Paediatrics Urology Unit
Prostate Growth And Greenlight Method
Premature Ejaculation (Early-Fast-Rapid Ejaculation)
Penile Prosthesis İmplantation
Sexually Transmitted Diseases (Venereal Diseases)
Testicle And Epididymis İnfection
• Assoc. Prof. Ömer ÖGE, MD
• Işık H. ÖZGÜ, MD
• Uğur SARAÇOĞLU, MD
TESTICLE AND EPIDIDYMIS INFECTION
Testes are the organs where male reproductive cell sperm is produced and male hormone testosterone is secreted. After sperm is formed in testis, it is developed with the help of accessory organs and it gains mobility capability and becomes functional. The most important one of these organs is epididiymis. Epididiymis is comprised of thin microscopic tubes in case wrapped intensively at the back of testis and is an accessory organ extended along testis just behind the testis. While sperm is progressing along epididiymis, it becomes ripe and it gains automatic capability of mobility.
Infection of epididiymis is called "epididiymitis" and infection of testis is called "orchitis". Infection of these two organs can be rapidly treated with a suitable antibiotic therapy but these are infections required early diagnosis and treatment due to potential complications such as infertility. Infection has two different types as acute and chronic. Acute infection occurs rapidly and generally retains both two organs and responds to treatment well. Chronic infection is a case with no complete inexplicable cause, characterized by recurrent attacked on general terms, occurred following a severe acute infection.
In acute epididiymitis, infection is in lower pole of epididiymis in the beginning cycle and then it progresses rapidly and then whole epididiymis and testis and therefore, the disease are called "epididimorchitis" or "orchitisepididiymitis".
Infections occur with severe symptoms starting suddenly and rapidly retrieve with a suitable treatment. It is mostly adult age period disease but it can be also encountered in children.
What are the causes of acute epididiymitis?
Bacteria frequently cause infection. Bacteria can reach epididymis from different ways.
In childhood period, bacteria generally reach from infection existing in bladder or kidney to epididymis and testis. Especially children younger than 1 year of age have frequently inborn urinary system anomaly (vesicoureteral reflux etc.), thus, bacteria origin kidney and bladder infection may reveal infection more easily in these children. Also it may be seen in children having undergone operation relating to urinary system and carrying urinary soda. In the children not having reached puberty age, the causes of most of the epididymitis are not known and it has been reported that microorganisms such as Haemophilus influenzae type B, salmonella, mumps and chlamydia may be factors.
Infection way of bacteria in sexually active males is urethra. Bacteria such as sexually transmitted gonorrhoea and chlamydia retaining urethra are the most frequently seen disease factors. Orchitisepididimitis may develop following urethra infection symptoms in burning while urinating and discharge. Sometimes bacteria may also reach directly epididym and testis without causing urethra infection. In homosexual men, bacteria originated bacteria and microorganism infection called Haemophilus influenzae can be the source of infection depending on anal intercourse.
Bacteria not sexually transmitted in men over 35 years of age but causing urinary tract infection or prostate inflammation are the disease factors.
Bacteria causing infection may reach epididym via blood way and typical example of this is tuberculosis epididmitis seen in tuberculosis patients.
Orchitepididimitis may developed with those with anatomic disorders in lower urinary tracts such has benign enlarged prostate and urethra stenosis or those having undergone operations or interventions on these areas and those carrying catheter.
Epididimorchitis may develop depending on viruses in AIDS patients or those using drugs suppressing immune system.
The drug called amiodarone used in the treatment of arrhythmia may cause chemical epididymitis by being accumulated in head section of epididym.
Chemical epididymitis may developed with back flow to epididym from urinary tracts of sterile urine during pressure increase occurred with heavy lifting.
Epididymitis may develop after excessive sexual excitement.
Cause of the disease may not be known in some of the patients.
What are the symptoms of Acute epididymitis?
The first symptom is blunt nature very severe pain in epididym and testis. Pain starts at the back of testis and then spreads to whole testis. Then, it starts to spread to groin and while patients are standing and walking, they need to lift their testis for mitigating the pain. Before emergence of this symptom, infection symptoms in another place in urinary tract may have emerged likely to be the source of previous infection. These are urethra-induced discharge in sexually transmitted urethritis, burning and itching in urethra, bladder infection (cystitis) groin pain, frequent urination, painful urination, urinary urgency feeling and prostate infection (prostatitis), fever, anus pain, frequent urination, urgent urination feeling and painful urination, kidney infection (pyelonephritis) flank pain and high fever. The disease may start from epididym without other infection symptoms mentioned herein in some patients.
Other important symptom is swelling in the bag. This occurs rapidly and the organ can reach two-three folds size within 3-4 hours. Bags become red and touch become sensitive and temperature occur on the skin. There might be a slight fever rise and chill-quiver seizure may develop together with fever rising up to 40 C°.
Tuberculosis epididymitis is usually painless and is not with fever and epididymitis symptoms depending on chemical epididymitis and amiodarona is lighter.
How Acute Epididymitis disease is diagnosed?
