Urology Book

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Epididymitis

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  1. Pathophysiology
    1. Ascending infection up vas from prostatic urethra
  2. Etiology
    1. Prepubertal boys and men over age 35 years
      1. Bacterial Urinary Tract Infection
    2. Postpubertal males under age 35 years
      1. Neisseria gonorrhoeae
      2. Chlamydia trachomatis
  3. Differential Diagnosis
    1. Testicular Torsion
    2. Torsion of Testicular Appendage
    3. Chronic Testicle inflammation from Tuberculosis
  4. Symptoms
    1. Gradual onset Scrotal Pain
    2. Fever
    3. Urethral discharge
    4. Urinary symptoms
  5. Signs
    1. Epididymis sensitive to palpation
    2. Epididymis enlarged and indurated
    3. Scrotal erythema
    4. Cremasteric Reflex present
      1. Absent in Testicular Torsion
    5. Prehn's sign Positive
      1. Elevation of scrotum relieves pain
      2. Does not offer relief in Testicular Torsion
  6. Labs
    1. Urinalysis
      1. Pyuria almost uniformly present
    2. Urethral Gram Stain and culture
      1. Directs treatment
    3. Sexually Transmitted Disease testing
      1. Gonorrhea
      2. Chlamydia
  7. Management
    1. General measures
      1. Bed rest
      2. Scrotal elevation/support
      3. Local Ice Therapy
      4. NSAIDs
    2. Gonorrhea and Chlamydia Treatment
      1. Rocephin 250 mg IM for 1 dose
      2. Zithromax 1g PO for 1 dose
    3. Urinary tract source
      1. Cipro 500 mg PO bid for 10-14 days
  8. Follow-up Evaluation
    1. Complete Urologic evaluation indications
      1. Child with epididymitis
        1. Structural or functional urinary abnormality in 39%
      2. Adult with non-STD epididymitis
  9. Prognosis
    1. Inflammation and pain resolve over 2-4 weeks
  10. Complications
    1. Chronic epididymitis
      1. Severe acute epididymitis
      2. Followed by frequent mild repeat attacks
    2. Fibroplasia
      1. Scarring of epidymis
      2. Patient feels "lump" in scrotum

Epididymitis (C0014534)

Definition (MSH)Inflammation of the EPIDIDYMIS. Its clinical features include enlarged epididymis, a swollen SCROTUM; PAIN; PYURIA; and FEVER. It is usually related to infections in the URINARY TRACT, which likely spread to the EPIDIDYMIS through either the VAS DEFERENS or the lymphatics of the SPERMATIC CORD.
Definition (CSP)inflammation of the epididymis, convoluted cordlike structure attached to the posterior of the testis.
ConceptsDisease or Syndrome (T047)
MSHD004823
EnglishEpididymitides, Epididymitis, Epididymitis unspecified
Spanishepididimitis, epididimitis no especificada
Parent ConceptsDisorder of male reproductive system (C0236099), MALE GENITAL ABNORMALITIES (C0549618), Epididymis disorders (C0700113), Genital Diseases, Male (C0017412), Epididymitis (C0014534), Inflammatory disorder of male genital organ (C0477765), Inflammation of specific body organs (C1285331), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, CST, DXP, MSH, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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