| Epididymitis Classification and external resources |
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| 1: Epididymis 2: Head of epididymis 3: Lobules of epididymis 4: Body of epididymis 5: Tail of epididymis 6: Duct of epididymis 7: Deferent duct (ductus deferens or vas deferens) |
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| ICD-10 | N45.0 |
| ICD-9 | 604 |
| DiseasesDB | 4342 |
| eMedicine | med/704 radio/261 emerg/166 |
| MeSH | D004823 |
Epididymitis is a medical condition in which there is inflammation of the epididymis (a curved structure at the back of the testicle in which sperm matures and is stored). The vas deferens (plural vasa deferentia also called ductus deferens, ( Latin: "carrying-away vessel" is part of the Male Anatomy The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens The epididymis is part of the Human Male Reproductive system and is present in all male Mammals It is a narrow tightly-coiled Tube The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male The term sperm is derived from the Greek word (σπέρμα sperma (meaning "seed" and refers to the male reproductive cells. This condition may be mildly to very painful, and the scrotum (sac containing the testicles) may become red, warm and swollen. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm In some Male Mammals the scrotum - also 'scrutum' or 'scrootum' - is a protuberance of Skin and Muscle containing the Testicles It may be acute (of sudden onset) or rarely chronic.
Epididymitis is the most frequent cause of sudden scrotal pain. In contrast with men who have testicular torsion, the cremaster reflex (elevation of the testicle in respons to stroking the upper inner thigh) is not altered. In testicular torsion the Spermatic cord that provides the blood supply to a Testicle is twisted cutting off the blood supply often causing Orchalgia. The cremasteric reflex is a cutaneous Reflex observed If the diagnosis is not entirely clear from the patient's history and physical examination, a Doppler ultrasound scan can confirm increased flow of blood to the affected epididymis. The medical history or Anamnesis of a Patient is information gained by a Physician or other healthcare professional by asking specific questions Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs
Infection is the most common cause. An infection is the detrimental Colonization of a host Organism by a foreign Species. In sexually active men, Chlamydia trachomatis is the most frequent causative microbe, followed by E. coli and Neisseria gonorrhoeae. Chlamydia trachomatis, an obligate intracellular human pathogen is one of three bacterial species in the genus Chlamydia, family Chlamydiaceae Neisseria gonorrhoeae, also known as Gonococci (plural or Gonococcus (singular is a species of Gram-negative kidney bean-shaped Diplococci In children, it may follow an infection in another part of the body (for example, a viral illness), or there may be an associated urinary tract anomaly. The urinary system (also called Excretory system or the genitourinary system (GUS is the Organ system that produces stores and eliminates Urine. Another cause is sterile reflux of urine through the ejaculatory ducts. The Ejaculatory ducts ( ductus ejaculatorii) are paired structures in male Anatomy, about 2 cm in length Antibiotics may be needed to control a component of infection. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa An infection is the detrimental Colonization of a host Organism by a foreign Species. Treatment otherwise comprises pain killers or anti-inflammatory drugs and bed rest if necessary, and symptom control by resting the scrotum in a supported position. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Bed rest is a Doctor's prescription to spend a longer period of time in bed
Contents |
Diagnosis
Epididymitis can be hard to distinguish from testicular torsion. In testicular torsion the Spermatic cord that provides the blood supply to a Testicle is twisted cutting off the blood supply often causing Orchalgia. Both can occur at the same time. A urologist may need to be consulted. Urology is the branch of Surgery that focuses on the Urinary tracts of males and females and on the reproductive system of males
Epididymitis usually has a gradual onset. On physical examination, the testicle is usually found to be in its normal vertical position, of equal size compared to its counterpart, and not high-riding. Physical examination or clinical examination is the process by which a Health care provider investigates the body of a Patient for signs Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The cremasteric reflex (if it was normal before) remains normal. The cremasteric reflex is a cutaneous Reflex observed This is a useful sign to distinguish it from testicular torsion. In testicular torsion the Spermatic cord that provides the blood supply to a Testicle is twisted cutting off the blood supply often causing Orchalgia. If there is pain relieved by elevation of the testicle, this is called Prehn's sign, which is however non-specific. Prehn's sign is a medical diagnostic indicator that helps determine whether the presenting injured Testicle is caused by acute Epididymitis or from testicular
Analysis of the urine may or may not be normal. A urinalysis (or "UA" is an array of tests performed on Urine and one of the most common methods of Medical Diagnosis. Before the advent of sophisticated medical imaging techniques, surgical exploration was the standard of care. Medical imaging refers to the techniques and processes used to create Images of the human body (or parts thereof for clinical purposes ( Medical procedures seeking to Nowadays, color Doppler ultrasound is the preferred test. It can demonstrated increased blood flow (also compared to the normal side), as opposed to testicular torsion. Nuclear testicular blood flow testing is rarely used. Nuclear medicine is a branch of Medicine and Medical imaging that uses the nuclear properties of matter in diagnosis and therapy
Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for sexually transmitted diseases may be done. A sexually transmitted disease ( STD) or venereal disease ( VD) is an illness that has a significant probability of transmission between Humans These may include microscopy and culture of a first void urine sample, Gram stain and culture of fluid or a swab from the urethra, nuclear acid amplification tests (to amplify and detect microbial DNA or other nucleic acids) or tests for syphillis and HIV. Microscopy is the technical field of using microscopes to view samples or objects A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory Gram staining (or Gram's method) is an empirical method of differentiating bacterial species into two large groups ( Gram-positive and In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of Deoxyribonucleic acid ( DNA) is a Nucleic acid that contains the genetic instructions used in the development and functioning of all known A nucleic acid is a Macromolecule composed of chains of monomeric Nucleotides In Biochemistry these Molecules carry Genetic information Syphilis is a Sexually transmitted disease caused by the spirochetal Bacterium Treponema pallidum pallidum. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome
Causes
Infection is the most common cause of epididymitis. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of The urinary system (also called Excretory system or the genitourinary system (GUS is the Organ system that produces stores and eliminates Urine. The reproductive system is a system of organs within an Organism which work together for the purpose of Reproduction. There can be associated urethritis (inflammation of the urethra). Urethritis is inflammation of the Urethra. The main symptom is Dysuria, which is painful or difficult urination Rarely, the infection reaches the epididymis via the bloodstream.
In sexually active men, Chlamydia trachomatis is responsible for two-thirds of cases, followed by Neisseria gonorrhoeae and E. coli (or other bacteria that cause urinary tract infection). Chlamydia trachomatis, an obligate intracellular human pathogen is one of three bacterial species in the genus Chlamydia, family Chlamydiaceae Neisseria gonorrhoeae, also known as Gonococci (plural or Gonococcus (singular is a species of Gram-negative kidney bean-shaped Diplococci A urinary tract infection ( UTI) is a bacterial Infection that affects any part of the Urinary tract. Less common microbes include Ureaplasma, Mycobacterium, and cytomegalovirus, or Cryptococcus in patients with HIV infection. Ureaplasma urealyticum is a Bacterium belonging to the family Mycoplasmataceae. Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae Cytomegalovirus (CMV (from the Greek cyto-, "cell" and -megalo-, "large" is a viral Cryptococcus (literally "Hidden Seed" is a Genus of Fungus. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome E. coli is more common in boys before puberty, the elderly and homosexual men. Old age consists of ages nearing or surpassing the Average life span of Human beings and thus the end of the human life cycle. Homosexuality refers to sexual behavior with or attraction to people of the same sex or to a Homosexual orientation.
Non-infectious causes are also possible. Reflux of sterile urine (urine without bacteria) through the ejaculatory ducts may cause inflammation with obstruction. The Ejaculatory ducts ( ductus ejaculatorii) are paired structures in male Anatomy, about 2 cm in length In children, it may be a response following an infection with enterovirus, adenovirus or Mycoplasma pneumoniae. The enteroviruses are a genus of (+ssRNA viruses associated with several human and mammalian diseases Adenoviruses are medium-sized (90–100 nm) Nonenveloped (naked Icosahedral viruses composed of a nucleocapsid and a double-stranded linear DNA Mycoplasma pneumoniae is a very small Bacterium in the class Mollicutes.
Epididymitis can also be caused by genito-urinary surgery, including prostatectomy and urinary catheterization. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental A prostatectomy is the Surgical removal of all or part of the Prostate gland. In urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their Congestive epididymitis is a long-term complication of vasectomy. Post-Vasectomy Pain Syndrome ( PVPS, PVP, CPTP, CPVSP) is a long-term Chronic pain condition that affects between 5% to 33% of Vasectomy is a surgical procedure in which the vasa deferentia of a man are cut for the purpose of sterilization. [1][2] Chemical epididymitis may also result from drugs such as amiodarone. Amiodarone is an Antiarrhythmic agent (medication used for irregular heart beat used for various types of tachyarrhythmias (fast forms of irregular heart beat both ventricular [3]
Complications
Most cases with adequate treatment develop no complications and don't result in infertility. Untreated, acute epididymitis can lead to a variety of complications. These include chronic epididymitis, abscess, permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process The epididymis is part of the Human Male Reproductive system and is present in all male Mammals It is a narrow tightly-coiled Tube The testicle (from Latin testiculus, diminutive of testis, meaning "witness" virility plural testes) is the male Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. Hypogonadism is a medical term for a defect of the Reproductive system that results in lack of function of the Gonads ( ovaries or testes) An infection is the detrimental Colonization of a host Organism by a foreign Species. In Biology, an organ ( Latin: organum, "instrument tool" from Greek όργανον - organon "organ instrument
Treatment
Antibiotics are used if an infection is suspected. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Fluoroquinolones are an option, although resistance of N. gonorrhoeae may limit their use. The quinolones are a family of synthetic Broad-spectrum antibiotics. Neisseria gonorrhoeae, also known as Gonococci (plural or Gonococcus (singular is a species of Gram-negative kidney bean-shaped Diplococci A cephalosporin (such as ceftriaxone) combined with doxycycline is an alternative. The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. Doxycycline ( INN) (ˌdɒksɪˈsaɪkliːn is a member of the Tetracycline antibiotics group and is commonly used to treat a variety of Infections Doxycycline Azithromycin can be used for susceptible strains. Azithromycin is an Azalide, a subclass of Macrolide Antibiotics. In children, quinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children, co-trimoxazole or suited penicillins (for example, cephalexin) can be used. Co-trimoxazole (abbreviated SXT TMP-SMX TMP-SMZ or TMP-sulfa is an Sulphonamide, Antibacterial combination of Trimethoprim and Sulfamethoxazole Penicillin (sometimes abbreviated PCN or pen) is a group of Beta-lactam antibiotics used in the treatment of Bacterial Infections Cefalexin ( INN) (sɛfəˈlɛksɨn/ /kɛfə- or cephalexin ( USAN) is a first-generation Cephalosporin Antibiotic. If there is a sexually transmitted disease, the partner should also be treated.
