the probability of the subsequent development of complications is high.

Inflammation of the epididymis often provokes the development of orchitis

Video: inflammation of the epididymis

Causes

Inflammation in the appendage occurs mainly as a result of penetration into the organ infection. It happens in two ways: hematogenous (with blood from another foci of infection) or canalicular - the infection rises through the vas deferens (if there is a lesion in the urethra or prostate gland). Epididymitis can occur as a complication after instrumental examinations (insertion of a catheter into the bladder) or endoscopic intervention (urethrocystoscopy).

Aseptic epididymitis can cause accumulation in the epididymis of Amiodarone, a drug used in cardiology. The danger of developing inflammation is the higher, the higher the dose of the medication taken.

The development of epididymitis is facilitated by stagnant processes in the male pelvis. Circulatory disorders reduce tissue resistance to infectious agents. At risk, the representatives of the stronger sex, suffering from chronic constipation, hemorrhoids. Congestive genital mutilation can be the result of frequent interrupted sexual intercourse.

In children, epididymitis most often appears as a complication of viral infection (influenza, chickenpox, etc.).

Provocative factors for the occurrence of the disease are:

  • hypothermia;
  • unprotected, promiscuous sex;
  • abnormalities of the urinary tract;
  • hyperplasia, prostate adenoma, disrupting the flow of urine;
  • postponed tuberculosis, sarcoidosis;
  • surgery on the genitals (including vasectomy) or pelvic organs.

Symptoms of the disease

Acute inflammation in the appendage begins with a rapid increase in temperature up to 40 ° C, chills, and increasing edema of the appendage. Inflammation quickly captures the shell of the testicle and scrotum. In a matter of hours, the scrotum may increase in size two or more times. The skin on it is stretched, reddens, the folds are smoothed. If the process of inflammation captures the testicle, the boundary between it and the appendage ceases to be palpable.

The pain is sharp, gives to the groin area, the perineum or sacrum, aggravated by the slightest movement. Pain may also appear in the stomach.

Other symptoms of epididymitis:

  • pain when urinating;
  • the presence of blood in the urine;
  • mucous or purulent discharge of the urethra (depending on the stage of inflammation);
  • feeling of bursting in the scrotum;
  • nausea;
  • severe weakness associated with increasing intoxication;
  • pain during intercourse and ejaculation;
  • increased urination;
  • discomfort during the act of defecation;
  • enlarged lymph nodes in the groin;
  • premature ejaculation.

Any of these manifestations should be a reason to consult a doctor, since similar symptoms can be observed in other dangerous conditions, such as torsion of the testicle. In this case, without urgent intervention, you can lose the body.

The most dangerous condition, accompanied by pain in the testicle, is its torsion

The following signs should especially alert:

  • burning during urination;
  • high temperature rise;
  • stomach ache;
  • induration of the testicle.

Often, on the 3-5th day of illness, the acute symptoms subside, but this does not indicate that epididymitis is gone. Without consultation with the doctor in any case can not do.

Chronic inflammation of the appendage usually proceeds latently (hidden). The patient can not guess that the disease is not cured until the end, since the chronic form is characterized by the absence of symptoms. Against the background of well-being, a man only during periods of exacerbation feels a slight pain in the testicle.

At the same time, the appendage and the spermatic cord connected with it become thicker over time, become dense, the vas deferens becomes wider. When feeling there is pain, which can also occur during exercise. Externally, the scrotum has a normal shape and color.

Chronic defeat, as a rule, captures both appendages. Prolonged latent inflammation leads to scarring of the tissues of the affected appendage and infertility.

Stage of the disease

According to the severity of the process, there are three stages of epididymitis:

  1. Light - characterized by mild manifestations of the disease, the temperature rises slightly.
  2. Medium - pronounced signs of intoxication, the temperature rises to 39 ° C, the focus of inflammation spreads to the surrounding tissues.
  3. Severe - the patient has fever, the symptoms are maximally manifested, the epididymis is enlarged, there are foci of purulent fusion.

Diagnostics

Diseases of the male genitalia - a reason to turn to the urologist. This specialist can easily make a preliminary diagnosis after interviewing the patient, visual inspection and palpation (palpation) of the scrotum. As a rule, diagnosis of epididymitis is not difficult.

