Orchoepididymitis

Orchyoepididymitis (or epididymoorchitis) is a simultaneous combination of two separate infectious and inflammatory urological diseases that can provoke and develop each other. Orchitis is an inflammatory process in a man's testicles, epididymitis is an inflammation of the epididymis. It is usually quite difficult to differentiate whether only the testicle is inflamed or the process also affects the epididymis. As a rule, in the presence of epididymitis, the inflammation soon spreads to the testicles, while orchitis can be localized.

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Causes orchoepididymitis

The route of infection is often due to a sexually transmitted infection or hematogenous, that is, any source of infection in the body can be a predisposing factor for the development of orchiepididymitis.

Orchiepididymitis requires mandatory timely treatment, otherwise advanced inflammation leads to disruption of the testicles, and, consequently, to infertility caused by the fact that spermatozoa cease to be produced.

Depending on the location of the disease, it can be divided into right-sided orchiepididymitis, left-sided orchiepididymitis, and bilateral orchiepididymitis. Mostly, in the initial stage, the disease is still unilateral.

The most common causes of orchiepididymitis are viral infections leading to inflammatory processes (urethritis, prostatitis). In men under 35, this disease is most often caused by sexually transmitted bacteria, as complications of gonorrhea or trichomoniasis. In men over 35, the causative agents of orchiepididymitis are most often non-sexually transmitted, gram-negative intestinal microorganisms that cause urinary tract infections (cystitis, pyelonephritis). This may be combined with a history of suspected urination disorders. There are also cross-cases, so obtaining complete information about the patient's sexual relationships is a mandatory condition for diagnosis.

Orchyoepididymitis caused by sexually transmitted enterobacteria can occur in homosexuals who practice penetrative anal sex.

There is also traumatic orchiepididymitis or posttraumatic orchiepididymitis, which can be caused by a testicular injury (as a result of blows to the groin area or a fall on the perineum), with possible infection or the development of nonspecific inflammatory reactions - swelling, pain, increased blood flow in the area of injury.

Less common is tuberculous orchiepididymitis, which can be caused by a tuberculosis or viral infection.

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Risk factors

Factors that predispose to the development of the disease include: hypothermia of the legs and perineum, previous infectious diseases (flu, pneumonia, typhoid or mumps), complications after operations on the pelvic organs, scrotum or prostate gland, or catheterization.

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Symptoms orchoepididymitis

The disease usually begins acutely. The first signs of orchiepididymitis are a rise in temperature to 39-40 degrees, that is, intoxication is already in a fairly progressive form and acute pain in the scrotum on the corresponding side of the lesion. The peculiarity of orchiepididymitis is that the temperature may rise before pain appears. Also, visually, you can see a suspicion of orchiepididymitis if there is redness and swelling of the scrotum over the inflamed testicle, sometimes a symptom can also be leucorrhoea from the urethra or blood in the sperm.

Orchyoepididymitis in children

In boys under 15 years of age, orchiepididymitis is quite rare and is caused mainly by complications of viral mumps and rubella, or by abnormalities of the urinary tract.

In children, other problems (torsion of the spermatic cord or testicle) that require urgent surgical intervention are often hidden under the guise of orchiepididymitis. The diagnosis of "orchiepididymitis" is made only after excluding other diseases, which is possible after studying a carefully collected anamnesis and a full examination of the child.

The development of orchiepididymitis at this age is often caused by severe hypothermia of the legs and perineum, and as a consequence, there is a decrease in the blood supply to this part. Orchiepididymitis can also be caused by injuries or previous surgeries.

Forms

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Acute orchiepididymitis

The acute stage is characterized by severe pain in the groin, which after a few hours is localized in one half of the scrotum. The external manifestation will be redness of the scrotum, significant enlargement on one, the affected side, smoothing of the folds. Any, even the most insignificant, touch to the inflamed area is very painful. Signs of intoxication also appear - headache, nausea, weakness, high temperature.

