Orchitis in men: consequences and complications, diagnosis, prognosis

Inflammatory disease of male genitourinary organs with testicle damage is orchitis. Consider the main causes and symptoms of the disorder, the methods of diagnosis and treatment.

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

N40-N51 Diseases of the male sexual organs.

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

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

Very often, orchitis develops against a background of a distant infectious or inflammatory process in the body. Pathology can be caused by traumatic factors and can occur both in a one-sided form and with a bilateral lesion. In the latter case, there are high risks of irreversible infertility.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Epidemiology

According to medical statistics, in 60% of cases, orchitis occurs due to the action of various infectious factors. The remaining 40% is occupied by trauma and stagnant processes in the body.

Most often, the disease is a complication of mumps. With this effect, about 20% of men in post-pubertal age face. Moreover, the disease has no age dependence, that is, it affects both young boys and men of mature age. The presence of risk factors significantly increases the chances of inflammatory processes in the genitourinary system.

[10], [11], [12], [13], [14]

Causes of the 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. See also: Causes of orchitis

[15]

Risk factors

There are a number of predisposing factors that increase the likelihood of orchitis. Consider the main risk factors for this disease:

• Irregular sex life.
• Prolonged sexual abstinence.
• Sexual excesses.
• A sedentary, sedentary lifestyle.
• Chronic hepatitis.
• Diabetes.
• Immunodeficiency conditions.
• Physical or mental fatigue.
• Overcooling or overheating of the body.
• Violation of urination.
• Various diseases of the genitourinary system.

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

[16], [17], [18], [19]

Pathogenesis

The mechanism of orchitis development depends on the causes that triggered the inflammatory process. Most often, pathogenesis is associated with the spread of the infection by the hematogenous pathway. Pathogenic microorganisms penetrate the organs of 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.

Infection can enter the testicle lymphogenically or by contact with orchid epididymitis. There is also a canal pathway for the spread of pathogenic flora, that is, along the vas deferens from the prostate gland, the posterior part of the urethra and seminal vesicles.

Various trauma and inflammatory processes in the urethra are characterized by hematogenous infection of the testis and its epididymis. The development of the disease can be the result of a violation of the blood circulation of the testicle. This occurs with a sharp strain of the anterior abdominal wall and squeezing the spermatic cord. Straight injuries of the scrotum with a ruptured testicle are complicated by acute orchitis.

[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]

Symptoms of the orchitis

The main sign of orchitis - a pronounced pain in the groin, which can give in the back. Gradually, the scrotum turns red and swelling occurs. At a palpation there are sharp pains, and inguinal lymph nodes are increased in sizes.

If the orchitis develops in an acute form, then the body temperature rises sharply to 39-40 ° C. Against this background, there is a chill and febrile condition, nausea and vomiting are possible. Defecation and urination are painful, in urine there may be impurities of blood.

Such a symptomatology develops within 1-3 days by increasing. Thus the discomfort descends in 2-3 days. But the disappearance of signs of the disease may indicate its transition to a chronic form, which threatens serious complications.

Other symptoms of orchitis can be found here.

Stages

Inflammation of the testicle has several stages, consider them:

• Light - subfebrile body temperature for 1-3 days, worsening overall health. The skin of the scrotum is hyperemic and swollen, painful sensations arise when trying to palpate.
• Average - high body temperature, general intoxication of the body. The scrotum is enlarged in size, hot to the touch and painful. Pain gives back and groin in the lower back.
• Heavy - body temperature 40 ° C for more than 5 days, pronounced symptoms of general intoxication, depressed consciousness. Inflammation is complicated by purulent processes, possibly the formation of abscesses and fistulas. There may also be an infectious-toxic shock.

From the diagnosed stage of orchitis depends the method of treatment of the disease and its prognosis.