The physician gets acquainted with medical story of the patient and conducts a physical examination. Diagnosis of the patient may be placed with examination and investigation at ease. In case of doubt of infection relating to urinary tracts, urinary analysis and urinary culture are conducted and if there is discharge from urethra, sample is obtained and is examined in terms of presence of bacteria. In case of especially doubt of testis torsion, separating diagnosis is resorted with colour Doppler ultrasound or testis scintigraphy. Treatment of testis torsion is totally different from epididymitisorchitis; operation may be required in the phenomena with no separating diagnosis conducted; for this reason, in case of doubt, conducting required studies is of utmost importance.
How Acute Epididymitis disease is treated?
The treatment varies according to the age of the patient and type of microorganism. Antibiotics received orally with 3 weeks are administered in the cases contemplated to be caused by microorganism sexually transmitted and in young and middle age adults. The patients with life threatening findings based on sepsis, whose immune system has been suppressed or with diabetes should be hospitalized and after findings decline, it should be discharged after 48 hours.
In addition to antibiotic treatment, bed resting, early cycle ice bag application, painkillers and anti-inflammatory drugs use may be requested. Local warm application may help recovery to the bags in 5th-7th days following acute period. Recovery is slow and disappearance of symptoms may last 2 weeks and normalization of epididym may last 4 weeks.
Tuberculosis epididymitis is attempted to be treated with anti-tuberculosis drugs; if organ damage is substantial, testis and epididym may be required to be removed with operation. Recovery period in those with no operation is very long; symptoms may not disappear totally and contraction in testis may occur. Dose reduction in infections based on amidoarone or cutting off drug may diminish symptoms and another specific treatment is not in question. Chemical epididymitis will automatically decline.
What are the complications of Acute epididymitis?
Complication development possibility is very low when early diagnosis is placed in infection in early period and suitable treatment is applied. Microorganism may spread to the body through blood means and then sepsis may develop. When it spreads to other testis, the disease retains both two testicles and this causes infertility. Following single sided acute infection seizure, even rarely, clogging in sperm carrying canals in epididym and reduction in sperm count in semen may occur. In this case, most of the patients may have a child since other testis is not affected. Insufficiency is not witnessed in secretion of male hormone of the testis. The disease may get chronic and abscess. In case of abscess, it is discharged with surgical intervention. Abscess gets opened to the skin automatically and become fistula in those not having intervened on time. The disease does not cause cancer.
What are the protection means from acute epididymitis?
It is important to recommend using a condom for being protected from sexually transmitted diseases and in case of an emergence of a disease- even if there is no complaint or finding - the partner should be treated. The other underlying urinary tract infections causing the disease should be appropriately treated and such epididymitis is not infected to your sexual partner and therefore, couple treatment is not required. Vasectomy is performed for the patients having recurrent acute seizures.
Acute Orchitis Causes, Symptoms, Treatment
Although Acute Orchitis is an infection accompanying epididymitis infection, the cases not causing infection in epididym retaining only testis are in question.
Testis vascularisation is a rich organ; for this reason, bacteria reach the organ via blood means in systemic infections and causes acute infection. The most common two microorganisms are Brucellosis mumps virus. Also even if very rarely, orchitis may emerge after bacteria mix with blood when there is bacteria originated infection is in question in another place of the body. Symptoms are like that of acute epididymitisorchitis.
The mumps infection occurred in puberty period and young adults are the most common cause of acute orchitis. This is very rare in those having undergone the mumps before 10 years of age and orchitis may develop in those having undergone the mumps over 10 years of age. In addition to this, orchitis may develop in adult men with the mumps vaccine. Epididymitis is not added to this portrait in this type of infection and only testis is retained. Symptoms are like that of acute epididymitisorchitis. Orchitis is added to the portrait after 3-4 day of swelling of parotid glands. With 10 % probability, both two testis may be retained at the same time. In this case, infertility may develop in one of three patients. Function of testis secreting male hormone is not disrupted. Vaccine is made on 18th month after birth for being protected from the mumps orchitis. Application of the mumps hyperimmunglobuline reduces the possibility of orchitis in very early period of the mumps. (where parotid glands get swollen, orchitis symptoms do not arise).
Antibiotics are administered in infections caused by bacteria. Antibiotics will not help in the mumps orchitis.
Painkiller, antipyretic and anti-inflammatory drugs may be administered for pain fever and swelling. Also bed resting, suspensory and heating application will do good.
Chronic Epididymitis Causes, Symptoms, Treatment and Complications
This is a case where a full recovery is not possible and there are irreparable changes in epididym, characterized by generally frequent light epididymitis seizures followed by severe acute epididymitis.
It does not give symptoms rather than acute exacerbations. Pain is not very severe in acute exacerbations, there is a little swelling and hardness in the bags and fever does not rise. Epididym gets thick in physical examination and gets bigger in small amount.
If it is detected that chronic epididymitis exacerbation is caused by a bacterial urinary tract infection, antibiotics should be administered. Vasectomy should be performed to the affected side for sometimes preventing seizures or epididymitis or seminal duct should be surgically removed with the operation.
If chronic epididymitis is two sided, infertility may develop depending on clogging formed in sperm canals.
The disease is not very important except for recurrent pain and infertility and does not cause cancer.