epididymo-orchitis: the foundations of its diagnosis and treatment
- causes of disease
- Symptoms and Diagnosis of the disease
- Accepted methods of treatment
- Forecastand prevention
Inflammation of the testicle and epididymis are very frequent diseases of urological nature.Allocate epididymitis (inflammation of the epididymis) and orchitis (testicular inflammation).
epididymo-orchitis is characterized by a set of inflammatory processes in the epididymis and testis, ie the simultaneous infection of a certain type of organ infection.
Medical Practice shows that the disease testicular appendages, and are recorded in about 5% of all urological diseases.At the same time, it epididymitis detected in 85-90% of the total number of diseases of the scrotum, and 10-15% of infections occur directly on epididymo-orchitis.
causes of disease
orchiepididymitis conventionally divided into 2 types:
inflammatory process in each case has it
beginning of the inflammatory process caused by hit of microorganisms in the blood or sperm ducts.Non-specific epididymo-orchitis may be called microflora opportunistic nature.They include: E. coli, some strains of staphylococcus, chlamydia.Development of the infection occurs on the background of a weakened immune system.
use of catheterization, urethral resection of the prostate in some cases become a cause epididimoorhita.It should focus on the development of nosocomial infections, which considerably complicates the treatment.
main causes of non-specific epididimoorhita:
- severe hypothermia (especially in the pelvic area);
- infectious diseases of the respiratory and digestive organs (due to lower immunity), dominated by hematogenous route of transmission;
- physical injury to the scrotum;
- surgery on the prostate gland;
- perform manipulation of medical character with urinary organs.
To date, there is no clear evidence that the non-specific inflammation of the epididymis and testis type is caused by a particular pathogen or is a frequent complication of other diseases.The disease is caused by a set of processes, based on individual characteristics.
specific epididymo-orchitis occurs on the basis of the spread and development of specific infections.There are the following subtypes of the disease:
Each subspecies specific epididimoorhita has its own characteristics and its treatment strategy.
Gonorrheal phase of the disease occurs on the background of complications of gonococcal urethritis due to improper treatment and its transition to the chronic form.Inadequate treatment leads to the fact that the seed fall gonococci duct, then in a retrograde fashion appendage and penetrate the egg.
Trichomonas epididymo-orchitis occurs, usually due to late initiation of treatment of trichomoniasis and inadequate therapeutic measures.Running form trichomoniasis can weaken the immune system, creates a favorable background for the department of organ scrotum.
Tuberculosis disease raises questions in modern medicine.It is not clear the mechanism of penetration of mycobacteria in the scrotum and tab source process.Nevertheless, there is an isolated lesion testicle and epididymis, which is typical of tuberculosis infection.
Symptoms and Diagnosis of the disease
Symptoms are usually nonspecific epididimoorhita clearly indicate the cause of the inflammatory process.Signs of infection of the epididymis and testis:
- sudden onset of pain (pain and pulling the rest is very strong when you touch the scrotum), irridatsiya pain in the groin;
- enlarged condition of the epididymis and testis (clearly revealed probing;
- redness and swelling of the scrotum
Diagnosis of the disease include examination of the patient, the appointment of ultrasound study of medical history, laboratory blood test is important to understand that it is necessary to differentiate nonspecific and specific form of the disease,..as well as its chronic therefore accepted diagnostic circuit includes:
- carrying out general analysis of blood and urine;
- procedure swab from the urethra (possible detection of Trichomonas, gonococci;
- research on the content of the tuberculosis pathogen in the urine (important when chronic.forms);
- PCR analysis;
- ultrasound of the scrotum;.
- Wasserman (RW)
is also necessary to emphasize that chronic and nonspecific indolent form epididimoorhita are implicit in nature.Many symptomatic aspects are hidden.For such forms inherent in the emergence of pain under load (running, walking, swimming).After its abolition is reduced or completely takes the pain.Palpation of the scrotum leads to a weak and diffuse pain.Symptoms of the disease is similar to epididymitis, orchitis and scrotal abscess.Therefore, an accurate diagnosis is made only on the basis of comprehensive data.
epididimoorhita nonspecific signs may differ significantly from the classic disease and depend on the particular pathogen.Most of the symptoms are kind of blurry.When gonorrhoeal orchiepididymitis seen such signs:
- pain in the scrotum;
- thickening of the spermatic duct;
- meager discharge from the urethra.
Diagnostic procedures include taking a smear, PCR diagnostics.
Trichomonas orchiepididymitis diagnosed thus:
- detection of Trichomonas in urine and semen;
- diagnosis by PCR;
- detection of antibodies to Trichomonas.
Clinical manifestations of tuberculous inflammation and testicular appendages:
- low-grade fever;
- detection of small hardness, in the scrotum;
- general weakness;
- fistula formation in the testes (in the later stages of the disease);
- simultaneous bilateral testicular damage.
Diagnosing specific orchiepididymitis deserves close attention, because there is a high likelihood of serious complications, especially in the form of tuberculosis, which may require urgent surgery organunosyaschey.
Accepted methods of treatment
Description of the main treatment options is the average character.In a real situation will require an individual adjustment of the urologist.
Methods of treatment of non-specific form of the disease includes the following measures:
- powerful antibiotic therapy, using fluoroquinolone antibiotics, cephalosporin and aminoglikozidovoy groups (selection of antibiotics is carried out individually and can include other groups of drugs);
- rigid diet;
- ice packs to the scrotum;
- preparations enzyme content (have a resolving action);
- strict bed rest;
- wearing special bandages (fixing the scrotum at the top orientation).
is important to bear in mind that with ineffective treatment by conservative may be an abscess.As a result, you will need emergency surgery for drainage of purulent discharge, and in the worst case it is necessary to carry out the removal of affected parts.Some recent research shows the advantage of the early operations, in connection with what is possible to achieve stable guarantees for the preservation of fertility.Classical schemes involve surgical intervention only in the case of septic forms of the disease.
specific epididymo-orchitis is treated depending on the type of agent.Treatment of gonococcal infection of the testicles and appendages shall be appointed by a urologist based on laboratory data.Global value has properly selected antimicrobial and time of its application.After treatment a repeated control study.It is particularly important to prevent recurrent events, which resulted in increased pathogen resistance.
Treatment of trichomoniasis form held complex.Antibiotics of different groups, immunomodulators, held trihovaktsinatsiya.The final stage of the treatment provides detailed control of presence of Trichomonas.At the same time carry out restorative procedures.
most difficult to treat TB phase.Patients most often delay the disease, as a result at the time of recourse observed severe picture of the disease.Not rare kidney damage, bladder and prostate.Treatment is carried out only permanently, according to anti-TB treatment regimens.
Prediction and prevention
description of all clinical cases epididimoorhita provides certain regularity.Treatment success is directly related to the timing of the disease.In time assist in non-specific form of the disease has a favorable prognosis.Chronic diseases and specific forms of leave grave prognosis.There is also the concept of hospital infections.Orchiepididymitis, which arose as a result of infection in a hospital, will require a very careful and professional treatment.This is caused by increased resistance of the pathogen to most antimicrobials.