Orchitis in men: consequences and complications, diagnosis, prognosis

An inflammatory disease of the male genitourinary organs with damage to the testicles is orchitis. Let's consider the main causes and symptoms of the disorder, diagnostic and treatment methods.

According to the International Classification of Diseases, 10th revision ICD-10, this disease belongs to class XIV Diseases of the genitourinary system:

N40-N51 Diseases of the male genital organs.

• N45. Orchitis, epididymitis and epididymo-orchitis with abscess. Abscess of epididymis or testicle.
• N45.9 Orchitis, epididymitis and epididymo-orchitis without mention of abscess. Epididymitis NEC, Orchitis NEC.

The testicles are a paired glandular organ that produces sperm and sex hormones. They are located in the scrotum and are covered by several protective membranes. The shape is oval, slightly flattened on the sides. The dimensions of an adult man are: 4-5 cm in length, 2-3 cm in width and about 3.5 cm in thickness, the weight of each testicle is up to 20-30 g. The testicles are separated from each other by a septum, but the right one is slightly higher than the left. The main functions of the organ include: the formation of sperm, androgens and estrogens.

Very often, orchitis develops against the background of a remote infectious or inflammatory process in the body. The pathology can be caused by traumatic factors and occur both in a unilateral form and with bilateral damage. In the latter case, there are high risks of irreversible infertility.

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Epidemiology

According to medical statistics, in 60% of cases orchitis occurs due to various infectious factors. The remaining 40% are due to injuries and stagnant processes in the body.

Most often, the disease is a complication of epidemic parotitis. About 20% of men in the post-pubertal period face this consequence. At the same time, the disease has no age dependence, that is, both little boys and mature men are susceptible to it. The presence of risk factors significantly increases the chances of inflammatory processes in the genitourinary system.

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Causes orchitis

Orchitis is not an independent disease. It develops against the background of infectious and inflammatory lesions of the genitourinary system, due to infectious processes in the body or as a result of injuries. Read also: Causes of orchitis

Risk factors

There are a number of predisposing factors that increase the likelihood of developing orchitis. Let's look at the main risk factors for this disease:

• Irregular sexual life.
• Long-term sexual abstinence.
• Sexual excesses.
• A sedentary, inactive lifestyle.
• Chronic hepatitis.
• Diabetes mellitus.
• Immunodeficiency states.
• Physical or mental fatigue.
• Hypothermia or overheating of the body.
• Urination disorder.
• Various diseases of the genitourinary system.

In addition to the above reasons, inflammation can be provoked by foci of chronic infection in the body.

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Pathogenesis

The mechanism of orchitis development depends on the causes that provoked the inflammatory process. Most often, pathogenesis is associated with the spread of infection by hematogenous route. Pathogenic microorganisms penetrate the genitourinary system through the blood vessels, affecting the testicles. In this case, the pathology can be caused by such diseases: mumps, brucellosis, pneumonia, rheumatism, scarlet fever.

The infection can enter the testicle lymphogenously or by contact in case of orchioepididymitis. There is also a canalicular route of pathogenic flora spread, i.e. through the vas deferens from the prostate gland, the posterior part of the urethra and the seminal vesicles.

Various injuries and inflammatory processes in the urethra are characterized by hematogenous infection of the testicle and its appendage. The development of the disease may be the result of impaired blood circulation in the testicle. This occurs with a sharp tension of the anterior abdominal wall and compression of the spermatic cord. Direct injuries of the scrotum with rupture of the testicle are complicated by acute orchitis.

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Symptoms orchitis

The main symptom of orchitis is severe pain in the groin, which can radiate to the back. Gradually, the scrotum turns red and swelling occurs. Sharp pain occurs during palpation, and the inguinal lymph nodes are enlarged.

If orchitis develops in an acute form, the body temperature rises sharply to 39-40°C. Against this background, chills and feverish condition appear, attacks of nausea and vomiting are possible. Defecation and urination are painful, there may be blood in the urine.

Such symptoms develop over 1-3 days in an increasing manner. The discomfort goes away after 2-3 days. But the disappearance of signs of the disease may indicate its transition to a chronic form, which threatens serious complications.

Read about other symptoms of orchitis here.

Stages

Inflammatory lesion of the testicle has several stages, let's consider them:

• Mild - subfebrile body temperature for 1-3 days, deterioration of general health. The skin of the scrotum is hyperemic and edematous, painful sensations occur when attempting palpation.
• Average - high body temperature, general intoxication of the body. The scrotum is enlarged, hot to the touch and painful. The pain radiates to the lower back and groin area.
• Severe – body temperature of 40 °C for more than 5 days, pronounced symptoms of general intoxication, depressed consciousness. Inflammation is complicated by purulent processes, formation of abscesses and fistulas is possible. Infectious toxic shock may also be observed.