For the differential diagnosis of epididymitis, the doctor will prescribe:

  • general urine analysis. The study is very informative to confirm epididymitis. The presence in the urine of a large number of leukocytes and protein will indicate the development of the inflammatory process. It should be clarified that the bacteria that caused the disease, in large quantities are in the urethra. Therefore, the study requires urine from the beginning of the stream; In the urine analysis of a patient with epididymitis, leukocytes and protein
  • bacterioscopy. Bacterioscopic urinalysis is performed to determine the causative agent of the disease. At the same time, a study of the sensitivity of the microbe to various antibiotics is appointed, so that the doctor can select the most effective antibacterial drug;
  • STI tests (PCR assay). Analysis of sexually transmitted infections is carried out using the PCR method. This technique is able to identify the genetic material of the pathogen in the urine, blood or smear from the urethra. It is better to perform tests for STIs for both partners at the same time;
  • complete blood count (necessarily with leukocyte formula). Examination of the patient's blood with existing inflammation of the epididymis will show a shift of the leukocyte formula to the left. The so-called increase in blood neutrophil count. Normally, the number of segmented neutrophils is 47-74%, band (immature) - 1-6%. An increase in the number of immature forms indicates the presence of an inflammatory focus in the body. At the same time, the erythrocyte sedimentation rate will increase (normally in men 18-55 years old - 2-14 mm / h, in men older than 55 years - up to 15-19 mm / h);
  • a study to identify antibodies to the causative agent of mumps;
  • Ultrasound and MRI of the testes and appendages. Methods such as ultrasound and MRI are extremely important for the diagnosis and differential diagnosis of epididymitis. Ultrasound can detect medium-sized foci of pus and establish the stage of inflammation. More accurate information about the condition of the scrotum organs can be obtained using MRI, but this study has a significant disadvantage - its high cost;
  • Doppler sonography of the scrotum. The study allows to assess the condition of the blood vessels in the inguinal region.

Differential diagnostics

Symptoms of nonspecific epididymitis are sometimes very similar to a specific infection, epididymis tuberculosis. Important in the diagnosis is the collection of a detailed history and identification of tuberculosis bacilli in the contents of the appendage. This form of epididymitis is dangerous because it leads to the formation of a tubercular abscess or fistula of the scrotum. If a tuberculosis bacillus is detected in the analysis, the patient should be referred for consultation to a phthiology specialist.

Acute epididymitis needs to be differentiated with a torsion of the epididymis, since in the second case the patient requires immediate surgical treatment. This condition is characterized by sudden severe pain in the absence of fever and redness of the scrotum. For the diagnosis is applied Doppler study of the vessels of the scrotum of the patient.

Frequently, including in young men, testicular neoplasms. At the same time, the organ significantly increases in size, but there are no signs characteristic of inflammation. If a tumor is suspected, an ultrasound of the scrotum is performed. Indicative will be the blood test for tumor markers.

Epididymitis treatment

Conservative methods are mainly used to treat this disease. The main therapy is antibacterial. Often, a combination of two antibiotics is prescribed if it is found that inflammation is caused by mixed flora.

For patients up to 40 years, two main schemes are used:

  • cephalosporins (Ceftriaxone) + tetracycline preparations (Ciprofloxacin), the course of therapy is 10 days;
  • Macrolide (Sumamed), course - 3-5 days.

Men of the age group of 40 years are treated with drugs:

  • Levofloxacin or Ciprofloxacin;
  • sulfanilamide preparation (Sulfalen, Sulfadimethoksin) + trimethoprim (Co-Trimoxazole).

The choice of antibiotic is the prerogative of the attending physician.

If it turns out that the inflammation of the appendage is non-infectious, the patient is given non-steroidal anti-inflammatory drugs - Ibuprofen, Nimesulide, Diclofenac and resolving agents - Longidaza.

Locally, you can apply compresses with Dimexide (10-15% solution), electrophoresis using potassium iodide, novocaine. Magnetic laser therapy gives a good effect.

During the period of subsidence of symptoms, physiotherapeutic procedures are prescribed, such as:

  • UHF (ultrahigh-frequency therapy) - exposure to electromagnetic fields accelerates blood circulation and the regeneration process in the affected organ;
  • diathermy on the scrotum - heat treatment stimulates the metabolism, helps reduce pain;
  • heat packs.

Photo Gallery: medications

Surgical intervention

If the epididymitis is complicated by an abscess, the patient will have surgery - the surgeon opens and drains the abscess cavity. With a massive and irreversible lesion, epididimectomy (removal of the epididymis) is indicated.

In addition, surgical treatment is carried out in the following conditions:

  • infertility caused by inflammation of the epididymis;
  • tuberculous epididymitis;
  • frequent exacerbations of the chronic process;
  • post-traumatic epididymitis;
  • severe course of the disease, lack of response to the treatment;
  • torsion of the appendage.

Treatment of tuberculous epididymitis

Tuberculous inflammation of the epididymis is treated differently than other forms of this disease.

