First, acute epididymitis

(1) etiology

There are three common causes of epididymitis: ① Secondary to prostatitis or urinary tract infection. ② After prostatectomy, especially transurethral surgery, there may be bacteria in urine 8~ 12 weeks after operation, and urine will flow back into ejaculatory duct when urinating, causing retrograde infection and epididymitis; Infection can also invade epididymis through peripheral lymphatic vessels. ③ The return of sterile urine to ejaculatory duct leads to chemical epididymitis. Recent studies have found that urine can return to seminal vesicle.

(2) pathophysiology and pathology

Early epididymitis is a kind of cellulitis, which starts from the ejaculatory duct and spreads to the tail of epididymis. In the acute stage, the epididymis swelled and hardened, and the infection spread from the tail of epididymis to the head. Small abscess can be seen on the pathological section, and the tunica vaginalis often secretes some serous fluid (inflammatory epididymal effusion). These fluids may contain pus, spermatic cord thickening and secondary testicular congestion and swelling, but generally no inflammation will occur. Under the light microscope, tissue edema, neutrophil, plasma cell and lymphocyte infiltration can be seen, and then abscess formation, epithelial necrosis and inflammation can be completely absorbed. However, fibrosis around epididymal tubules often leads to lumen obstruction, and if it is bilateral epididymitis, it can cause infertility.

(3) Clinical manifestations

1. Symptoms Epididymitis often occurs after heavy physical labor, such as lifting heavy objects, or after intense sexual excitement. The injury caused by the operation of transurethral instruments can lead to epididymitis, which can also be complicated after prostatectomy. Epididymitis is often secondary to prostatitis.

Scrotal pain often occurs suddenly and can radiate to groin and lumbosacral region along spermatic cord. Usually, the pain is severe, the tenderness is obviously refused, and the swelling progresses rapidly. In 3~4 hours, the volume of epididymis can double, and the body temperature can reach about 40℃. Secretions can appear in the urethra, which may be accompanied by cystitis and urine turbidity.

2. Symbols

There is tenderness in inguinal region, scrotum swelling and local skin swelling, such as abscess formation, dry and thin skin and easy to fall off. Abscess can also rupture on its own. If you see a doctor in time, the boundary between swollen and hardened epididymis and testis is clear. But after a few hours, the testis and epididymis will become a mass, and the spermatic cord will thicken due to edema. After a few days, there will be secondary hydrocele of testis. There may be secretions in the urethra.

Prostate palpation can find acute or chronic prostatitis, and it is forbidden to do prostate massage in the acute stage.

3. Laboratory inspection

White blood cells in peripheral blood can reach (2 ~ 3) × 109/L, and urine secretion can be examined with or without staining. Urine analysis is also an important means of examination.

4. Ultrasonic examination

It can show the swelling and inflammation range of epididymis and testis.

5. Magnetic vibration inspection

Epididymitis is diffuse or focal, and the signal of epididymis on T2-weighted image can be the same as or higher than that of testis.

(4) Differential diagnosis

1. Tuberculous epididymitis has little pain. At palpation, the boundary between epididymis and testis is clear, the vas deferens is beaded, the surface of prostate is uneven, the seminal vesicles on both sides are thickened, and "sterile" urine can be seen on smear. Mycobacterium tuberculosis can be found by culture.

2. Testicular tumor

As a painless mass, when there is acute bleeding in the tumor, the white membrane of testis suddenly increases due to the swelling and pain of testis and epididymis. Testicular masses can be distinguished from normal epididymis, and prostate examination and urine analysis are normal. If in doubt, you can check the chorionic gonadotropin, and about 15% of testicular tumors can be positive. In the case of uncertain diagnosis, rapid pathological examination should be done during operation before deciding whether to perform orchiectomy.

