Orhoepididymitis

Orhoepididymitis (or epididymoorkhit) is a simultaneous combination of two separate infectious inflammatory urological diseases that can provoke and develop each other. Orchitis is an inflammatory process in the testicles of a man, epididymitis is an inflammation of the epididymis. Usually, it is difficult to differentiate if only the testicle is inflamed, or the process also affects the appendage. As a rule, in the presence of epididymitis, inflammation soon spreads to the testes, whereas orchitis may be localized.

[1], [2], [3], [4]

Causes of the orcoepidymitis

The path of infection is often due to a sexually transmitted infection, or hematogenous, that is, any focus of infection in the body can be a predisposing factor for the occurrence of orhoepididymitis.

Orhoepididymitis requires obligatory timely treatment, otherwise neglected inflammation leads to disruption of the testicles, and, consequently, to infertility caused by the fact that spermatozoa cease to be produced.

The place of flow can be divided into orhoepididymitis on the right, orhoepididymitis on the left and bilateral orthoepididymitis. Primarily, in the initial stage, the disease is still one-sided.

The most frequent causes of orhoepididymitis are viral infections, leading to inflammatory processes (urethritis, prostatitis). In men younger than 35 years, this disease is most often caused by sexually transmitted bacteria, as complications of gonorrhea or trichomoniasis. In men over 35 years of age, the causative agents of orhoepididymitis are most commonly non-sexually transmitted, Gram-negative intestinal microorganisms that cause urinary tract infections (cystitis, pyelonephritis). This can be combined with an alleged history of micturition disorders. There are also cross cases, so a prerequisite for diagnosis is to obtain complete information about the patient's sexual relations.

Orhoepididymitis caused by enterobacteria, sexually transmitted infections, may be in homosexuals practicing penetrating anal sex.

There is also a traumatic orchoepididymitis or post-traumatic orcoepididymitis, which can be caused by a testicle trauma (as a result of striking the groin or falling on the perineum), with the possible infection or the development of nonspecific inflammatory reactions - swelling, pain, increased blood flow in the area of injury.

Less common is tuberculous orchid epididymitis, the causative agent of which may be a tuberculosis or viral infection.

[5], [6]

Risk factors

Factors that have an impact on the development of the disease include: hypothermia of the legs and perineum, previously transmitted infectious diseases (influenza, pneumonia, typhoid or parotitis), complications after surgery on the pelvic organs, scrotum or prostate gland or catheterization.

[7], [8], [9], [10],

Symptoms of the orcoepidymitis

The disease often begins acutely. The first signs of orhoepididymitis are a rise in temperature to 39-40 grams, that is, intoxication is already in a fairly progressive form and acute pain in the scrotum from the corresponding side of the lesion. The peculiarity of orcoepididymitis is that the rise in temperature can occur before the pain sensations appear. Also visually you can see a suspicion of orchid epididymitis, if there is redness and swelling of the scrotum over the inflamed testicle, sometimes a bleeding from the urethra or blood in the semen can also be a symptom.

Orhoepididymitis in children

In boys under the age of 15, orcoepididymitis is rare, and is mainly caused by complications of viral mumps and rubella, or abnormalities of the urinary tract.

Children under the mask of orhoepididymitis often hide other problems (torsion of the spermatic cord or testicle), which require urgent surgical intervention. The diagnosis of "orcoepididymitis" is made only after the exclusion of other diseases, which is possible after studying carefully collected history and full examination of the child.

To the development of orcoepidymitis at this age often leads to severe hypothermia of the legs and perineum, and as a result, the blood supply of this part decreases. Orhoepididymitis may also be caused by trauma or previous surgery.

Forms

[11], [12], [13]

Acute orchiepididymitis

The acute stage is characterized by severe pain in the groin, which in a few hours are localized in one half of the scrotum. The external manifestation will be the redness of the scrotum, a significant increase from one, the affected side, the smoothing of the folds. Any, even the most insignificant, touch to the inflamed place is very painful. There are also signs of intoxication - headache, nausea, weakness, high fever.

