Epididymo-orchitis

Uncontrolled pain can be relieved by surgical excision of the appendix.

Reduced activity and scrotal support (e.g. tight underwear or jock strap) are indicated.

NSAIDs and ice are the mainstays of therapy for inflammation.

Pain usually resolves within 1 week but may persist for several weeks.

Necrotic tissue of the testicular appendices causes no damage other than damage to itself. Most cases, therefore, are treated conservatively.

Treatment

Note!According to the current guidelines of the European Society for Paediatric Urology (ESPU) and the American Association of Pediatric Urologists (AAPU) torsion of the appendix testis can be managed conservatively (Level of evidence: 4; Grade of recommendation: C). During the six-week-follow-up, clinically and with ultrasound, no testicular atrophy was revealed.

Surgical exploration is done in equivocal cases and in patients with persistent pain.

Epididymo-orchitis - also known as or related to orchitis and epididymitis (disorder), inflammation of testis, epididymitis, orchitis, orchitis/epididymitis, non-specific orchitis.

Epididymitis means inflammation of the epididymis (the structure next to the testis that is involved in making sperm). Orchitis means inflammation of a testis (testicle).

As the epididymis and testis lie next to each other, it is often difficult to tell if the epididymis, the testis, or both are inflamed. Therefore the term epididymo-orchitis is often used (Image 8.6).

Image 8.6 Schema of epididymo-orchitis anatomy.

 

Epididymitis is the most common inflammatory process involving the scrotum and more common in adults.

Infections generally originate in the lower urinary tract from the bladder, urethra or prostate and are typically caused by urinary tract pathogens or sexually transmitted organisms (Chlamydia or gonorrrhhea).

Epididymitis also occurs in children, but is then due to infection with Streptococcus or Staphylococcus. In urinary tract abnormalities also infection with E.Coli is seen.

In prepubertal boys, the aetiology is usually unclear, with an underlying pathology of about 25%. A urine culture is usually negative, and unlike in older boys, a sexually transmitted disease is very rare.

A sterile chemical epididymitis can result from reflux of sterile urine through the ejaculatory ducts, for instance if the ureter inserts in the prostatic urethra, this may lead to increased pressure in the vas deferens. On the left a child with a meningocele who had epididymitis.

Due to increased bladder pressure and contractions against a closed sphincter, there was reflux not only into the left ureter and porstate, but also into the epididymis, which resulted in epididymitis.

Orchitis is characterized by focal, peripheral, hypoechoic testicular lesions that are poorly defined, amorphous, or crescent-shaped.

Orchitis also exhibits testicular hyperemia on color Doppler sonography images and is usually accompanied by epididymal hyperemia due to concomitant epididymitis. A reactive hydrocele is also frequently associated with epididymoorchitis. Focal testicular infarction can occur as a complication of epididymitis when swelling of the epididymis is severe enough to constrict the testicular blood supply. This appears as a hypoechoic intratesticular mass devoid of blood flow.