3. Torsion of spermatic cord

It is common in children before puberty and occasionally in adults. Epididymitis is more common in the elderly. In the early stage of spermatic cord torsion, the palpable epididymis is located in front of the testis, and the testis contracts upward. In the later stage, the epididymis and testis form an enlarged tender mass. Prehn sign is helpful to distinguish the two: if the scrotum is raised to pubic symphysis, if the pain is relieved, it is mostly epididymitis, if the pain is aggravated, it is mostly spermatic cord torsion, if the torsion cannot be ruled out, it should be explored surgically.

4. Testicular or epididymal appendage torsion

This is a rare disease of prepubescent boys. These pedicled objects can get entangled together, causing local pain and swelling. Hard nodules can be palpated on the testis in the early stage, while the epididymis is normal. It is difficult to distinguish epididymitis, spermatic cord torsion or adnexal torsion in the late stage of testicular enlargement. Because spermatic cord torsion must be treated in time, surgical exploration should be actively carried out in this case.

5. Testicular injury can cause acute epididymitis, but the history of trauma and pyuria are helpful for differentiation.

6. orchitis caused by mumps

Usually accompanied by mumps, there are no symptoms of urinary system, and there are no pus cells and bacteria in urine sediment.

(5) Complications

Abscess is rare, but it may occur if urethral instrument examination or prostate massage is performed. Abscess can be drained automatically along scrotum or require surgical drainage. Epididymis abscess can extend and destroy testis (epididymitis orchitis), but this situation is rare.

(6) Prevention

Prostatitis and urinary tract infection should be thoroughly treated. If necessary, bilateral vasectomy should be performed to prevent the recurrence of acute epididymitis.

(7) treatment

1. Special treatment

If the patient sees a doctor within 24 hours of onset, the condition can be completely relieved by infiltrating the spermatic cord above the testis with 1% procaine 20ml or lidocaine local anesthetic. Generally, the body temperature drops rapidly, the pain can disappear completely, and the inflammatory mass can be absorbed within a few days, otherwise it usually takes 2~3 weeks to be absorbed. If 1 injection can't completely achieve the goal, you can inject 1 injection again the next day.

Antibiotics are helpful for treatment, and secondary cystitis will soon be cured. The choice of antibiotics should be determined by bacterial culture and drug sensitivity test. Commonly used drugs include second and third generation quinones and cephalosporins such as compound sulfamethoxazole, norfloxacin and fluorozinic acid, all of which have good curative effects.

2. General therapy

In the acute stage (3~4 days), you should stay in bed. The application of scrotum support can relieve symptoms, and the self-made large scrotum support with cotton pad will be more comfortable to use. Painkillers can be used for patients with severe pain, and local hyperthermia can relieve symptoms and promote inflammation regression. However, premature use of hyperthermia will aggravate the pain and promote the spread of infection, so it is advisable to use ice packs for local cold compress in the early stage. Sexual life and manual labor can aggravate infection and should be avoided.

(viii) Forecast

The therapeutic effect of acute epididymitis is ideal, and the symptoms gradually disappear in about 1~2 weeks, but it takes 4 weeks or more for epididymitis to return to normal size and texture with few complications. Patients with bilateral epididymitis may be infertile.

Second, chronic epididymitis.

The irreversible terminal stage of severe acute epididymitis is chronic epididymitis, which is often lighter than acute epididymitis. Chronic epididymitis hardens the whole epididymis due to fibrous hyperplasia, and the scar is very obvious under the microscope. It is often seen that the epididymal duct is occluded and the tissue is infiltrated by lymphocytes and plasma cells.

(1) Symptoms Chronic epididymitis is usually asymptomatic. Unless it is acute, local discomfort may occur at this time. The patient can touch the mass in the scrotum, and the epididymis is thickened and enlarged with or without tenderness. It is easy to distinguish epididymis from testis by palpation, and the spermatic cord is often thickened. Sometimes the diameter of the vas deferens increases, the prostate is sclerotic and fibrotic, and pus cells are often seen in the prostatic fluid. Urine analysis can show infection secondary to prostatitis.

