Epididymo-orchitis
• Etiology
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Epididymo-orchitis
• common infectious causes
■ <35 yr: N. gonorrhoeae or Chlamydia
trachomatis
■ ≥35 yr or penetrative anal intercourse: GI
organisms (especially E. coli)
• other causes
■ mumps infection may involve orchitis,
post-parotitis
■ TB
■ syphilis
■ granulomatous (autoimmune) in elderly
men
■ amiodarone (involves only head of
epididymis)
■ chemical: reflux of urine into ejaculatory
ducts
Clinical Features
• sudden onset scrotal pain and swelling ±
radiation along cord to flank
• scrotal erythema and tenderness
• fever
• storage symptoms, purulent d/c
• reactive hydrocele
Investigations
• U/A, urine C&S
• ± urethral d/c: Gram stain/culture
• if diagnosis uncertain, MUST rule out
testicular torsion (U/S Doppler)
Treatment
• Risk Factors
• rule out torsion (see Investigations Table 24,
• UTI
U29)
• unprotected sexual contact
• see Table 9, U12 for ABx therapy
• instrumentation/catheterization
• scrotal support, bed rest, ice, analgesia
• increased pressure in prostatic urethra
(straining, voiding, heavy lifing) may cause reflux Complications
• if severe → testicular atrophy
of urine along
• 30% have persistent infertility problems
vas deferens → sterile epididymitis
• immunocompromise
Testicular torsion
• Definition: Twisting of spermatic cord leading to vascular
insufficiency of testes.
• H/P:  very painful and swollen testes, nausea, vomiting;
fever, testes displaced superiorly, mass in spermatic cord
may be felt, absent cremasteric reflex.
• Radiology: US may show torsion.
• Treatment:  emergent surgical reduction of torsion
within several hours of onset; manual detorsion can be
attempted before surgery (may be difficult to determine
correct direction to rotate); testes attached to scrotal wall
(i.e., orchiopexy) to prevent recurrence.
• Complications:  testicular ischemia or infarction without
prompt treatment.
Testicular appendage torsion
Blue dot sign
Acute Idiopathic Scrotal Edema (AISE)
• Definition  AISE is a rare cause of acute scrotum but
important to recognize as it is a benign, self-limiting condition.
• C/P The characteristic findings on ultrasound are those of
edematous thickening and increased vascularity of the scrotal
wall which produces the “Fountain Sign” on transverse color
Doppler imaging.
• The testes and epididymis are normal in appearance and
enlarged, hypervascular inguinal lymph nodes may be seen.
• Correct diagnosis can prevent unnecessary surgical
exploration
• Resolve in 3–5 days.
• NSAIDs and antibiotics have been used in management