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Urology - Surgery > Epididymo-Orchitis > Flashcards

Epididymo-Orchitis Flashcards

1
Q

What is Epididymo-Orchitis?

A

Acute infection of the epididymus (epididymitis) +/- testes (orchitis)

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2
Q

What are the peak ages of incidence?

A

Bimodal distribution

Males aged 15-30 yrs & > 60yrs

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3
Q

What is the pathophysiology of EO?

A

Local extension of infection from the lower urinary tract (bladder & urethra), either via enteric (e.g. UTI) or non-enteric (e.g. STI) organisms

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4
Q

What is the most common cause in younger men?

A

STIs

such as N. gonorrhoeae & C. trachomatis

(E.coli in patient’s who have anal sex)

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5
Q

What is the most common cause in the > 60s ?

A

Enteric organism from a UTI

Most common pathogens are E. coli, Proteus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa

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6
Q

How else can EO arise?

A

Viral infection (e.g. mumps)

Drug induced

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7
Q

How does Mumps orchitis present & what is the disease progression?

A

Unilateral / bilateral orchitis +/- fever, around 4-8 days after the onset of mumps parotitis.

Self-resolves within a week w/ supportive management, but can lead to complications such as testicular atrophy and infertility.

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8
Q

How do you investigate suspected mumps orchitis?

A

Mumps IgM/IgG serology should be measured

Mumps is a notifiable disease in the UK, meaning that the local Health Protection Team must be informed if there is suspicion of mumps.

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9
Q

What are the risk factors for EO?

A

For non-enteric causes:

  • Unprotected sex
  • Males who have sex with males (MSM)
  • Multiple sexual partners
  • Known contact of gonorrhea

For enteric causes:

  • Recent instrumentation / catheterisation
  • Bladder outlet obstruction (e.g. prostate enlargement, urethral stricture)
  • Immunocompromised state
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10
Q

What are the symptoms of EO?

A
  • Unilateral scrotal pain & swelling
    • Gradual onset
  • Fever / rigors
  • Associated symptoms
    • Dysuria
    • Storage LUTS
    • Urethral discharge possible
  • Relevant sexual history
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11
Q

What are the signs of EO on examination?

A
  • Unilateal redness & swelling of affected side
    • Rarely bilateral
  • Tenderness of epididymis +/- the testis
  • Associates hydrocele possible
  • Normal cremasterix reflex
  • +ve Prehn’s sign
    • Pain relieved by elevating testis.
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12
Q

What is a positive Prehn’s sign? & How reliable is it in clinical practice?

A

Testicular pain is relieved by elevation (while pt is supine)

  • Suggestive of epididymitis

Prehn’s sign is unreliable

  • It has good sensitivity, but relatively poor specificity, therefore is not used routinely.
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13
Q

What is the most important differential to consider when a patient presents with testicular pain? & why?

A

Testicular torsion

Because it is a surgical emergency

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14
Q

How is the presentation of testicular torsion different from EO?

A
  • Age
    • Torsion occurs mostly in patients under 25 (esp teenagers)
  • Pain
    • Torsion pain is more severe & has rapid onset
  • Exam
    • High-lying, laterally orientated testis suggests torsion
    • Absent cremasteric reflex
    • -ve Prehn’s sign
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15
Q

Aside from testicular torsion, what other differential diagnoses may you consider with a presentation of EO?

A
  • Testicular trauma
  • Testicular tumour
  • Testicular abscess
  • Epididymal cyst
  • Hydrocele
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16
Q

How do you investigate EO?

A
  1. Urine dipstick & urine culture (MC&S)
  • For evidence of infection
  • First void urine should be collected and sent for Nucleic Acid Amplification test to assess for N. gonorrhoea, C. Trachomatis
  1. STI testing
  2. Routine bloods
    * FBC & CRP = Looking for infective causes

+/- Blood cultures (if there’s evidence of systemic infection

  1. Doppler USS
    * To confirm diagnosis and rule out abscess
17
Q

How do you manage Orchitis?

A

1. Supportive measures

  • Bed rest
  • Scrotal support
  • Sufficient analgesia

2. Antibiotics (definitive treatment that can be started empirically prior to culture results)

Enteric organisms:

  • Ofloxacin 200mg PO BD for 14 days

OR

  • Levofloxacin 500mg BD for 10 days

STI organisms:

  • Ceftriaxone 500mg IM single dose

AND

  • Doxycycline 100mg PO twice daily for 10-14 days

+/- Oral Azithromycin 1g single dose (if gonorrhoea likely)

IV Abx if septic / unwell

3. Abstinence from sexual activity until antibiotics finished & counselling on safe sex

4. Safety netting = “Seek further assessment if symptoms do not resolve or get worse”

18
Q

What are complications of EO?

A
  • Reactive hydrocele formation
  • Abscess formation (rare)
  • Testicular infarction (rare)
  • Chronic pain
  • Infertility

Urology - Surgery (12 decks)

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