Such inflammation, in the absence of necessary treatment, can last for about a week or two, and then either regress or become chronic. However, acute orchitis often abscesses and can be complicated by thrombosis of the testicle vessels and its necrosis.

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Chronic orchiepididymitis

At the chronic stage, the temperature usually normalizes, the pain is periodic and may intensify during sexual intercourse. During physical examination of the testicle, a painful lump is detected - an inflamed appendage.

Periods of chronic exacerbation are usually followed by short periods of remission, and exacerbations most often occur in early spring and autumn. The main problem with chronic orchiepididymitis is that the disease can spread to the other side of the testicle with appendages, which will affect spermatogenesis.

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Purulent orchyoepididymitis

In the worst case scenario, acute orchiepididymitis can provoke suppuration of the appendage or the testicle itself, resulting in a decrease in the patency of its duct and, consequently, a violation of spermatogenesis. With bilateral inflammation, it often leads to infertility. Therefore, until bilateral orchiepididymitis is diagnosed, the prognosis is favorable.

Complications and consequences

Regardless of the stage of the disease, qualified treatment of orchiepididymitis must be carried out as soon as possible after detection. Such inflammatory diseases can cause severe complications for the entire genitourinary system of a man. If the disease is not treated in a timely manner, suppuration may occur in the testicle or appendages or the inflammation may spread to the other side of the scrotum, which will ultimately lead to infertility. In addition, the possibility of sexual intercourse is limited, since complete rest is necessary for these organs, and arousal will be accompanied by severe pain.

The sooner qualified treatment begins, the greater the chances of a favorable outcome without surgical intervention. An advanced stage of orchiepididymitis, when the lesion has spread to both sides of the organs, can lead to serious disorders of the male reproductive function, and even to infertility!

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Diagnostics orchoepididymitis

To determine the diagnosis, if symptoms are present, after examination by a urologist, laboratory diagnostics are carried out, after which the nature of the infection is determined and the pathogen is identified, in order to prescribe appropriate treatment. In addition, an ultrasound examination of the scrotum organs is mandatory.

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Tests

• general blood test and three-glass urine test;
• collection of midstream urine to isolate bacterial culture.

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Instrumental diagnostics

• urethral smear or first portion of urine to detect urethritis (presence of excess PMNL);
• Patients with urethritis are examined for the presence of gram-negative intracellular diplococci to exclude the diagnosis of gonorrhea.
• the presence of mucopurulent/purulent discharge from the urethra also indicates urethritis;
• test for the presence of chlamydia bacteria.

Differential diagnosis

Orchyoepididymitis must be clearly differentiated from orchitis, epididymitis, strangulated inguinal hernia and suppurating spermatic cord cyst, since treatment in different cases is radically different.

It is of the utmost importance to immediately differentiate between orchiepididymitis and torsion of the spermatic cord, using all available information. Color Doppler ultrasound scanning can help with this diagnosis. Also, the elevated position of the scrotum in orchiepididymitis significantly reduces pain, whereas in torsion of the spermatic cord, on the contrary, it increases it.

Diagnosis of spermatic cord torsion is of utmost importance because this condition requires immediate surgery. All patients with similar symptoms are checked for spermatic cord torsion and ruled out first because the more time is lost, the less likely it is that the testicles can be saved.

Treatment orchoepididymitis

All patients with orchiepididymitis are given a trial of treatment before obtaining microbiological analysis. Antibiotic treatment of orchiepididymitis is based on the results of immediately performed tests, taking into account the patient's age, medical history, sexual relations, the fact of recent instrumentation or catheterization, and the presence of any known urinary tract anomaly in the patient.

The patient is recommended bed rest, scrotum elevation and support with a jockstrap or ice towel. Analgesics are prescribed, and nonsteroidal anti-inflammatory drugs are also possible.

In addition, treatment of the infectious disease that caused the inflammation is prescribed. To begin with, antibiotics of general use are prescribed (for example, Nitroxoline - taken in powder form, during meals, for adults - 100 mg 4 times a day, for 2 weeks), antibiotics of the quinolone/fluoroquinolone group (Ofloxacin or Pefloxacin), enzymes, absorbable drugs. Homeopathy and vitamins of group E are almost always prescribed, supporting and stimulating the immune system and accelerating recovery.

