eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Epididymal Tuberculosis: Differential Diagnoses & Workup

Author: J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
Contributor Information and Disclosures

Updated: Nov 21, 2008

Differential Diagnoses

Epididymitis
Testicular Seminoma
Hydrocele
Testicular Torsion
Scrotal Trauma
Testicular Trauma
Spermatocele
Testicular Tumors: Nonseminomatous

Other Problems to Be Considered

Testicular teratocarcinoma

Workup

Laboratory Studies

  • Microscopic urinalysis often reveals pyuria or hematuria.
  • Obtain urine for culture.
    • If genitourinary tuberculosis is suspected, 3-5 consecutive early-morning urine samples should be cultured for acid-fast bacilli.
    • Molecular probes are also available for more rapid identification of the organisms in urine.
  • Blood studies include complete blood cell count, serum electrolytes, and erythrocyte sedimentation rate (ESR). The ESR is commonly elevated in patients with epididymal tuberculosis, and its normalization can be used to follow the course of therapy.

Imaging Studies

  • Chest radiography should be obtained to assess for evidence of pulmonary tuberculosis.
  • Plain abdominal radiography is useful to search for evidence of renal or ureteral tuberculosis (ie, renal or ureteral calcifications). Renal ultrasonography to evaluate the upper urinary tract for evidence of hydronephrosis is also warranted.
  • Although scrotal ultrasonography is helpful in assessing for complications of epididymal tuberculosis, such as fistula or abscess formation, the appearance of epididymal tuberculosis on ultrasonography is not distinct from that of bacterial epididymo-orchitis.

Other Tests

  • Purified protein derivative of tuberculin
    • Intradermal injection of purified protein derivative of tuberculin (PPD) is an important component of the tuberculosis evaluation. An indurated area larger than 10 mm in diameter is considered a positive result, and an area greater than 15 mm in diameter may indicate active disease.
    • False-negative test results in the setting of malignancy, immunosuppression, liver disease, and nutritional deficiencies must be considered.
    • A positive test result, in and of itself, is not confirmatory of the diagnosis of active tuberculosis.

Procedures

  • Fine-needle aspiration of the epididymis may be useful to distinguish epididymal tuberculosis from bacterial epididymo-orchitis, but, because of the risk of tumor spillage, fine-needle aspiration should be avoided if a neoplasm is suspected.5,6

Histologic Findings

Histologic findings of tuberculous epididymitis are similar to those of tuberculosis elsewhere in the body (granuloma formation, nonspecific inflammatory infiltrate). Additionally, mycobacteria are present.

More on Epididymal Tuberculosis

Overview: Epididymal Tuberculosis
Differential Diagnoses & Workup: Epididymal Tuberculosis
Treatment & Medication: Epididymal Tuberculosis
Follow-up: Epididymal Tuberculosis
References
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References

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Further Reading

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Keywords

epididymal tuberculosis, epididymal TB, tuberculous epididymitis, genital tuberculosis, genital TB, genitourinary tuberculosis, genitourinary TB, mycobacterial tuberculosis, Mycobacterium tuberculosis, MTB, granulomas, extrapulmonary tuberculosis, nonpulmonary tuberculosis, extrapulmonary TB, nonpulmonary TB, male genital tuberculosis, male genital TB

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Contributor Information and Disclosures

Author

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Medical Editor

Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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