Epididymitis Diagnostics and Treatment

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Stoyanov
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Epididymitis Diagnostics and Treatment

#1 Post by Stoyanov » 01 May 2018, 15:57

Methods of Diagnostics and Identification

The first diagnostic measure for making diagnose is medical examination of the affected side of the testicle, and lymph nodes in the groin. If epididymitis is suspected due to an increase in the prostate, a rectal examination should be performed.

Then, in vitro methods are used:
• urethral smear for microscopic analysis and isolation of the STI-causative agent;
• PCR diagnostics (identification of the pathogen by polymerase chain reaction);
• clinical and biochemical blood test;
• urinalysis (general “three-glass sample” with sequential urination to 3 glasses, culture-based examination, etc.);
• analysis of seminal fluid.

Instrumental diagnostics involves the following testing:
• Ultrasound of the scrotum to detect the disease sites, stages of inflammation, tumor processes, assessment of blood flow velocity (Doppler study);
• nuclear scanning, when a small amount of radioactive substance is introduced, and the blood flow in the testicles is monitored by means of special equipment (to diagnose epididymitis, testicular torsion);
• cystourethroscopy. i.e. the introduction of an optical instrument, a cystoscope, through the urethra, to inspect the internal surfaces of the organ.
Computer and magnetic resonance imaging are less common.

Treatment of Epididymitis

Epididymitis should be treated strictly under the supervision of a professional urologist.
After the examination and identification of the pathogen, a rather long (up to a month or more), course of antibiotic therapy is usually prescribed.

Preparations are selected with due regard to the sensitivity of the pathogenic microorganism; if the type of pathogen cannot be established, then a broad-spectrum antibacterial agent is used. Fluoroquinolones are the main drugs of choice for epididymitis, especially if there are other pathologies of the urogenital system, and in young people. Also, tetracyclines, penicillins, macrolides, cephalosporins, sulfanilamide preparations can be prescribed. In a situation where the disease is caused by STI, simultaneous treatment of the sexual partner is necessarily required.

To mitigate the inflammatory process and relieve the pain, the doctor can also recommend non-steroidal anti-inflammatory drugs (such as Indomethacin, Nimesil, Diclofenac, etc.); for pronounced soreness, procaine block of the spermatic cord is performed. The following measures can be further recommended:
• intake of vitamins;
• physiotherapy;
• enzymes, resolving (Lydazum) and other drugs.

With a mild course of the disease, hospitalization is not required, but if the condition worsens (temperature rises above 39 degrees, general toxicity manifestations, a significant increase in the epididymitis), the patient should be sent to hospital.

If there is no effect, an alternative antibiotic may be required. If the disease persists, especially with bilateral damage, tubercular nature of the pathology may be suspected. In such a situation, consultation of the phthisiourologist is required and, when the diagnosis is confirmed, the specific anti-tuberculosis drugs will be prescribed.

The chronic form shall be treated similarly, however it is more time-consuming.

In addition to taking medication, the patient must adhere to the following rules:
• remain at bed rest;
• ensure an elevated position of the scrotum, for example, by means of a rolled towel;
• exclude weight lifting;
• strictly observe absolute sexual abstinence;
• eliminate the consumption of spicy, fatty foods;
• ensure adequate liquid consumption;
• to mitigate the inflammation, apply cool compresses/ice on the scrotal area;
• wear a suspensory bandage to support the scrotum, which provides rest of the scrotum, preventing commotion when walking;
• wear tight elastic panties, swimming trunks (can be used until the pain symptoms disappear).

As the state is improved, easy habitual physical activity is allowed: walking, running, save for riding a bicycle. Throughout the treatment and thereafter, always avoid general and local hypothermia.

About three weeks after completing the course of antibiotic therapy, you should see a doctor for re-testing (urine, ejaculate analysis) in order to confirm complete elimination of the infection.

Natural remedies can be used only in addition to the main therapeutic course and only if permitted by the attending physician. Folk healers recommend:
• cranberry leaf, tansy flowers, horsetail decoctions;
• leaves of nettle, mint, lime-colored and other herbal teas.

If purulent abscess develops, the suppuration is surgically dissected. In severe cases, it may be necessary to remove a part or all of the affected epididymis. In addition, the operation can be resorted to:
• to correct physical anomalies that cause the development of epididymitis;
• if a testicular torsion/epididymal appendage (hydatid) is suspected;
• in some situations with tuberculous epididymitis.

Complications

Typically, epididymitis is well treated with antibacterial drugs. However, without adequate therapy, the following complications may develop:
• changing to a chronic form;
• bilateral lesion;
• orchiepididymitis (spread of the inflammatory process to the testicle);
• abscess of testis (purulent, limited inflammation of tissues of the organ);
• development of an adhesion process between the testis and scrotum;
• testicular infarction (necrosis of tissues) due to blood supply disorders;
• atrophy (decrease in volume, with subsequent disruption of sperm production and a decrease in testosterone production) of the testicle;
• formation of fistulas (narrow pathological canals with purulent discharge) in the scrotum;
• infertility as a consequence of both a decrease in the production of spermatozoa, and formation of obstacles to the normal promotion of the latter.

Preventive Treatment of Epididymitis

The principal measures for the prevention of epididymitis include:
• healthy lifestyle;
• safer sex;
• ordered sexual activity;
• timely detection and elimination of recurrent urinary tract infections;
• prevention of traumatic injury of the testicles (by wearing protective equipment when engaging in traumatic sports);
• compliance with personal hygiene requirements;
• elimination of hyperthermia, hypothermia;
• prevention/adequate therapy of infectious diseases (including vaccination against mumps), etc.

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