If chlamydia viruses are detected as the causative agent, therapy must also be supplemented by taking the drug doxycycline, 200 mg/day, duration of treatment is at least 2 weeks.

At the end of the acute process, local thermal procedures and physiotherapy (laser) are used. Troxevasin venotonic is also used for orchiepididymitis, for lubricating the scrotum between compresses. A diet is prescribed that excludes alcohol, spicy and fatty foods, and plenty of fluids.

Treatment of chronic epididymitis is the same as acute, but longer, with the use of therapeutic procedures, homeopathic and vitamin complexes.

If a purulent abscess develops, an urgent operation is performed to open and drain the testicle to cleanse it of pus. Otherwise, if this is delayed, the affected testicle will need to be removed so that the suppuration does not spread further.

If chlamydial or gonococcal orchiepididymitis is detected, all partners who have been in contact with the patient are also treated.

Most patients are shown the use of laser-magnetic effects on the affected organs. Magnetic therapy for orchiepididymitis reduces the duration of the acute phase of inflammation of the scrotum organs by 2-3 times and promotes faster restoration of testicular tissue.

Folk treatment of orchiepididymitis

The use of traditional methods of treatment is permissible only after their approval by the attending physician, and determination of the absence of allergy to any component.

The most common and effective method of traditional medicine is herbal treatment. For example, tea from tansy flowers, horsetail, lingonberry leaf. It is necessary to take an incomplete tablespoon of each of the herbs, pour boiling water (0.3 l) and leave for half an hour. Then strain, so as not to form a too tart concentrate and cool. Take 200 ml 3 times a day on an empty stomach.

Also take a collection of 1 teaspoon of anise, parsley, juniper, horsetail root, dandelion, bearberry leaves, poured with 0.5 liters of boiling water and infused for about half an hour. Then strain and take 250 ml in the morning and evening.

Also, with the permission of the attending physician, wax is used to treat orchiepididymitis. Namely, a homemade ointment is made from wax, vegetable oil, and egg yolk, which is capable of weakening purulent and inflammatory processes. To prepare it, you need to melt 20 grams of beeswax in a saucepan on a steam bath, and, stirring thoroughly, add a hard-boiled chicken yolk and 30 grams of vegetable oil. Cook this way for about 5 minutes and cool.

Another effective herbal mixture for home treatment includes 3 teaspoons of St. John's wort, mint, dried currant leaves, rose hips, 4 teaspoons of corn silk, lingonberry leaves, horsetail, 5 teaspoons of parsley and couch grass roots. Pour 1 liter of hot boiled water over the entire mixture and let it brew. Drink throughout the day.

Chewing honey with wax is useful - if there are no allergic reactions, chew 0.5 teaspoon of wax cappings at intervals of 45-50 minutes.

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Prevention

For prevention purposes, it is necessary to follow fairly simple rules:

• avoid casual and questionable sexual contacts, use contraception;
• undergo annual testing for STIs;
• observe the rules of personal hygiene;
• timely treatment of infectious diseases of the genitourinary system;
• carefully monitor your health during common infectious diseases, if you have suspicious symptoms, immediately contact a urologist;
• Avoid injuries to the pelvic area and hypothermia.

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Forecast

Usually, if you contact an experienced doctor in a timely manner, the prognosis is favorable, the disease is successfully treated. If you neglect it and the inflammation becomes purulent or, even worse, affects the other side of the scrotum, this can lead to the removal of the testicle and appendages, and, accordingly, the prognosis worsens. The probability of infertility with improper or untimely treatment of ochoepididymitis can reach 50%, and with a bilateral process - up to 100%.

Therefore, with orchiepididymitis, timely referral to an experienced specialist, correct diagnostics and early treatment are of great importance. Do not self-medicate under any circumstances, without notification and agreement with your doctor - the price for this is too high for your future.

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