[33], [34], [35], [36], [37], [38], [39], [40], [41]

Complications and consequences

With timely diagnosis and treatment, orchitis is completely cured. But if the disease takes a chronic form or is complicated by a secondary infection, then there is a high risk of developing such consequences of the disease:

• Abscess - a purulent lesion of the tissues of the organ with a pronounced intoxication syndrome.
• Formation of adhesions between the testis and scrotum.
• Formation of fistulas in the tissues of the scrotum.
• Infringement of blood supply of the organ with subsequent atrophy and necrosis of the testicle.
• Two-sided epididymitis.
• Infertility.

Violation of the 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 face a violation of the childbearing function. Infertility develops because of the direct action of the infection on spermatozoa, the violation of the secretion of the sex glands and immune mechanisms.

Also, the disease can be complicated by a violation of the production of testosterone. Because of this, the libido decreases, the erection weakens, the overall muscle mass of the body decreases and the working capacity decreases significantly.

One of the serious complications of orchitis is an abscess. It develops as a result of hypothermia, with a reduced immune system, infection with the infection, and as a result of injuries. The abscess is formed in the tissues of the testicle and is a capsular formation with purulent contents.

Symptoms of complications:

• Swelling and redness of the scrotum.
• Intensive pain in the groin, which persist both during movement and at rest.
• General and local increase in temperature to febrile values.
• Febrile state.
• Muscle pain and weakness.

The new formation leads to the fact that the testicles are melted, so when they palpate, a sensation of mobility of the liquid contents of the capsule appears. An abscess can occur under the guise of acute pathologies of the inguinal and scrotal area, simulating tuberculous orchitis or neoplastic tumors. Clear signs of an abscess make themselves felt when the antibiotic therapy is ineffective.

To diagnose a purulent focus of inflammation, scrotal ultrasound is prescribed. Differentiation is performed with tumors of the epididymis, testicular infarction, epididymitis. The method of treatment 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 the risk of spreading the infection, then the affected testicle is removed, that is, an orchiectomy is performed.

[42], [43], [44], [45], [46], [47], [48], [49], [50]

Diagnostics of the orchitis

As a rule, the process of diagnosing inflammation of the testicle is not difficult. Suspicions of orchitis may occur during the collection of anamnesis and examination of the patient. To establish the exact cause of the disease and choose an effective method of treatment, a set of laboratory and instrumental studies is conducted.

A physical examination of the testicle, that is, palpation and palpation, is the basis for diagnosing orchitis. To identify a specific infection, differentiate prostatitis and prostate adenoma, a rectal examination of the prostate, the cupern glands and seminal vesicles is performed. To determine the condition of the inflamed organ, ultrasound of the scrotum and diaphanoscopy is necessary.

Particular attention is paid to laboratory methods. To determine the causes of inflammation and determine the causative agent, a general analysis of urine and culture on the microflora. If you have an infection, you may need to analyze the ejaculate. It is also necessary to analyze for STDs. If there is a suspicion of a tumor, the patient donates blood to cancer markers.

[51], [52], [53], [54], [55], [56], [57], [58], [59], [60]

Analyzes

Laboratory diagnosis for suspected orchitis is necessary not only to confirm the diagnosis, but also to determine the causative agent and assess the general condition of the body.

With inflammation of the testicle, patients are prescribed a complex of tests:

1. A general blood test - determines the severity of the inflammatory process. With bacterial infection, there is an elevated level of leukocytes and shift of the leukocyte formula to the left, increased ESR. At a virus infection - high values of leukocytes. If the cause of the disease is parasitic infection or allergic reactions, the analysis reveals an increased level of eosinophils,
2. General analysis of urine - determines the degree of inflammatory damage of the genitourinary system. With orchitis, pyuria is detected, the presence of erythrocytes and cylinders in the urine.
3. Bacteriological analysis of urine - reveals pathogenic microorganisms and determines their sensitivity to antibacterial drugs. Inflammation of the testicle can be detected: E. Coli, Staphylococcus, Pseudomonas aeruginosa, Proteus, Streptococcus and other pathogens.
4. A smear from the urethra - determines the type of pathogenic microorganism and the nature of the inflammatory process. In the analysis, staphylococci, mycoplasma, chlamydia, gonococci can be detected. It is also possible an increased number of leukocytes, the presence of red blood cells, purulent cells and mucus.
5. Spermogram - a microbiological study of seminal fluid is necessary for assessing the spermatozoids condition and determining their readiness for conception. Because of the inflammatory process, it is possible to reduce the amount of ejaculate and decrease the activity of spermatozoa. Also, various microorganisms, leukocytes, erythrocytes can be detected.

