Epididymitis

Epididymitis is a condition characterized by discomfort or pain in the epididymis (structure at the back of the testicle), in which sperm mature and stored.
This urological disease can be acute or chronic. In the acute phase (initial) felt pain in the testes accompanied by inflammation, redness and warmth in the scrotum. In chronic form pain may be the only symptom.
In either case, pain in one or both testicles may vary from mild to severe, and one or both of the epididymis can significantly swell and solidify. Pain is often cyclical and it can last from less than an hour to several days.
If the inflammation extends to the testicle, a disease called orchiepididymitis.
Swelling caused epididymitis can stretch along the inguinal canal and may be similar to an inguinal hernia.
Chronic epididymitis occurs for more than six weeks after the acute phase and is characterized by inflammation. For correct diagnosis it is necessary to apply for examination by urologist. Be sure to consult a doctor as to exclude a number of other diseases that can cause constant pain in the scrotum, for example testicular cancer (although it is often painless), increased scrotal veins (varicocele), and possible cyst within the epididymis.
Chronic epididymitis is most often associated with low back pain.

Signs and symptoms
The average age of patients applying us with epididymitis is 41-43 years. The acute form usually develops within a few days and is accompanied by pain and swelling often only one testicle. Also frequently observed discharge from the urethra. Fever is also a common symptom. In chronic disease patient complains of pain on palpation. Some patients suffer from a chronic disease is not detected by ultrasound for 3-5 years.

Causes of epididymitis
Although urinary tract infections in men are rare bacterial infection is the most common cause of acute epididymitis. Bacteria reach epididymis through urethra, bladder and reproductive structures. In rare cases, infection reaches epididymis through the bloodstream.
In sexually active men chlamydia is the cause in two-thirds of acute cases followed by gonorrhea, and E. coli (or other bacteria that cause urinary tract infections). Minimal influence ureaplasma, mycobacteria and cytomegalovirus, or Cryptococcus in patients with HIV infection. E. coli is more common in boys before puberty, the elderly, and men who have sex with men.
Any shape can be caused epididymitis undergoing surgery on the urogenital system including the urinary catheter and prostatectomy. Congestive epididymitis can lead to the need for a vasectomy. Chemical epididymitis may also be the result of taking drugs.

Diagnostics
Epididymitis usually develops gradually. Typical symptoms – redness, warmth and swelling of the scrotum.
Doppler ultrasound is a common test that gives a visual picture of the flow field, which gives the expert to distinguish epididymitis from testicular twist.
Medical examination and palpation is mandatory for diagnosis.
Additional studies may be needed to identify the underlying causes of disease. In children frequent urinary tract anomaly. Sexually active men may be recommended tests for sexually transmitted diseases. These tests are urine microscopy and culture inoculation.

Treatment
In acute and chronic forms if infection is suspected, the treatment used primarily antibiotics, analgesics or anti-inflammatory drugs.
In acute cases to relieve pain and other symptoms can be used for applying cold packs to the scrotum. Hospitalization is shown in severe cases as well as in identifying infection that caused the disease.
Surgical removal of the epididymis is rarely needed as it leads to infertility and provides relief from pain only about 50 % of cases. Nevertheless, acute epididymitis pus may be recommended epididymotomy; in very severe cases may require a full epididymectomy (salpingo). In cases of very severe pain in the testicles can also be offered orchiectomy (removal of the testicles).

Complications
Without treatment serious complications of acute epididymitis may occur such as abscess and testicles myocard. Chronic epididymitis can cause permanent damage or even destruction of the epididymis and testis (that leads to infertility and/or hypogonadism). Infection can also spread to any other organ or system.