The method of treatment of the disease and its prognosis depend on the diagnosed stage of orchitis.

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Complications and consequences

With timely diagnosis and treatment, orchitis is completely curable. But if the disease becomes chronic or is complicated by a secondary infection, there is a high risk of developing the following consequences of the disease:

• An abscess is a purulent lesion of organ tissue with pronounced intoxication syndrome.
• Formation of adhesions between the testicle and the scrotum.
• Formation of fistulas in the tissues of the scrotum.
• Disruption of the blood supply to the organ with subsequent atrophy and necrosis of the testicle.
• Bilateral epididymitis.
• Infertility.

Impaired formation, development and transport of spermatozoa from the testicle to the urethra is most often observed with bilateral lesions. Medical statistics indicate that about 40% of patients with chronic inflammatory process in the testicles experience impaired reproductive function. Infertility develops due to the direct effect of infection on spermatozoa, impaired secretion of the sex glands and immune mechanisms.

The disease can also be complicated by a violation of testosterone production. Because of this, libido decreases, erection weakens, overall muscle mass decreases, and work capacity is significantly reduced.

One of the serious complications of orchitis is an abscess. It develops as a result of hypothermia, a weakened immune system, infection, and also as a result of injuries. An abscess forms in the tissues of the testicle and is a capsulated formation with purulent contents.

Symptoms of complications:

• Swelling and redness of the scrotum.
• Intense pain in the groin that persists both during movement and at rest.
• General and local increase in temperature to febrile values.
• Feverish condition.
• Muscle pain and weakness.

The neoplasm causes the testicular tissue to melt, so when palpating them, there is a feeling of mobility of the liquid contents of the capsule. An abscess can occur under the guise of acute pathologies of the inguinal-scrotal region, simulating tuberculous orchitis or tumor neoplasms. Obvious signs of an abscess make themselves known when antibacterial therapy is ineffective.

To diagnose a purulent inflammation focus, an ultrasound of the scrotum is prescribed. Differentiation is carried out with tumors of the epididymis, testicular infarction, epididymitis. The treatment method depends on the stage of the disease. As a rule, the abscess capsule is opened and drained with further treatment with antiseptics and antibiotics. If there are complications or a risk of infection spreading, the affected testicle is removed, that is, an orchiectomy is performed.

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Diagnostics orchitis

As a rule, the process of diagnosing testicular inflammation is not difficult. Suspicions of orchitis may arise during the process of collecting anamnesis and examining the patient. To establish the exact cause of the disease and choose an effective treatment method, a set of laboratory and instrumental studies is carried out.

Physical examination of the testicle, i.e. palpation and feeling, is the basis for diagnosing orchitis. To identify a specific infection, differentiate prostatitis and prostate adenoma, a rectal examination of the prostate, Cowper's glands and seminal vesicles is performed. To determine the condition of the inflamed organ, ultrasound of the scrotum and diaphanoscopy are necessary.

Particular attention is paid to laboratory methods. To establish the causes of inflammation and determine the pathogen, a general urine test and microflora culture are performed. If there is an infection, an ejaculate test may be required. An STD test is also necessary. If there is a suspicion of a tumor process, the patient gives blood for tumor markers.

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Tests

Laboratory diagnostics in case of suspected orchitis is necessary not only to confirm the diagnosis, but also to identify the pathogen and assess the general condition of the body.

In case of testicular inflammation, patients are prescribed the following set of tests:

1. General blood test – determines the severity of the inflammatory process. In case of bacterial infection, there is an increased level of leukocytes and a shift in the leukocyte formula to the left, increased ESR. In case of viral infection – high values of leukocytes. If the cause of the disease was a parasitic infection or allergic reactions, then the analysis reveals an increased level of eosinophils,
2. General urine analysis – determines the degree of inflammatory damage to the genitourinary system. In case of orchitis, pyuria, the presence of erythrocytes and cylinders in the urine are detected.
3. Bacteriological analysis of urine – pathogenic microorganisms are detected and their sensitivity to antibacterial drugs is determined. In case of testicular inflammation, the following may be detected: E.coli, staphylococcus, pseudomonas aeruginosa, proteus, streptococcus and other pathogens.
4. A smear from the urethra determines the type of pathogen and the nature of the inflammatory process. The analysis may reveal staphylococci, mycoplasmas, chlamydia, and gonococci. An increased number of leukocytes, the presence of erythrocytes, purulent cells, and mucus are also possible.
5. Spermogram - microbiological examination of seminal fluid is necessary to assess the condition of spermatozoa and determine their readiness for conception. Due to the inflammatory process, a decrease in the amount of ejaculate and a decrease in spermatozoa activity is possible. Various microorganisms, leukocytes, and erythrocytes can also be detected.

