eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Epididymal Tuberculosis

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

Introduction

Background

Tuberculosis has plagued humankind since before recorded history. The story of humankind's battle against tuberculosis parallels that of the development of the practice of medicine in general. Although largely controlled in developed countries, tuberculosis remains a significant worldwide health problem because of the incidence in developing countries. Genitourinary tuberculosis represents 2-4% of cases of tuberculosis or approximately 15% of nonpulmonary manifestations of tuberculosis. Genitourinary tuberculosis is the most common extrapulmonary site of tuberculosis.1

Pathophysiology

The spread of tuberculosis to the epididymis is thought to occur hematogenously or by retrocanalicular descent of organisms from the hematogenously infected prostate. Because epididymal tuberculosis is more common than prostatic tuberculosis, hematogenous spread is likely more common. Distal spread through the genitourinary tract from a renal source is also possible.

In very rare cases, tuberculous epididymitis has been reported following intravesical bacille Calmette-Guérin (BCG) therapy for superficial bladder tumors, presumably due to retrocanalicular descent of organisms from the prostatic urethra.2,3,4

The formation of granulomas in the epididymis is responsible for the clinical manifestations of epididymal tuberculosis, as in other organ systems.

Frequency

United States

Approximately 4000 cases of extrapulmonary tuberculosis are reported annually in the United States. This incidence is stable, despite a decreasing incidence of pulmonary tuberculosis. Much of the increase in the relative incidence of genital tuberculosis can be attributed to tuberculosis in men with HIV infection, which apparently predisposes to tuberculosis.

International

The incidence of tuberculosis in some developing countries is 30 times greater than that in the United States. In developing countries, the percentage of cases of tuberculosis with genitourinary involvement is approximately double that in developed areas.

Race

In developed countries, most cases of tuberculosis are observed in the immigrant population. Only 20% occur in white people.

Age

Epididymal tuberculosis most commonly develops in sexually active young men. Before the age of antituberculous chemotherapy, the typical patient was aged 16-40 years. Now, more than 70% of men with genital tuberculosis are older than 35 years, and 15-20% are older than 65 years.

Clinical

History

  • The typical presentation of epididymal tuberculosis is painful enlargement of the scrotum.
  • Involvement is usually unilateral.
  • Voiding problems are usually absent when only the external genitalia are involved. However, associated renal, vesical, or prostatic tuberculosis may contribute to irritative voiding symptoms.
  • Malaise, fevers, and chills are common in individuals with epididymal tuberculosis.
  • Epididymal tuberculosis can result in infertility.1

Physical

  • In the early phases, tuberculous epididymitis is indistinguishable from bacterial epididymo-orchitis. The scrotal contents are enlarged and tender, with loss of definition between the epididymis and testicle.
  • Secondary tuberculous involvement of the testicle can be observed in advanced cases.
  • Prostatic examination may reveal induration or bogginess of the prostate if this organ is involved. The vas deferens may be enlarged and beaded. Occasionally, a draining sinus is based posteriorly upon the epididymis.

Causes

  • Venereal acquisition of male genital tuberculosis is unlikely, although cases of male-to-female transmission of genital tuberculosis have been reported.
  • Male genital tuberculosis usually is a manifestation of the usual pulmonary acquisition of tuberculosis.
  • Tuberculous epididymo-orchitis has been reported as a sequela of intravesical BCG treatment for bladder cancer.2,3,4

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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  3. Salvador R, Vilana R, Bargalló X, Araque X, Nicolau C. Tuberculous epididymo-orchitis after intravesical BCG therapy for superficial bladder carcinoma: sonographic findings. J Ultrasound Med. May 2007;26(5):671-4. [Medline].

  4. Falkensammer C, Gozzi C, Hager M, Maier H, Bartsch G, Höltl L, et al. Late occurrence of bilateral tuberculous-like epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma. Urology. Jan 2005;65(1):175. [Medline].

  5. Garbyal RS, Gupta P, Kumar S. Diagnosis of isolated tuberculous orchitis by fine-needle aspiration cytology. Diagn Cytopathol. Oct 2006;34(10):698-700. [Medline].

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  27. Türkvatan A, Kelahmet E, Yazgan C, Olcer T. Sonographic findings in tuberculous epididymo-orchitis. J Clin Ultrasound. Jul-Aug 2004;32(6):302-5. [Medline].

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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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