eMedicine Specialties > Urology > Common Problems of the Testicle

Epididymitis: Follow-up

Author: Edmund S Sabanegh, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Coauthor(s): Badrinath R Konety, MD, Associate Professor, Department of Urology, University of California at San Francisco; Christina B Ching, MD, Resident, Department of Urology, Cleveland Clinic Foundation
Contributor Information and Disclosures

Updated: Jun 12, 2008

Follow-up

Complications

  • Acute epididymitis and bacterial orchitis  
    • Scrotal abscess and pyocele
    • Testicular infarction: Cord swelling can limit testicular artery blood flow.
    • Recurrence, chronic epididymitis, and orchalgia: True local pain can be distinguished from referred pain by spermatic cord injection with 1% lidocaine. Refractory pain that is not improved by analgesics has also been managed by denervation of the spermatic cord.
    • Fertility problems: Sterility is uncommon after acute epididymitis, although the documented true incidence is unknown. Disturbances in the sperm quality secondary to leukocytospermia and inflammation are usually transient. More important is the far less common azoospermia, which is caused by the epididymal duct obstruction observed in untreated and improperly treated men with epididymitis. The incidence of this condition is unknown.
    • Testicular atrophy
    • Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (seen especially in TB)
  • Mumps orchitis  
    • Hypogonadotropic hypogonadism can occur as a result of testicular atrophy, which is observed in 30-50% of patients
    • Sterility occurs in 7-13% of affected patients. Orchitis affects the testicular interstitium more than the Leydig and Sertoli cells, but sperm counts, mobility, and morphology can be affected. 
    • Orchalgia may develop. 
    • Mumps orchitis is not associated with the development of testicular tumors.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis of testicular torsion is a potential pitfall.
  • Failure to recognize and treat both partners for STDs is a potential pitfall. Patients found positive for C trachomatis or N gonorrhoeae infection should be referred for further testing of other STDs, including HIV. 
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Michael Franks, MD, to the development and writing of this article.



More on Epididymitis

Overview: Epididymitis
Differential Diagnoses & Workup: Epididymitis
Treatment & Medication: Epididymitis
Follow-up: Epididymitis
Multimedia: Epididymitis
References
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References

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Further Reading

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Keywords

epididymitis, epididymo-orchitis, orchitis, epididymis, testicular torsion, bladder outlet obstruction, BOO, urethral stricture, ectopic ureter, ectopic vas deferens, prostatic utricle, urethral duplication, posterior urethral valves, urethrorectal fistula, detrusor sphincter dyssynergia, vesicoureteral reflux, benign prostatic hyperplasia, BPH, sexually transmitted diseases, STDs, inflammation of the epididymis, epididymal pain, acute epididymitis, chronic epididymitis, urethritis, prostatitis, tuberculous epididymitis, genitourinary tuberculosis, genitourinary TB, mumps orchitis, urogenital malformations, scrotal pain, scrotal swelling, urethral discharge, parotiditis, funiculitis, Prehn sign, reactive hydrocele, beading of the vas deferens, scrotal cellulitis, urinary coliforms, Chlamydia, Neisseria gonorrhoeae, Ureaplasma urealyticum, Treponema pallidum, Trichomonas, Gardnerella vaginalis, sterile reflux, urethro-vasal reflux, amiodarone epididymitis, trauma to the scrotum, brucellosis, coccidioidomycosis, blastomycosis, cytomegalovirus, candidiasis, coxsackievirus type A, varicella, echoviral infections

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Contributor Information and Disclosures

Author

Edmund S Sabanegh, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Edmund S Sabanegh, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwestern Oncology Group
Disclosure: Nothing to disclose.

Coauthor(s)

Badrinath R Konety, MD, Associate Professor, Department of Urology, University of California at San Francisco
Badrinath R Konety, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, and International College of Surgeons
Disclosure: Nothing to disclose.

Christina B Ching, MD, Resident, Department of Urology, Cleveland Clinic Foundation
Christina B Ching, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Student Association/Foundation, and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Assistant Professor, Program Director, Department of Urology, Columbia-Presbyterian Medical Center, Columbia University
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

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

CME Editor

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

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director, Lorain Kidney Stone Research Center; Clinical Assistant Professor, Department of Urology, University of Toledo
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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