Treatment of epididymitis

Epididymitis often develops against the background of other inflammatory or infectious diseases, such as urethritis or prostatitis. Therefore, the symptoms of the disease may vary.

Epididymitis can be:

• unilateral;

• bilateral.

Most often, men develop unilateral epididymitis — inflammation affects the epididymis of only one testicle. Due to the fact that the epididymis of the left testicle is more elongated, it is most commonly affected. Bilateral inflammation occurs less frequently, mainly in patients with weakened immunity.

The disease has three stages:

• acute epididymitis — inflammation is in the active phase and is accompanied by pronounced symptoms; in the absence of timely and appropriate treatment, it may cause inflammation of the testicle and other serious complications (lasts no more than 6 weeks);

• subacute — a transitional stage of the disease, during which symptoms become less pronounced but may periodically intensify;

• chronic epididymitis — develops as a result of delayed or improper treatment of the acute form and is accompanied by persistent low-grade inflammation that leads to the growth of fibrous tissue and obstruction of the vas deferens.

Most men seek medical attention during the acute stage of the disease, as it is accompanied by severe pain, high body temperature, and other pronounced symptoms. If treatment is started late or inappropriate medications are used, epididymitis may lead to complications or gradually progress to a chronic form. It is important to understand that a reduction in symptoms does not always indicate recovery. In some cases, this reflects a transition to the subacute or chronic stage. Therefore, treatment should be carried out under medical supervision.

Epididymitis may cause the following complications:

• inflammation of the second epididymis (bilateral epididymitis);

• progression of the disease to a chronic form;

• orchitis — inflammation of the testicle;

• abscess of the epididymis and/or testicle (purulent inflammation);

• scrotal fistula;

• formation of adhesions;

• tissue necrosis;

• infertility.

In most cases, patients initially develop unilateral epididymitis, and the spread of infection to the second epididymis is considered a complication. In the absence of adequate treatment, inflammation often extends to the testicle, leading to orchitis. This, in turn, may result in purulent inflammation (abscess) and tissue necrosis, which require surgical treatment and often removal of the entire testicle.

When the disease progresses to the chronic stage, relative or absolute infertility may develop. Due to inflammation of the epididymis, sperm quality may decrease, and as a result of adhesions, obstruction of the spermatic cord may occur. Disruption of normal testicular secretion is also possible due to autoimmune processes or damage to the tissues of the spermatic cord.

If epididymitis is suspected, it is necessary to consult a urologist or andrologist.

During the appointment, the doctor will review the patient’s complaints and medical history, as well as perform a physical examination. Based on this, an experienced specialist can make a preliminary diagnosis and prescribe treatment to relieve acute symptoms.

To confirm the diagnosis, laboratory tests and instrumental examinations are performed. The doctor may prescribe:

• CT scan or ultrasound of the scrotal and pelvic organs;

• complete blood and urine tests;

• blood biochemistry;

• bacteriological analysis of urogenital discharge.

Ultrasound is the main method of primary diagnosis. It allows detection of structural changes, thereby confirming inflammation of the epididymis. However, its limitation is insufficient visualization, which makes it difficult to detect purulent foci and determine the severity of the disease. In such cases, a CT scan may be required.

Laboratory tests also help confirm the presence of inflammation in the body and identify the type of infection that caused it. This enables the doctor to select the most appropriate treatment method.

Epididymitis is treated using medical and surgical methods. The choice of therapy primarily depends on the stage of the disease, as well as the man’s general health, age, and reproductive plans.

In most cases, conservative treatment is prescribed. The patient is given antibiotics to fight the infection, as well as anti-inflammatory, antipyretic, analgesic, and other medications to treat the condition and relieve symptoms. In some cases, physiotherapy procedures are also used to restore normal blood microcirculation and eliminate congestion.

During treatment, the patient is advised to follow bed rest and a diet. Spicy and fried foods are excluded from the diet first.

In cases of significant enlargement of the epididymis, body temperature above 40 °C, deterioration of general well-being, or development of complications, hospitalization may be required.

In severe cases of the disease and when complications occur, surgical treatment is applied.

Indications for surgery include:

• purulent inflammation of the epididymis;

• acute post-traumatic epididymitis and orchitis with hematoma;

• tuberculous epididymitis;

• frequent exacerbations of chronic epididymitis;

• ineffectiveness of medical treatment.

Depending on the extent of tissue damage, one of the following procedures is performed:

• epididymotomy — incision of the epididymis with removal of pus and damaged tissues while preserving healthy tissue as much as possible;

• epididymectomy — removal of the epididymis and the vas deferens;

• orchiectomy — removal of the testicle and epididymis.

Epididymotomy makes it possible to preserve the reproductive function of the testicle. In most cases, surgeons aim to perform this procedure. Epididymectomy and orchiectomy are performed when complications develop and the organ can no longer be preserved.