Orchitis and epididymo-orchitis

By Dr Teo

Rare,except a/w mumps Blood-borne infection Surgical procedure on the lower urinary

tract,e.g. TUR Organism: Neisseria gonorrhoeae,

Escherichia coli and Chlamydia. In young man, the commonest is Chlamydia

Tuberculosis

Aetiology and pathological features

Preceding Hx of an operation or of dysuria, frequency and heamaturia

Acute pain in scrotum,swelling Epididymis:acutely tender and

enlarged(although it maybe difficult to differentiate from the equally tender testis)

Overlying redness and oedema maybe present

Clinical features

FBC: leucocytosis Blood culture: helpful to direct antibiotic

treatment Urinalysis: pyuria, organism maybe revealed

by culture Aspiration of the epididymis USG: increased blood flow

Investigation

Bed rest,scrotal elevation Tetracycline or erthromycin Other antiobiotic refer to culture Partner should also be investigated and

treated

Management

Undescended testis

Both testes are undescend in 30% of premature infants

Term:3% One year:1% Spontaneous descent after one year is rare

Epidemiology

Failure of migration along the normal line of descent

Ectopic testis:testicle deviates away from the line and lie in front of the penis in the superficial inguinal pouch,in the perineum or in the thigh.(reason unknown)

Aetiology

Prematurity Low birth weight Twin gestation Down syndrome(fetus) or other chromosomal

abnormality Gestational diabetes mellitus Prenatal alcohol exposure Hormonal abnormalities (fetus) Toxic exposures in the mother Mother younger than 20 A family history of undescended testes

Risk factor

An empty scrotal sac or hemiscrotum at 1 year indicates:

Proximal to the external inguinal ring(undescended)

Truly absentRetractile-the cremaster muscle reflexly

pulls the organ up towards the inguinal canalEctopic

Clinical features

Infertility:inevitable in bilateral and common in unilateral undescent,frequent in those who are undescent treated.

Torsion Trauma Inguinal hernia Malignant disease

Complication

Investigation USG,CT and laparoscopy

ManagementTarget is to bring the testicle with its blood

supply into the scrotum as early as possible

Orchidopexy:should be done beyong puberty

Testicular prosthesis can be placed in the scrotum

Testicular torsion1 Epididymis 2 Head of epididymis 3 Lobules of epididymis 4 Body of epididymis 5 Tail of epididymis 6 Duct of epididymis 7 Deferent duct (ductus deferens or vas deferens)

Testicular torsion occurs when the spermatic cord(from which the testicle is suspended) twists, cutting off the testicle's blood supply(ischemia)

Cause: recognised complication of testicular maldescent wherein the testis is inadequately affixed to the scrotum allowing it to move freely on its axis and susceptible to induced twisting of the cord and its vessels.

Occurs most probably between birth and early adolescence

Testicular torsion

Twist deprives the organ of its blood supply If untwist does not take place within 6

hours,ischaemia is irreversible,gangrene develops and the testis either suppurates or atrophies

Twist VS Untwist

Acute severe testicular pain(affected side) Testis is tender,swollen and hang higher up(compared

to other side) Poorly localized central abdo pain Vomitting(sometimes) Scrotal skin become red,hot and edematous in later

stage Palpation may feel the twisted cord

Pain is increase or no improvement by raising the testis

Presentation & Finding

Urinalysis:sterile,acellular urine USG:absence of blood supply to the affected

testicle

Investigation

Surgical emergency Non-operative

Maybe possible to de-rotate the testis Surgical

Failure of non-operative reduction require emergency operation

The testis is de-rotated and fixed The gangrenous testis is removed

Management