Epididymo-orchitis

Question 1

Define Epididymo-orchitis? Who does it commonly affect?

Answer 1

refers to inflammation of the epididymis and the testicle.

Sexually active males, age 19-35years

Question 2

Causes of Epididymo-orchitis?

Answer 2

STI (e.g. chlamydia in those age<35years; gonorrhoea)

UTI (e.g. E.coli in age >35yrs)

Less common:
- Mumps
- Tuberculosis

Question 3

Presentation of Epididymo-orchitis?

Answer 3

Acute scrotal pain

Testicular swelling and tenderness
Fever
Dysuria
Urethral discharge

Prehn’s positive (lifting up testicle relieves pain due to inflammation)

Cremasteric reflex is intact (this helps differentiate clinically from torsion)

Question 4

Diagnosis/IVx of Epididymo-orchitis?

Answer 4

Hx + examination

Urinalysis, urine culture (rule out UTI)

STI screening (NAATs)
- Urethral swab and gram stain can be performed.
- intracellular organism = Chlamydia
- negative diplococci = Gonorrhoea.

Scrotal US (rule out testicular torsion)

Question 5

Management of Epididymo-orchitis?

Answer 5

Analgesia
Scrotal elevation and rest

STI:
- ceftriaxone (IM) + oral doxycycline + refer to sexual health clinic and contact tracing

• chlamydia or other non-gonococcal organisms (not gonorrhoea); OFFER doxycycline
• E.coli or UTI; OFFER levofloxacin or ofloxacin

Question 6

Define/cause of bladder cancer?

Answer 6

Malignant growth within the urinary bladder.

Most common: TRANSITIONAL CELL CARCINOMA
- smoking
- exposure to aromatic amines (rubber, dyes, chemical)

then squamous cell carcinoma:
- Schistosomiasis infection
- Long-term catheterisation

Question 7

Presentation of bladder cancer?

Answer 7

painless visible haematuria
Recurrent UTIs
Hydronephrosis
Unintended weight loss
Night sweats

Question 8

Diagnosis/IVx of bladder cancer?

Answer 8

CT urogram
Flexible cytoscopy + biopsy
Urine MC&S -confirms haematuria

TNM staging

Question 9

Management of bladder cancer?

Answer 9

Depends on whether the cancer is muscle invasive or non-muscle invasive.

Non-muscle invasive bladder cancer:
- Transurethral resection of the bladder tumour (GOLD STANDARD)

Muscle invasive bladder cancer:
- radical cystectomy with urinary diversion (GOLD STANDARD)
- radiotherapy and chemotherapy (non-surgical)

Question 10

2ww referral criteria for bladder cancer?

Answer 10

age ≥45years AND:
- Unexplained visible haematuria without UTI
OR
- Visible haematuria that persists or recurs after successful treatment of UTI

≥60years AND:
- unexplained non-visible haematuria
AND
- either dysuria OR a raised WCC