m
 



Y

› 9
 

  

› 9
 
    

› 9
 
  

 
  
 
   

       99
9 9!
©
 
› à


   


›      


›   
› à      
 
› 

 
¬
¬ 



 ¬ 
› Urinary tract pathogens like E.coli

› Primary infection of urethra

› Outflow obstruction

› Results in Secondary urinary infection- a

high pressure in the prostatic urethra cause
reflux of infected urine up into the vasa
 


 ¬ 

› chlamydia and gonorrhoea

› Both are associated with urethritis

› the infection can track down the vas

deferens to the epididymis and testis.


 


› common cause

› mumps in boys also causes epididymo-

orchitis in about 1 in 5 cases
› The virus gets to the testes via the
bloodstream
› now uncommon since the MMR
immunisation is now routinely given to
children.
 
  





› Epididymo-orchitis used to be a
common complication after
prostatectomy (removal of the prostate)
› This may allow bacteria into the urethra
which may track down to the testes
› This is now rare due to better surgical
techniques.

¬

¬
› 9nfection from other parts of the body
rarely, travel in the blood to the testes
› TB (tuberculosis) and brucellosis.
› 9njury to the scrotum can cause
inflammation of the epididymis and
testis.
› when unusual exertion or violent strain
when the bladder is full causes injection
of urine into the vasa under pressure
©¬ 

› initial symptoms are those of acute
prostatitis
› ache in the groin, fever
› The epididymis and testis swell rapidly
and become exquisitely painful
› scrotal wall which is at first red,
oedematous and shiny may become
adherent to the epididymis
› Resolution- 6-8 weeks
݈cute tuberculous epididymitis
vas is thickened
there is little response to the
usual antibiotics
› àcute epididymo-orchitis of mumps
18 percent of males suffering
from mumps, usually¶ as the parotid
swelling is waning
› main complication is testicular atrophy
bilateral(not usual) - testicular
atrophy which may cause infertility
Partial atrophy - persistent
testicular pain

› absence of parotitis - infants





› organism is isolated from the urine, this

simplifies the choice of antibiotic
› should rest in bed while the acute
symptoms persist
› Doxycvcline (100 mg daily) - treatment of
choice for chlamydial infection
› The scrotum is supported on a sling made
of broad adhesive tape attached between
the thighs. The inflamed organ rests on a
pad of cotton wool placed on the sling.




› patient should be warned that the testis

may atrophy.
› àntibiotic treatment should continue for
2 weeks or until the inflammation has
subsided.
› 9f suppuration occurs, drainage is
necessary.
©
¬
¬  



¬
› 9nsidious onset
› infection is retrograde from a tuberculous
focus in the seminal vesicles.
› ©

 

firm discrete swelling of the 9ower
pole of the epididvmis which aches a little
a characteristic beading of the vas is
apparent due to subepithelial tubercles
seminal vesicle feels indurated and
swollen
©
¬
¬  



¬
› in neglected cases, a tuberculous µcold¶
abscess forms which may discharge
› body of the testis may be uninvolved for
years
› but the contralateral epididymis often
becomes diseased.
› urine and semen should be examined
repeatedly for tubercle bacilli
› 9ntravenous urographv and chest
radiography should be performed.



› Treatment with antituberculous drugs
› 9f resolution does not occur within 2
months, epididymectomy / orchidectomy
is advisable
› full course of antituberculous
chemotherapy should be completed
even if there is no evidence of disease
elsewhere.
©
¬ 
¬ 



› failure of an acute attack to resolve fully
› difficult to distinguish from tuberculosis
but the swelling may be larger and
smoother
› Should exclude urethral
stricture,sarcoidosis
› Epididymectomy / orchidectomv should
be considered if there is no resolution
after 4²6 weeks of conservative
treatment.
©
¬ 

› àn abscess (a collection of pus due to

infection) occasionally develops in the
scrotum. This may need a small operation to
drain the pus.
› Reduced fertility in the affected testis,
especially in cases caused by the mumps
virus.
› àn ongoing (chronic) inflammation
occasionally develops.
› Rarely, serious damage to the testis may
occur and result in gangrene (dead tissue) in
the testis that needs to be surgically removed.