Epididymitis
| Classification according to ICD-10 | |
|---|---|
| N45 | Orchitis and epididymitis |
| ICD-10 online (WHO version 2019) | |
Epididymitis or epididymitis , the inflammation of the epididymis called. It usually arises from a bladder or prostate inflammation (also after transurethral manipulation or as a complication of a vasectomy ) over the spermatic cord and can occur on one or both sides. A distinction is made between two types of the disease, acute and chronic epididymitis .
The most common pathogens are all cystitis- causing bacteria, but also Neisseria gonorrhoeae and Chlamydia trachomatis
Symptoms
Typical symptoms include slowly increasing pain , reddening, overheating, swelling of the scrotum and a painful swelling of the epididymis , possibly fever and pain when urinating, similar to a urinary tract infection . Blood can also appear in the urine and ejaculate. Accompanying this, as well as a few days before, the ejaculate can appear yellowish as a sign of the addition of pus. Sometimes the symptoms can be confused with the dangerous testicular torsion , which often leaves only a short window of time to save the testicle. If there is pain in the testicles, a urologist should always be consulted quickly.
Diagnosis
- Clinical examination
- Rectal digital palpation examination (accompanying prostatitis?)
- Prehn's sign
- Microbiological examination of the urine
- Residual urine determination
- Sonography
therapy
Calculated antibiosis after taking a urine culture. General treatments that help relieve pain and help the healing process progress positively include strict bed rest, cooling, and elevating the testicles. Elevation of the testicle is extremely important because it reduces the risk of reactive cyst formation ( spermatocele ) in the epididymis. The disease can last up to 10 days and should be examined sonographically every 3–4 days. In the case of a purulent meltdown that can be detected by ultrasound and spread to the testicles, surgical removal is necessary. It can take up to 6 weeks for the scrotum to feel normal again. The usually typical hardening of the epididymal head can persist for up to three months. A spermiogram , about 6 weeks after the inflammation, can provide information about whether the disease has impaired sperm quality or even caused infertility (in about 2 out of 10 cases).
Different antibiotics are used, depending on the pathogen .
| Pathogens | etiology | antibiotic |
|---|---|---|
| Neisseria gonorrhoeae | Sexually transmitted | Cephalosporins (e.g. single intramuscular ceftriaxone followed by oral doxycycline for 10 days) or gyrase inhibitors |
| Chlamydia trachomatis | Doxycycline | |
| Pathogen unknown | ( unique ) Ceftriaxone and Doxycycline | |
| Enterobacteria , Pseudomonas , Enterococci | Urinogenic | Gyrase inhibitors (e.g. levofloxacin , ofloxacin, or ciprofloxacin ) |
Epidemiology
Epididymitis accounts for 1 in 144 outpatient visits (0.69%) of men 18 to 50 years old, or 600,000 cases of men 18 to 35 years old in the United States. The disease occurs primarily in men aged 16 to 30 and 51 to 70 years.
Web links
- Martina Sticker, Arne Schäffler: testicular inflammation and epididymitis. In: Health Today. Wissenschaftliche Verlagsgesellschaft mbH, March 4, 2008, accessed June 30, 2010 .
- Dirk Manski: Epididymitis (inflammation of the epididymis). In: Urology: Online textbook for doctors. Retrieved June 30, 2010 .
Individual evidence
- ↑ Thomas Colombo: Inflammation of the testicles and epididymis (orchitis and epididymitis). (No longer available online.) In: Diseases. NetDoktor.at, archived from the original on August 15, 2011 ; accessed on June 30, 2010 : "It can take up to six weeks for the scrotum to feel normal again." Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Jürgen Wehner: Epididymitis / epididymitis. (No longer available online.) MedizInfo, archived from the original on June 17, 2010 ; Retrieved June 30, 2010 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Dieter Hauri, Peter Jaeger: Urology checklist . 4th edition. Thieme, Stuttgart 2000, ISBN 3-13-572904-4 , p. 486 .
- ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 201.
- ↑ TH Trojian, TS Lishnak, D. Heiman: epididymitis and orchitis: an overview . In: Am Fam Physician . tape 79 , no. 7 , April 1, 2009, p. 538-537 , PMID 19378875 (American English: Epididymitis and orchitis: an overview. ).
