Nonspecific epididymitis is caused by gram-negative bacilli and gram-positive cocci and can be classified into acute and chronic forms. Epididymal lesions caused by specific pathogens such as epididymal subcutaneous nodules, gonococcal infections, and filariasis are discussed in Chapter 81 of this book. Nonspecific epididymitis is more common in young and middle-aged adults as well as children, often secondary to urinary tract infections or prostatitis and seminal vesiculitis. The infection typically spreads retrogradely via the vas deferens, while hematogenous spread is rare. Acute epididymitis frequently occurs in patients undergoing prostatectomy, and bilateral vasectomy can be performed as a preventive measure.

bubble_chart Diagnosis

(1) Acute epididymitis

The onset is sudden, with obvious systemic symptoms, fatigue and lack of strength, possibly accompanied by high fever and shivering. The affected side of the scrotum shows significant swelling, fever, redness, and swelling, with thickening of the spermatic cord. Both the testis and spermatic cord exhibit marked tenderness and pain upon touch. It may also cause symptoms such as urgency and frequency of urination. Differential diagnosis is required with conditions like testicular torsion, subcutaneous node epididymitis, and acute gonococcal epididymitis.

(2) Chronic epididymitis

This is more common than the acute form. Some patients develop chronic epididymitis due to incomplete recovery during the acute phase, while many others have no history of acute episodes but develop chronic epididymitis, which is often secondary to prostatitis. Clinical manifestations often include sensations of scrotal pain, distension, and sagging, with pain radiating to the lower abdomen and the inner side of the ipsilateral thigh. Upon examination, swelling of the epididymal head and tail may be palpable, which may feel hard or nodular, with tenderness. The vas deferens may also appear thickened and tender. This condition needs to be differentiated from epididymal subcutaneous nodes and filariasis.

(1) Acute Epididymitis

Acute suppurative epididymitis is a serious condition that requires aggressive treatment to prevent infertility caused by obstruction due to epididymitis and the disruption of testosterone production. Absolute bed rest is necessary, with elevation of the scrotum and local cold compresses until the acute inflammation is under control. Pain relief can be achieved through spermatic cord block or by placing an ice pack on the scrotum. If there is high fever, bacteriuria, pyuria, prostatitis, or other evidence of bacterial infection, broad-spectrum antibiotics should be administered immediately. For example, cephalosporin IV 250mg orally four times daily, or ampicillin 1g every 6 hours, with a minimum course of 10 days. Depending on bacterial sensitivity, erythromycin 500mg every 6 hours or SMZ combination (with sulfonamide potentiator) 1g every 12 hours may be used. Sexual activity is prohibited. If there is no improvement after 5 days of antibiotic therapy, further investigation should be conducted for rare causes of epididymitis, such as subcutaneous nodules, fungal infections, gonorrhea, syphilis, or inflammatory carcinoma. If an abscess forms in the epididymis, incision and drainage or epididymectomy may be performed.

(2) Chronic Epididymitis

This condition often coexists with chronic prostatitis. Treatment may include local physiotherapy, antibiotic iontophoresis, or spermatic cord block therapy. For cases with severe local symptoms that are refractory to prolonged treatment, surgical removal of the epididymal mass, nodules, or the entire epididymis may be considered. Generally, the testis is unaffected, and orchiectomy is unnecessary.