Such inflammation, if there is no necessary treatment, can last about a week or two, and then either regress or go into a chronic stage. However, acute orchitis often abscesses, can be complicated by thrombosis of the testicles, its necrosis.

[14], [15], [16]

Chronic orchid epididymitis

At a chronic stage, the temperature is usually normalized, the pain is of a periodic nature, can be intensified by sexual contact. In the physical examination of the testicle, a painful compaction is determined-an inflamed appendage.

Periods of chronic exacerbation are usually followed by short periods of remission, with exacerbations often occurring in early spring and autumn. The main problem with the chronic form of orhoepididymitis is that the disease can spread to the other side of the testicle with appendages, which will affect spermatogenesis.

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Purulent orchid epididymitis

In the worst case scenario, acute orchiepididymitis can provoke suppuration of the epididymis or the testis itself, as a result of which there is a decrease in the patency of its duct and, consequently, a violation of spermatogenesis. With bilateral inflammation, it often leads to infertility. Therefore, until a bilateral bilateral orchid epididymitis is diagnosed, the prognosis is favorable.

Complications and consequences

Regardless of the stage of the disease, a qualified treatment for orhoepididymitis should be carried out as soon as possible after detection. Such inflammatory diseases can give strong complications to the entire genitourinary system of men. If untimely treatment of the disease can occur suppuration in the testicle or appendages or the transition of inflammation to the other side of the scrotum, which, in the final analysis, will lead to infertility. In addition, the possibility of sexual intercourse is limited, since complete rest for these organs is necessary, and excitation will be accompanied by strong pain sensations.

The sooner a qualified treatment starts, the more likely it is that the outcome will be favorable, without prompt intervention. The launched stage of orhoepididymitis, when the lesion has spread to both sides of the organs, can lead to serious violations of the reproductive function of men, and even to infertility!

[18], [19], [20]

Diagnostics of the orcoepidymitis

To determine the diagnosis, in the presence of symptoms, after examination, the urologist conducts laboratory diagnostics, after which the nature of the infection is determined and the causative agent of the disease is identified, for the purpose of appropriate treatment. In addition, ultrasound examination of the scrotum organs is mandatory.

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Analyzes

• a general blood test and a three-glass urine test;
• the collection of the average portion of urine, for the isolation of the bacterial culture.

[22], [23], [24], [25],

Instrumental diagnostics

• a smear from the urethra or the first portion of urine to detect urethritis (the presence of an excessive number of PMNs);
• patients with urethritis are examined for the presence of Gram-negative intracellular diplococci, to exclude the diagnosis of gonorrhea.
• presence of mucopurulent / purulent discharge from the urethra also indicates urethritis;
• a study for the presence of chlamydia bacteria.

Differential diagnosis

Orhoepididymitis must be clearly differentiated with orchitis, epididymitis, cramped inguinal hernia and suppurating cyst of the spermatic cord, since the treatment in different cases is radically different.

The most important is the immediate differentiation between orchoepididymitis and torsion of the spermatic cord, using all available information. With this diagnosis, color Doppler ultrasound scanning can help. Also, the elevated position of the scrotum with orhoepididymite significantly reduces pain, whereas on the twist of the spermatic cord, on the contrary, it strengthens.

Diagnosis of torsion of the spermatic cord is of paramount importance, since this condition requires immediate operation. With similar symptoms, all patients are checked for torsion of the spermatic cord and are excluded in the first place, since with the loss of time, the rescue of the testicles becomes less likely.

Treatment of the orcoepidymitis

A trial treatment is performed for all patients with orcoepidymitis before receiving a microbiological analysis. Treatment of orchoepidymitis with antibiotics is performed according to the results of immediately performed tests taking into account the age of the patient, anamnesis, sexual relations, the fact of recent instrumental intervention or catheterization and the presence of any known abnormality of the urinary tract in the patient.

The patient is recommended bed rest, lifting and supporting the scrotum with a suspension or an ice towel. Appointed analgesics, also possible non-steroidal anti-inflammatory drugs.