Tuberculous epididymitis is very similar to chronic epididymitis. The vas deferens are beaded and the seminal vesicles are thickened. The urine test is "sterile urine" or "tuberculous urine", which may indicate tuberculous epididymitis. Cystoscope can show bladder ulcer, and urine X-ray examination is also helpful for diagnosis. Testicular tumor can have testicular mass, palpation can find epididymis thickening and hardening, testicular hypoesthesia (tumor). Epididymal tumors are rare, and the differentiation from epididymitis depends on pathology. If chronic epididymitis is bilateral, it will lead to infertility.

(2) Simple antibiotic therapy is often not ideal, and prostatitis must be controlled. For example, if prostatitis is caused by repeated epididymitis, vasectomy in the non-attack period can cure prostatitis, and sometimes epididymitis is also feasible.

(iii) Forecast

Chronic epididymitis has no serious consequences, except pain and bilateral epididymitis may lead to infertility. Once it reaches the stage of fibrosis, it cannot be reversed.

Epididymitis can be divided into several types. What are the characteristics of its clinical manifestations?

Epididymitis is a common disease in young and middle-aged men, which is caused by pathogenic bacteria such as Escherichia coli, Staphylococcus or Streptococcus retrograde into epididymis through vas deferens. Therefore, this disease is mostly secondary to post-urethritis, prostatitis and seminal vesiculitis, or occurs after urethral instrument operation or long-term indwelling catheter, and it is more common to cause infected people in a retrograde way.

Clinically it can be divided into acute epididymitis and chronic epididymitis.

Acute epididymitis is more acute, manifested as scrotum discomfort on the affected side, severe local pain, and even affecting activities. Pain can radiate to the ipsilateral groin area and lower abdomen, accompanied by general malaise and high fever. Physical examination: swelling and tenderness of the affected epididymis. When the inflammation is serious, it can spread to the testicles, and the scrotum skin can be red and swollen.

Chronic epididymitis is more common than acute epididymitis, and some patients become chronic because they cannot be cured in the acute stage. Most patients have no history of acute attack and are often accompanied by chronic prostatitis. The clinical manifestations of the disease are varied, including scrotal pain and distension, and the pain can radiate to the lower abdomen and the inner thigh of the same side. Physical examination can touch epididymis with slight swelling, hardening, induration, local tenderness, ipsilateral ureteral thickening, and chronic epididymitis can often be acute.

What are the western medicine treatment methods for epididymitis?

Because epididymitis is divided into acute and chronic, the treatment is also focused. For acute epididymitis, patients are advised to stay in bed and hold up scrotum to relieve pain. In the early stage, an ice pack can be placed at the epididymis to prevent swelling. In the later stage, hot compress can be used to promote local blood supply and accelerate inflammation regression. Because it belongs to infection, it is necessary to carry out anti-infection treatment, and broad-spectrum antibiotics and antibiotics with better effect on gram-negative bacteria are often used in clinic. For pain, fever and other systemic symptoms, antipyretic and analgesic drugs should be used for symptomatic treatment. If the epididymal pain is severe, please ask a specialist to give 1% lidocaine 10 ~ 20ml to partially seal the spermatic cord from the upper end of the testis, which can relieve the pain and relieve the swelling pain. If the inflammatory mass of epididymis is enlarged, the scrotal skin is swollen and wavy, forming an abscess, and it must be cut and drained. If the disease is caused by indwelling catheter, the catheter should be removed. In addition, sexual impulse and heavy physical activity should be avoided in the acute phase, so as not to aggravate infection and symptoms. For a few stubborn patients, and the disease control is not ideal, epididymal and even testicular resection is feasible.

Because chronic epididymitis often coexists with chronic prostatitis, both diseases are treated at the same time.

(1) Pay attention to the rules of life, combine work and rest, and avoid the spicy stimulation of alcohol and tobacco.

(2) keep the stool unobstructed.

(3) Avoid sitting for a long time.

(4) Sexual life should not be too frequent.