Household remedies such as elevation of the scrotum and cold compresses applied regularly to the scrotum may relieve the pain. In some Male Mammals the scrotum - also 'scrutum' or 'scrootum' - is a protuberance of Skin and Muscle containing the Testicles In some Male Mammals the scrotum - also 'scrutum' or 'scrootum' - is a protuberance of Skin and Muscle containing the Testicles Painkillers or anti-inflammatory drugs are often necessary. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Hospitalisation is indicated for severe cases, and check-ups can ensure the infection has cleared up. An infection is the detrimental Colonization of a host Organism by a foreign Species. Surgery is rarely necessary, for example in those rare instances where an abscess forms. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process
Epidemiology
Chronic epididymitis
Chronic epididymitis is epididymitis which ensues for more than six weeks. Chronic epididymitis is characterised by inflammation even when there is no infection present. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens An infection is the detrimental Colonization of a host Organism by a foreign Species. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain. These include testicular cancer, enlarged scrotal veins (varicocele) or a cyst within the epididymis. Testicular cancer is Cancer that develops in the Testicles a part of the Male reproductive system Varicocele is an abnormal enlargement of the Veins in the Scrotum draining the Testicles. A cyst is a closed sac having a distinct membrane and Division on the nearby tissue. The epididymis is part of the Human Male Reproductive system and is present in all male Mammals It is a narrow tightly-coiled Tube As well, the nerves in the scrotal area are connected to those of the abdomen, sometimes causing pain similar to a hernia (see referred pain). A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury's origin This condition can develop even without the presence of the previously described known causes.
Typically, a second, longer round of treatment is used. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. Hypersensitivity (also called hypersensitivity reaction refers to undesirable (damaging discomfort-producing and sometimes fatal reactions produced by the normal immune system A procedure called a cord block is a last measure. This consists of an injection into the nerve that traces along the epididymis. The injection is a compound of several medications including a steroid, pain killers, and a high dose of an anti-inflammatory. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects This treatment can quell the pain for 2-3 months in ideal conditions. Some patients may only experience an even shorter duration of 2-3 days, while the fortunate ones in rare occasions are never bothered again. This procedure would of course have to be repeated when necessary, until the problem goes away completely, or until the routine is simply too bothersome. As a last resort, a patient may then decide to have the epididymis completely removed.
Epididymitis in bulls
Epididymitis can be a concern in cattle herds. Bulls with epididymitis can spread bacteria to other cattle when they mount them. The cattle with epididymitis can often be detected early by the presence of white blood cells in their semen. In later stages, it can be detected by the swelling and hardening of the epididymis of the bull.
References
- ^ Schwingl PJ, Guess HA (2000). "Safety and effectiveness of vasectomy". Fertil. Steril. 73 (5): 923–36. doi:. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 10785217.
- ^ Raspa RF (1993). "Complications of vasectomy". American family physician 48 (7): 1264–8. PMID 8237740.
- ^ Ibsen HH, Frandsen F, Brandrup F, Møller M (August 1989). "Epididymitis caused by treatment with amiodarone". Genitourin Med 65 (4): 257–8. PMID 2807285. Full text at PMC: 1194364
Further reading
- Galejs LE (February 1999). PubMed Central is a free digital database of full-text Scientific literature in biomedical and life sciences "Diagnosis and treatment of the acute scrotum". Am Fam Physician 59 (4): 817–24. PMID 10068706.
- Nickel JC (2003). "Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma". Rev Urol 5 (4): 209–15. PMID 16985840. Full text at PMC: 1553215
External links
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