In addition, it is necessary to prescribe the treatment of the infectious disease that caused the development of inflammation. For the beginning, prescribe antibiotics for general use, (for example Nitroxoline - taken in the form of powder, during meals, adults - 100 mg 4 times a day, 2 weeks course), antibiotics of the quinolone / fluoroquinolones group (Ofloxacin or Pefloxacin), enzymes, resorbants . Almost always homoeopathy and vitamins of group E are supported, which support and stimulate the nominal system and speed up recovery.

When detecting chlamydia viruses as a causative agent, therapy should also be supplemented with doxycycline, 200 mg / day, with a duration of treatment of at least 2 weeks.

At the end of the acute process, local thermal procedures, physiotherapeutic treatment (laser) are used. Also use venotonik Troxevasinum with orhoepididimite, for lubricating the scrotum in the intervals between the installation of compresses. Necessarily prescribed diet with the exception of alcohol, spicy and fatty foods, abundant drinking.

Treatment of chronic epididymitis occurs in the same way as acute, but longer, with the use of therapeutic procedures, homeopathic and vitamin complexes.

With the development of a purulent abscess, an urgent operation is performed to dissect and drain the testicle for its purification from pus. Otherwise, if delayed, it will be necessary to remove the affected testicle so that the suppuration does not spread even further.

When detecting chlamydial or gonococcal orchoepidymitis, treatment is also carried out for all partners who have been in contact with it.

Most patients showed the use of laser-magnetic effects on the affected organs. Magnetic therapy with orhoepididymite 2-3 times reduces the duration of the acute phase of inflammation of the scrotal organs and contributes to a more rapid recovery of testicular tissues.

Alternative treatment of orhoepididymitis

Use alternative methods of treatment is allowed only after their approval by the attending physician, and determining the absence of allergies to any component.

The most common and effective method of alternative medicine is herbal medicine. For example, tea made from tansy flowers, horsetail, cranberry leaf. It is necessary to take an incomplete tablespoon of each herb, pour boiling water (0.3 liters) and soak for half an hour. Then strain, so that too much tart concentrate is formed and cooled. Take 3p per day for 200 ml on an empty stomach.

They also take a collection of 1 tsp. Anise, parsley, juniper, stalk root, dandelion, bearberry leaves, filled with 0.5 liters of boiling water and infused for about half an hour. Then strain and take 250ml every morning and evening.

Also, with the permission of the attending physician, wax is used to treat orchoepidymitis. Namely - a home ointment is made of wax, vegetable oil, egg yolk, which can reduce purulent and inflammatory processes. To make it, you must melt 20 grams of beeswax in a saucepan on a steam bath, and stir thoroughly, add the steeply cooked egg yolk and 30 grams of vegetable oil. Cook this way for 5 minutes and cool.

Another active herbal remedy for home treatment includes 3 tsp St. John's wort, peppermint, dried currant leaves, dog rose, 4 tsp corn stigmas, cranberry leaves, horsetail, 5 tsp parsley and roots of wheatgrass. All mixture pour 1 liter of hot boiled water and let it brew. To drink during the day.

It is useful to chew honey with wax - if there are no allergic reactions, with an interval of 45-50 minutes chew 0.5 ts.l zabrusa.

[26], [27]

Prevention

For the purpose of prevention, it is necessary to observe fairly simple rules:

• avoid accidental and doubtful sexual contacts, use of contraception;
• undergo an annual STI screening;
• follow the rules of personal hygiene;
• timely treatment of infectious diseases of the genitourinary system;
• closely monitor their health during common infectious diseases, in the presence of suspicious symptoms immediately go to the urologist;
• avoid trauma in the pelvic area, as well as hypothermia.

[28], [29], [30]

Forecast

Usually, if you contact an experienced doctor in a timely manner, the prognosis is favorable, the disease is successfully treated. If you start and the inflammation goes into purulent or, worse, affects the other side of the scrotum, it can lead to the removal of the testicles and appendages, and, accordingly, the prognosis worsens. The probability of infertility in the case of incorrect or untimely treatment of hovoepididymitis can reach 50%, and in the bilateral process - up to 100%.

Therefore, with orhoepididimite, a timely appeal to an experienced specialist, correct diagnosis and previous treatment is of utmost importance. Do not self-medicate, without notification and agreement with the attending physician, - the price is too high for your future.

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