The Epididymitis is the inflammation of the epididymis (epididymis), sometimes in conjunction with the inflammation of the testicle (orchitis Epididymo). Scrotal pain and swelling usually occur on one side. The diagnosis is made by physical examination. Treatment consists of antibiotics, analgesics, and the elevation of the testicle.
The Epididymitis is the inflammation of the epididymis (epididymis), sometimes in conjunction with the inflammation of the testicle (orchitis Epididymo). Scrotal pain and swelling usually occur on one side. The diagnosis is made by physical examination. Treatment consists of antibiotics, analgesics, and the elevation of the testicle. Bacterial etiology epididymitis Most Epididymitiden (and Epididymo-Orchitiden) are caused by bacteria. Subject inflammation and the vas deferens, creates a Vasitis. If all structures of the vas deferens are concerned, the diagnosis is Funikulitis. Occur rarely epididymal abscesses, scrotal extraepididymale abscesses, Pyocele (collection of pus in a hydrocele) or testicular infarction. In men <35 years, most cases are caused by sexually transmitted pathogens, v. a. Neisseria gonorrhoeae or Chlamydia trachomatis. An infection can begin as urethritis. In men> 35 years, most cases occur due to gram-negative coliforms and are typically used in patients with urological abnormalities, indwelling catheters or shortly after surgery. Tuberculous epididymitis and syphilitic Gumma come – except in immunocompromised patients in developed countries now rarely vor.Nichtbakterielle epididymitis Viral problem (such as cytomegalovirus infection.) And mycotic causes (for (for example, HIV-infected people.). B. actinomycosis, blastomycosis) of epididymitis are rare in developed countries, except for immunsupprimiertem patients. Epididymitiden and Epididymoorchitiden noninfectious etiology may be caused in the epididymis by chemical irritation due to a retrograde inflow of urine. This may (heavy lifting z. B.) or come to a local trauma to the Valsalva maneuver. Symptoms and complaints pain occurs in both bacterial and non-bacterial epididymitis. You can be strong and sometimes radiate to the abdomen. In a bacterial epididymitis patients may have fever, vomiting rare and often Harnwegsbefunde. A urethral discharges can occur with urethritis. Red .:. (Note d. Unlike the testicular pain symptoms slowly starts with epididymitis. As a rule, no nausea occurs with vomiting, and Prehn’s sign is positive [improvement of symptoms after lifting of the testis]. In the color duplex sonography there is a multi-to hyperperfusion of the epididymis.) the physical examination shows a swelling, induration, tenderness, and sometimes erythema a part or the entire affected epididymis and sometimes also of the associated testis. Fever, tachycardia, hypotension and a toxic appearance suggest a sepsis. Diagnosis Clinical evaluation Sometimes urethral swab and urine culture, the diagnosis of epididymitis is confirmed by swelling and tenderness of the epididymis. If the findings but not clearly speak for epididymitis, <30 years has to be thought of testicular torsion especially in patients. A color Doppler sonography is indicated when the cause is unknown and the disorder occurs repeatedly. (N. D. Talk .: But you will not pronounce on the surgical exposure, as a perfusion even in torsion, esp. Marginal can be shown.) Tips and risks in men with acute scrotal pain, testicular torsion must be excluded, be because the findings are clearly limited to the epididymis. Urethritis suggests that the cause of epididymitis is a sexually transmitted pathogens; therefore, a urethral swab for gonococcal or chlamydial culture or for PCR to the laboratory should be sent. In other cases, the infecting organisms can usually be identified by urine culture. Urinalysis and urine culture are normal in non-bacterial causes. Antibiotics Supportive measures Treatment of epididymitis is to bed rest; High storage and cooling of the scrotum (e.g., in an upright position with a "jock".) To intercept repetitive small bumps; in anti-inflammatory analgesics, as well as a broad-spectrum antibiotic such. As ciprofloxacin, 500 mg p.o. 2 times a day, or levofloxacin, 500 mg po 1 times daily for 21-30 days. Alternatively, doxycycline, 100 mg p.o. 2 times a day, or trimethoprim / sulfamethoxazole in double strength (160/800 mg) p.o. 2 times are given daily. If sepsis is threatening an aminoglycoside such can. B. Tobramycin (1 mg / kg iv every 8 h) (Red. N. D .: common is gentamicin) or a 3rd generation cephalosporin as ceftriaxone (1-2 grams / day iv) be helpful to the infectious agents and its sensitivity are known. Abscesses and pyocele usually require surgical relief. Recurrent bacterial Epididymitiden due to a chronic urethritis or prostatitis can be prevented by a vasectomy sometimes. A Epididymektomie, which is carried out occasionally for chronic epididymitis, however, can lead to the persistence of symptoms. Patients who must wear an indwelling catheter, are at risk of developing a recurrent epididymitis and epididymo. In such cases, the placement of a suprapubic cystostomy or directing the self-catheterization may be helpful. The treatment of nonbacterial epididymitis meets the general measures mentioned above, however, antibiotic therapy is not necessary. The nerve block of the spermatic cord structure with a local anesthetic may relieve symptoms in severe, persistent cases. Conclusion The most common causes of epididymitis are bacteria: Neisseria gonorrhoeaeund Chlamydia trachomatis in young men and young and gram negative coliforms in older men. Sensitivity relates to the epididymis and often the testicles. The epididymitis is clinically diagnosed and testicular torsion must go through clinical findings or, if necessary, be excluded by color Doppler sonography. In most cases, antibiotics are given (z. B. for outpatient treatment, a fluoroquinolone, doxycycline, or trimethoprim / sulfamethoxazole) and treats the pain.