acute epididymitis
Introduction
Introduction to acute epididymitis Acute epididymitis is a non-specific infection of the epididymis and is the most common infectious disease in the scrotum. Mostly due to posterior urethritis, prostatitis and seminal vesiculitis caused by retrograde infection of the vas deferens, blood infection is rare. Pathogenic bacteria are more common in Escherichia coli and Staphylococcus, common in young and middle-aged, urethral stricture, improper use of instruments in the urethra, indwelling catheters after bladder and prostate, often cause epididymitis, followed by lymphatic pathway. Blood infections are the least common. basic knowledge The proportion of sickness: 0.1% - 0.5% Susceptible people: male Mode of infection: non-infectious Complications: abscess orchitis acute epididymitis chronic epididymitis
Cause
Acute epididymitis
Causes
Various pathogens can cause acute epididymitis, but the main two categories are: one is the pathogen causing sexually transmitted diseases urethritis, such as Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum; the other is the leather represented by Escherichia coli Blue-negative bacilli and a few Gram-positive cocci.
Pathogenesis
1. Acute epididymitis is prone to occur in the following clinical situations:
1 long-term indwelling catheter and intraurethral examination of the urethra can induce prostate infection, followed by acute epididymitis;
2 after prostatectomy, especially after transurethral resection of the prostate after urethra, urethral pressure can flow urine into the seminiferous tube;
3 patients had a history of scrotal injury before acute epididymitis.
2, epididymitis can occur on one side or both sides, more common on one side. Acute epididymitis often occurs from the tail of the epididymis. The epithelial epithelial edema, shedding, and purulent discharge appear in the lumen, and then infiltrate into the body and head of the epididymis through the interstitial, and can form a minute abscess. Late scar tissue forms occlusion of the epididymis, so bilateral epididymitis often causes infertility.
Prevention
Acute epididymitis prevention
Prevention of acute epididymitis should be thoroughly treated with urinary tract infection and prostatitis. If necessary, in order to prevent recurrent attacks, the ipsilateral vas deferens can be ligated.
Complication
Acute epididymitis complications Complications abscess orchitis acute epididymitis chronic epididymitis
If the treatment is timely, the lesion can disappear completely without damage, but the epididymis function may still be affected. If the treatment is not timely or the treatment is improper, the inflammation may develop an abscess, which may cause serious damage to the epididymis. In addition, epididymitis may be secondary. Fibrosis, leading to stenosis or occlusion of the epididymal duct, bilateral epididymal damage can often lead to male infertility or low fertility of the man, in the case of testicular involvement, can also cause testicular spermatogenesis dysfunction, epididymal abscess can be extended and Destruction of the testis (sigmoid orchitis), acute epididymitis can evolve into chronic epididymitis.
Symptom
Acute epididymitis symptoms common symptoms epididymal cyst leukocytosis chills abscess edema
Sudden onset, high fever, elevated white blood cells, painful scrotal pain on the affected side, feeling of sinking, pain in the lower abdomen and groin, increased when standing or walking. The affected side of the epididymis is swollen, with obvious tenderness. When the inflammation is large, the epididymis and testicles are swollen. The boundary between the two is unclear. The mouth is called epididymal orchitis. The spermatic cord on the affected side is thickened and tender. In general, acute symptoms can gradually subside after a week.
Examine
Acute epididymitis examination
Leukocytosis, nuclear shift to the left, urine culture can have pathogenic bacteria growth.
B-mode ultrasonography: visible diffuse uniformity of the epididymis can be increased, but also limited, the internal echo is uneven, the spot is thickened, the epididymis and testicular swelling and inflammation range can be displayed.
Diagnosis
Diagnosis and differentiation of acute epididymitis
Medical history
Including history of unclean sexual intercourse, history of sexually transmitted diseases, presence or absence of urethral stricture, benign prostatic hyperplasia and other diseases, as well as history of urology surgery, history of transurethral instrument operation.
symptom
Sudden onset, the scrotum of the scrotum swelled and discomfort, and the local pain was very heavy, affecting the action. Pain can be radiated to the ipsilateral spermatic cord, groin, and lower abdomen. At the same time, there is general discomfort and high fever. There may be urinary tract irritation.
Sign
At the time of examination, the epididymal swelling of the affected side was seen, there was obvious tenderness, and sometimes the boundary between the testis and the epididymis was unclear. When the inflammation is heavier, the scrotal skin is red and swollen. The ipsilateral spermatic cord is thicker and the tenderness is heavier. Sometimes accompanied by hydrocele and varicocele.
an examination
1. Laboratory examination: peripheral blood leukocytes can reach (2~3)×109/L. Urethral secretions can be stained or not stained. Urine analysis is also an important means of examination.
2, ultrasound examination: ultrasound examination is of great value in the diagnosis of acute epididymitis, especially differential diagnosis. In acute epididymitis, B-ultrasound shows diffuse uniform swelling of the epididymis; it can also be locally enlarged, more common in the tail, nodular, and spherical. The internal echo is uneven, the spot is thickened, the echo intensity is lower than the testicle, and the boundary is blurred. Some can adhere to the scrotum wall, the scrotum wall thickens, often accompanied by hydrocele. The ipsilateral spermatic cord is thickened and the varicocele is varicose veins. Color Doppler flow imaging (CDFI) showed a significant increase in blood flow signals, and pulsed Doppler (PD) detected arterial blood flow velocity.
Differential diagnosis
1. Testicular torsion: common in prepubertal children, less common in children over 30 years old, Prene sign positive, and acute epididymitis Prairie sign negative, radionuclide scan showed reduced blood perfusion on the torsion side, color Doppler reduced blood flow in the testis Or disappear.
2. Testicular tumor: a painless mass, hard texture, heavy sense, normal testicular morphology disappeared, epididymis is often difficult to sputum, negative light transmission test, B-ultrasound and CT can help diagnosis, blood AFP or HCG often increased.
3. Tuberculous epididymitis: generally there is little pain and fever, the boundary between the epididymis and the testis is clear, the mass is hard, the lesion often adheres to the scrotum wall or has abscess, the sinus is formed, the vas deferens may have bead-like changes, the prostate and The seminal vesicle also has tuberculosis lesions.
