Orchitis

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Classification according to ICD-10
N45 Orchitis and epididymitis
B26.0 Mumps orchitis
ICD-10 online (WHO version 2019)

The term orchitis refers to inflammation of the testicle . This is very sensitive to pressure and touch. The causes are in particular ascending bacterial, but in some cases also viral infections (e.g. mumps orchitis). Orchitis is a possible cause of infertility . The therapy is symptomatic, antibiotics can be used in appropriate cases. In the differential diagnosis, testicular torsion and epididymitis (inflammation of the epididymis ) must be differentiated.

causes

Already in 1834 Johann Lukas Schönlein differentiated according to its cause the "simple orchitis" (including the traumatic form) from orchitis rheumatica, orchitis erysipelacea, tripper- related orchitis and arthritic inflammation of the testicle.

Today the main cause is assumed to be infections ascending through the deferens duct in the case of pre-existing urethritis or prostatitis . Frequent pathogens are staphylococci , E. coli , streptococci , Proteus and Neisseria . Rarely, especially in the tuberculous and viral forms (e.g. mumps orchitis caused by the mumps virus ), the hematogenous (via the blood) path of infection is obvious. In addition, granulomatous orchitis, which occurs in older men and is believed to be an autoimmune disease , and syphilis orchitis deserve mention.

In Ireland, according to a study in BJU International (2010; 105: 1060-1065), there has been an increase in orchitis cases in teenagers and young adults.

Due to a later withdrawn study in the late 1990s that linked MMR vaccination with later diagnoses of autism and inflammatory bowel disease, many parents - increasingly in England and Ireland - did not have their children vaccinated. The unvaccinated children are now (as of 2010) reaching puberty and are therefore exposed to increased complications if they contract measles , mumps or rubella as part of one of the rare but possible epidemics .

It is unclear whether orchitis also increases the risk of testicular cancer . According to UC Davis, the association is at best low. The incidence could be 0.5 percent.

Clinical manifestations

In orchitis, the testicle swells (sometimes within a few hours) and is painful. The scrotum can become bright red and shiny. In many cases, symptoms of a urinary tract infection are also accompanied .

Epididymis ( positive Prehn's sign ), testicular torsion (negative Prehn's sign), testicular tumor , hydrocele , varicocele and spermatocele can cause similar disease symptoms ( differential diagnosis ) .

Diagnosis

Inspection and tactile findings are groundbreaking . It should also be noted that epididymid inflammation can also occur. In addition, a bacteriological urine test and, in unclear cases, a sonographic display can be useful.

therapy

Therapeutically, the focus is on elevation and cooling of the testicle as well as the administration of a suitable antibiotic. If the pain persists, it may also be necessary to give decongestant and pain reliever medication.

Individual evidence

  1. a b J. L. Schönlein: General and special pathology and therapy. Literatur-Comptoir, 1834, pp. 472-476 ( online ).
  2. a b c d e J. Barle: General medicine . Thieme Verlag, 2004, ISBN 3-13-126814-X , p. 424 ff. ( Online ).
  3. K. Feyl et al.: Pathology in questions and answers. Urban & Fischer-Verlag, 2004, ISBN 3-437-43260-5 , p. 151 ( online ).
  4. ^ Günter Schmidt: Sonographic differential diagnosis. Thieme Verlag, 2002, ISBN 3-13-126141-2 , p. 389 ff. ( Online ).