The above-mentioned analyses are carried out not only at the stage of disease diagnosis, but also during the treatment process to determine the effectiveness of the prescribed therapy.

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Instrumental diagnostics

To assess the degree of damage to the testicles and the entire genitourinary system, instrumental diagnostic methods are used.

To determine orchitis, the following studies are carried out:

1. Diaphanoscopy – the scrotum is illuminated with a beam of bright light. This method allows identifying the cause of painful sensations in the testicles, differentiating inflammation from testicular torsion, hydrocele and a number of other diseases.
2. Ultrasound examination – determines the extent of the inflammatory process. Allows to assess the size and shape of the affected organ. In case of orchitis, either one or both testicles may be enlarged. An echo-negative zone with echo structures is determined around the organ. Inflamed tissues appear as hypoechoic formations measuring 5-10 mm.
3. Magnetic resonance imaging is a more accurate diagnostic method compared to ultrasound. It determines the stage of the disease and the extent of the inflammatory process with maximum accuracy. It also determines the smallest foci of pus accumulation.

Instrumental diagnostic methods make it possible to promptly identify and prevent the development of abscesses, testicular atrophy and other degenerative changes in the organ.

Ultrasound diagnostics

Ultrasound examination is a mandatory diagnostic method if orchitis is suspected. All pathological foci are clearly visualized on ultrasound.

When performing ultrasound, high-frequency convex and linear sensors of more than 7.5 MHz are used. During the examination, the patient lies on his back, fixing the genital organ to the anterior abdominal wall with his hand. The ultrasound specialist directs the transducer perpendicular to the examined area and sequentially obtains tomograms in different planes (transverse, longitudinal, oblique) on the right and left sides of the scrotum.

If the inflammation is acute, the ultrasound will show the testicle to be enlarged in volume and its echogenicity to be reduced. Very often, effusion is detected in the organ membranes. When diagnosing chronic orchitis, minor changes in the organ size, its uneven contour and heterogeneous internal structure are determined. If there are signs of thrombosis, differentiation with tumor diseases is carried out.

Differential diagnosis

In its symptoms, orchitis is similar to many other diseases of the male genital organs. To determine the true cause of pathological symptoms, differential diagnostics are carried out.

Orchitis is differentiated from the following pathologies:

• Testicular tuberculosis.
• Tumor neoplasms.
• Testicular torsion.
• Strangulated hernia.
• Epididymitis.

As a rule, diagnosis is made using ultrasound, but if necessary, a biopsy may be prescribed.

Treatment orchitis

Read also:

• Folk treatment of orchitis
• Treatment of orchitis with medications

Prevention

Any disease is much easier to prevent than to treat. This also applies to testicular inflammation, the prevention of which comes down to such simple rules:

• Timely treatment of any diseases of the body, especially infectious and inflammatory lesions of the genitourinary system.
• Active lifestyle.
• Use of protective equipment to prevent injury to the genitals while working or playing football, hockey, martial arts and other traumatic sports.
• A balanced diet rich in vitamins and microelements that are beneficial for the body.
• Regular sexual life with one stable and healthy partner.
• Abstinence from sexual perversions and excesses.
• Protected sex, that is, using a condom, especially during casual sex.
• Conducting special gymnastics to eliminate congestion in the genital area and pelvis during prolonged sexual abstinence.
• Vaccination against epidemic mumps.
• Careful observance of personal hygiene.
• Giving up bad habits: alcohol, smoking, sedentary lifestyle, overeating.

Prevention of orchitis also involves avoiding overwork, hypothermia or overheating, since such conditions negatively affect the protective properties of the immune system, reducing them and increasing the risk of infection.

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Forecast

Provided that the diagnosis is early and the treatment is chosen correctly, orchitis has a favorable prognosis. In this case, the disease does not pose a danger to the reproductive system and is treated with conservative methods. As for the chronic form of the disease and bilateral lesions, the prognosis is often unfavorable, since there are high risks of developing irreversible complications that lead to infertility and disruption of the production of male sex hormones.

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