The above analysis is carried out not only at the stage of diagnosis of the disease, but also in the treatment process to determine the effectiveness of the prescribed therapy.

[61], [62], [63], [64], [65], [66]

Instrumental diagnostics

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

To determine orchitis, the following studies are carried out:

1. Diaphanoscopy - the scrotum is visible through a beam of bright light. This method allows you to identify the cause of pain in the testicles, differentiate inflammation from torsion of the testicle, hydrocele and a number of other diseases.
2. Ultrasonography - determines the extent of the inflammatory process. Allows you to estimate the size and shape of the affected organ. With orchitis, both one testicle and both can be enlarged. An echo-negative zone with echostructures is defined around the organ. Inflamed tissues look gipoehogennymi formations of 5-10 mm.
3. Magnetic resonance imaging - a more accurate method of diagnosis in comparison with ultrasound. It determines the stage of the disease and the degree of prevalence of the inflammatory process as precisely as possible. It also determines the smallest foci of pus accumulation.

Methods of instrumental diagnostics make it possible to detect and prevent the development of the abscess in a timely manner, atrophy of the testicle and other degenerative changes in the organ.

Ultrasound diagnosis

Ultrasound is a mandatory diagnostic method for suspected orchitis. Ultrasound clearly visualizes all pathological foci.

When performing ultrasound, high-frequency transducers of more than 7.5 MHz convection and linear sensors are used. During the study, the patient lies on the back, fixing the genital organ to the front wall of the abdomen. Uzist directs the transducer perpendicular to the area under investigation and sequentially receives tomograms in different planes (transverse, longitudinal, oblique) from the right and left side of the scrotum.

If the inflammation proceeds in an acute form, then the testis is enlarged in volume in the ultrasound, and its echogenicity is lowered. Very often, an effusion is found in the shell of the organ. In the diagnosis of chronic orchitis, unimportant changes in the size of the organ, its uneven contour, and the heterogeneous internal structure are determined. If there are signs of thrombosis, then differentiation is carried out with tumor diseases.

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 diagnosis is performed.

Orchitis differentiate with such pathologies:

• Testicular tuberculosis.
• Tumor neoplasms.
• Testicular torsion.
• Injury of the hernia.
• Epididymitis.

Usually, the diagnosis is carried out using ultrasound, but if necessary, a biopsy can be administered.

Treatment of the orchitis

Read also:

• Folk treatment of orchitis
• Treatment of orchitis with medicines

Prevention

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

• Timely treatment of any diseases of the body, and 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 soccer, hockey, when engaged in single combat and other traumatic sports.
• A balanced diet rich in vitamins and microelements useful for the body.
• Regular sexual life with one constant and healthy partner.
• Abstention from sexual perversions and excesses.
• Protected sex, that is, the use of a condom, especially with occasional sexual intercourse.
• Carrying out special gymnastics to eliminate stagnation in the genital and pelvic region with prolonged sexual abstinence.
• Vaccination against mumps.
• Careful observance of personal hygiene.
• Refusal from bad habits: alcohol, smoking, sedentary lifestyle, overeating.

Also, prevention of orchitis means avoiding fatigue, hypothermia, or overheating, since such conditions adversely affect the protective properties of the immune system, reducing them and increasing the risk of infection.

[67], [68], [69], [70], [71], [72]

Forecast

Under condition of early diagnosis and properly selected treatment, orchitis has a favorable prognosis. In this case, the disease poses no danger to the reproductive system and is treated with conservative methods. As for the chronic form of the disease and bilateral lesion, the prognosis is more often unfavorable, since there are high risks of development of irreversible complications that lead to infertility and disruption of the production of male sex hormones.

[73], [74], [75]