(5) Sit bath with warm water twice a day, with the water temperature controlled at 42℃ ~ 50℃ for 20 ~ 30 minutes each time.

(6) ion permeation of berberine or neomycin.

If chronic epididymitis occurs repeatedly, epididymitis can be considered. It is worth noting that both acute and chronic epididymitis occur bilaterally, which may lead to infertility, so epididymitis should be treated in time.

Antibacterial therapy

(1) Pay attention to the rules of life, combine work and rest, and avoid the spicy stimulation of alcohol and tobacco.

(2) keep the stool unobstructed.

(3) Avoid sitting for a long time.

(4) Sexual life should not be too frequent.

(5) Sit bath with warm water twice a day, with the water temperature controlled at 42℃ ~ 50℃ for 20 ~ 30 minutes each time.

(6) ion permeation of berberine or neomycin.

If chronic epididymitis occurs repeatedly, epididymitis can be considered. It is worth noting that both acute and chronic epididymitis occur bilaterally, which may lead to infertility, so epididymitis should be treated in time.

Anti-inflammatory therapy

The best treatment for acute epididymitis is cephalosporins plus levofloxacin and other effective anti-inflammatory treatments. Treatment should be enough, usually two weeks. Your medical history is over three years. It may be that the epididymis left nodules after the first epididymitis, leading to repeated inflammation. If there are no symptoms, you can leave them untreated. If there are symptoms, you can surgically remove the nodules. Don't be afraid, the operation is small, the recovery is quick, and it has no effect on the body.

The best treatment for acute epididymitis is

1, anti-inflammatory treatment, cephalosporin can add levofloxacin.

2. If there are symptoms, the nodule can be removed by surgery.

I hope to accept.

Treat with antibiotics

Hello! First of all, I wish you a speedy recovery! Let me tell you something about epididymitis.

Epididymitis is the most common infectious disease of scrotum, which often occurs in young adults. Bacteria mostly spread from infected urine, prostate, posterior urethra and seminal vesicle to epididymis through vas deferens. Patients with prostate surgery and indwelling catheter are also prone to epididymitis, and urine flowing back to the vas deferens during urination can also lead to epididymitis. If children have recurrent epididymitis, the possibility of ureter opening to seminal vesicle should be considered. The common bacteria causing epididymitis are Escherichia coli, Staphylococcus, Mycobacterium tuberculosis, Neisseria gonorrhoeae and Chlamydia. Because epididymis is the place where sperm mature and store, it plays an important role in fertility. Bilateral epididymal lesions can lead to infertility.

Epididymitis can be divided into acute epididymitis and chronic epididymitis.

1) Acute epididymitis, scrotum swelling and pain, very sensitive to touch. Radiation to the groin and lower abdomen can increase the volume by 1 times in a few hours, and the number of white blood cells can increase to 20,000-30,000 /m3. The pain is aggravated when standing, often accompanied by high fever. When inflammation is serious, scrotal skin edema and redness can form abscess.

2) Chronic epididymitis is common in clinic, which can be turned into chronic if the acute treatment is not thorough, but most patients have no history of acute attack and are often accompanied by chronic prostatitis. Patients often feel pain in one scrotum and radiate to the groin. He has a history of irregular epididymal swelling and pain. The epididymis is slightly enlarged and hardened, with mild tenderness, but there is little obvious nodular feeling.

3) It differs from epididymal tuberculosis in that:

1. The vas deferens of epididymal tuberculosis are beaded;

2. Epididymal tuberculosis often adheres to the scrotal wall and even forms a sinus.

Epididymitis does not have these two characteristics.

The treatment of chronic epididymitis focuses on chronic prostatitis. Epididymitis surgery is generally not performed unless the patient has multiple acute attacks or suppurative epididymitis. For patients with recurrent abscess, epididymal resection is feasible, and if bilateral epididymis is removed, its fertility will not be preserved.

If the above answer is satisfactory. Please don't live up to my kindness and click "adopt as the answer" in time.

Anti-inflammatory treatment