Epididymo-orchitis

Section: Urology Curriculum: Curriculum, page 28

Definition

• Infection and inflammation of the testicle and epididymis

Epidemiology

• Generally 20-40 yr olds or elderly

Aetiology

• Bacterial
  • STI - ascending infection, any age
    • Commonly gonorrhoea or chlamydia
  • Coliforms with anal intercourse
  • UTI - older patients
    • E.coli, klebsiella, pseudomonas
  • Other causes - urethral instrumentation, TURP, biopsy, prostatism
• Viral
  • Mumps

Pathophysiology/pathogenesis

• Introduction of STI bacteria via UPSI with bacterial migration to the epididymis and testicle
• Retrograde urine flow (elderly) or stasis along the GU tract results in UTI bacterial infection
• Other - introduction of bacteria via biopsy/TURP secondary to prostatism

Clinical

• Testicular and cord pain with constitutional sx
• LUTS or STI sx
• Infective signs

Investigation

• Bloods - inflammatory markers and renal function
• Urine - PCR for STIs (FVU) and MSU culture for UTI (MSU)
• USS - suspicion of torsion or abscess
  • Orchitis - increased blood flow, thickened epididymis
  • Torsion - poor flow and normal size

Differential Diagnosis

• Torsion of testes or appendix
• Hernia
• Haematocoele/varicocoele
• Malignancy

Management

• Principles
  • Treat underlying infection
  • Supportive - analgesia, elevation, support, anti-inflammatories
  • Antibiotics - depends on cause and culture
    • STI - 1 shot Ceftriaxone and stat Azithromycin
    • UTI - Augmentin for 1 week
  • Referral to sexual health clinic and barrier advice
• Indications for admission
  • Cant take PO abx - intolerance etc, sepsis, abscess
• Surgery - abscess drainage and exploration to R/O torsion if dx uncertainty

Prognosis

• 50% testicular atrophy
• 10% impaired fertility
• Hydrocoele and abscess sequelae