Drug therapy is the appointment of Isoniazid, Ethambutol, Rifampicin, Streptomycin, and other anti-TB drugs. Based on the severity of the process, drugs are taken orally, are administered intramuscularly, intravenously or endolymphatic method (in the inguinal lymph nodes).

Isoniazid - an anti-TB drug that has a detrimental effect on Koch's wand

Mode and diet

Patients with acute inflammation of the appendage require strict bed rest. It is important to ensure peace and elevated position of the affected organ. To do this, use a roller from a towel or special tight melting (suspension).

In the first few days, the doctor prescribes topical cold compresses. To reduce pain, candles with ketorolac or drotaverine are used.

Diet for epididymitis involves the rejection of spicy, salty and fried foods, alcoholic beverages. The patient is recommended to drink plenty of fluids (at the rate of 30 ml per 1 kg of weight).

To ensure the immobility of the appendage use special tight heat

Sex with epididymitis

Acute inflammation, like relapse of the chronic form of the disease, implies sexual rest.

Outside of acute epididymitis, sex is not prohibited. If the disease is provoked by a sexually transmitted infection, the use of a condom is mandatory. At least as long as the results of the control analyzes are obtained.

Masturbation during remission is allowed.

Treatment of folk remedies

Важно понимать, что народная медицина не заменяет лекарственную терапию, а лишь дополняет её. It is impossible to cure epididymitis only by folk methods.

There are many folk remedies for the treatment of inflammatory diseases of the genital sphere. The natural components in them have an antiseptic, antibacterial, soothing effect, enhance the regeneration of tissues affected by inflammation.

Here are some recipes:

  1. To make a collection of equal parts of juniper cones, shepherd's bag and bearberry leaves, dandelion roots and harvester, aniseed seeds and dill. In a half-liter container put 3 tablespoons of this collection, add boiling water and leave for half an hour. Then strain the infusion and drink it over the course of a day in 2 doses.
  2. Make a collection of the same number of birch leaves, juniper cones, celandine, harrow roots and Potentilla grass. In a liter container, place 4 tablespoons of the mixture and pour boiling water, let cool, then strain. Drink during the day in 3 receptions.
  3. Mix equal quantities of corn stigmas, birch buds, dry pods of beans and violet flowers. Make an infusion of 1 tablespoon of the mixture and 0.5 liters of boiling water. Take it to 2 spoons three times a day.
  4. Make a mixture of equal amounts of lingonberry leaves, horsetail grass and tansy flowers. Take 4 tablespoons of the collection and make the infusion in a half-liter capacity. Drink in 2 receptions during the day.
Folk remedies will accelerate recovery, but will not replace drug treatment

Medicinal infusions are recommended to be taken within a month. In chronic inflammation, it is advisable to repeat the course of therapy up to 4 times a year.

Prognosis and possible complications

The prognosis is in most cases favorable. The disease is relatively easily diagnosed, successfully treated with the help of a wide range of drugs and in the future does not affect the sexual health of men.

However, in some cases, the process may recur.

As a rule, the success of therapy depends on the joint actions of the doctor and the patient. In the era of the Internet, patients often not only diagnose themselves, but also prescribe a “treatment”. As a result of such actions increases the likelihood of complications, with which they then come for help to the doctors.

The later the treatment is started, the further the destructive process in the affected organs will go.

Possible complications of epididymitis:

  • chronic disease;
  • involvement in the process of inflammation of the surrounding tissues;
  • abscess of the scrotum;
  • testicle dying off (necrosis);
  • sepsis (spread of infection throughout the body);
  • Fournier's gangrene (rapidly progressive necrosis of the scrotum);
  • scrotal fistula;
  • obstruction of the vas deferens;
  • infertility;
  • chronic pain in the groin, especially in the scrotum.

Bilateral untreated epididymitis is complicated by infertility in 40-60% of patients.

Influencing factors affect the outcome of the disease:

  • high fever;
  • a large number of leukocytes;
  • high levels of urea, C-reactive protein in the urine;
  • the presence of diabetes mellitus;
  • age and state of health.

Prevention

Epididymitis is an extremely unpleasant, dangerous disease.

In order not to get sick, a man should:

  • follow the rules of intimate hygiene;
  • use a condom;
  • avoid genital trauma;
  • prevent the development of a stagnant process in the pelvic organs (do not interrupt sexual intercourse);
  • do not supercool;
  • Do not get carried away by self.

Video: external genital hygiene

Epididymitis is a serious disease that should be treated responsibly. Modern medicine has a huge list of tools to help the patient as soon as possible to get rid of the disease and avoid unpleasant complications. To do this, it is necessary to consult a competent doctor in time and make appointments in good faith.

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