Diagnosis of Epididymitis at the Early Stage

Author: John
Time: 2019/8/24 16:16:00

Early epididymitis is a cellulitis that begins in the ejaculatory duct and spreads to the tail of the epididymis. In the acute phase, the epididymis is swollen and hard, and the infection spreads from the rear of the epididymis to the head. On pathological sections, small abscesses can be seen, and the sheath often secretes serous fluid. The fluid may include pus, enlarged spermatic cord, secondary hyperemia, and swelling of the testis, but generally, there is no inflammation. 

Under optical microscopy, tissue edema, infiltration of neutrophils, plasma cells and lymphocytes were observed, followed by abscess formation, necrosis of epithelium, and complete absorption of inflammation. However, peritubular fibrosis of the epididymis often leads to lumen obstruction. If bilateral epididymitis is present, it can cause infertility. What can be done to diagnose early epididymitis?

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1. Symptoms

Epididymitis often occurs after heavy manual labor, such as lifting heavy objects, can also occur after intense sexual excitement. Injuries caused by transurethral instrumentation can lead to epididymitis. Epididymitis can also happen after prostatectomy, and it is often secondary to prostatitis.

Scrotal pain often occurs suddenly. It can radiate along the spermatic cord to the inguinal region and lumbosacral region. The pain is usually severe with apparent Tenderness. The swelling progresses quickly, and it can double the volume of epididymis within 3-4 hours. The body temperature can reach about 40 centigrade. Urinary secretions can appear, cystitis and turbidity of urine can be accompanied.

2. Signs

Tenderness, scrotal enlargement, local skin redness can be found In the inguinal region. If there is an abscess, your skin becomes dry and thinning and comfortable to fall off, abscesses can also burst by themselves. If the treatment is timely, the boundaries between the enlarged and stiffened epididymis and testis are clear. 

However, within a few hours, the testis and epididymis become a hard mass. The spermatic cord becomes thicker due to edema. A few days later, secondary hydrocele of the testicular sheath appears. Urethral secretions may be present. Acute or chronic prostatitis can be found by palpation of the prostate, and prostatic massage should not be done in the acute phase.

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3. Laboratory Inspection

Peripheral white blood cells can reach (2~3)*109/L. Urethral secretions can be examined by staining or non-staining tests. Urine analysis is also an essential means of examination.

4. Ultrasound examination

The swelling and inflammation of the epididymis and testis can be shown.

5. Magnetic resonance examination

Epididymitis is diffuse or focal. The signal of epididymis on T2-weighted image can be the same or higher than that of the testis.

If chronic epididymitis is not treated regularly, it is challenging to cure it only by body resistance. When the condition becomes severe, it may even cause the loss of epididymis function. The epididymis is the place where sperm matures and stores, thus affecting the environment of sperm survival, resulting in the decrease of sperm vitality, the increase of deformity rate and the reduction of semen quality.

1. General treatment: The general treatment of chronic epididymitis includes bed rest, lifting scrotum to alleviate the heavy feeling, physical activity, and sexual life should be avoided, and cold compress with ice bag in the early stage of onset is an excellent treatment.

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2. Antibacterial and analgesic treatment: Because epididymitis is mostly caused by a bacterial infection, chemical medicine often uses antibiotics sensitive to bacteria, such as cephalosporins, azithromycins, quinolones or tetracyclines, etc. If necessary, it will also be used combined with drug therapy. Antibiotics are mainly used to kill bacteria and promote the absorption of inflammation. 

But inevitably, long-term use will cause some side effects. Therefore, most patients will still take conservative treatment, such as Diuretic and Anti-inflammatory Pill, which is natural and has no side effects. It can cure the epididymitis thoroughly without relapse, and will not cause harm to the human body. Patients can take it safely for a long time.

3. Surgical treatment: In a few cases, surgical treatment is needed. If the symptoms do not improve or worsen after comprehensive treatment, the abscess of testis or scrotum wall needs incision and drainage to decompress. When the symptoms of ischemia and hypoxia are severe due to the spread of testis and epididymis inflammation, surgical treatment should also be considered.

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