Epididymitis is one of the reasons for decreased male fertility

Epididymitis is an inflammatory process in the epididymis. This organ is directly involved in the formation of sperm. His disease, in the absence of adequate treatment, can lead to the most serious consequences, including infertility.

Most often, epididymitis affects men and adolescents aged 15-30 years, as well as older people over 60 years of age.

In addition, the reasons for the development of epididymitis can be:

• complications after infectious mumps (so-called mumps);
• hypothermia;
• constant difficulty urinating;
• complications of tuberculosis.

Indications

Surgical treatment is indicated in the following cases:

• Abscess of the epididymis or testicle.
• Accumulation of pus.
• Lack of results from antibiotic treatment.
• Acute form of the disease.
• Infertility due to obstruction of the appendage.

Contraindications

It is not recommended to perform surgery in case of exacerbation of chronic diseases and allergic reactions to medications and painkillers.

Treatment of the disease

Therapy depends on the course of the disease. If it is acute, but there are no complications, then patients are treated on an outpatient basis. If there is a threat of complications, the patient is hospitalized. For drug treatment, drugs from the following groups are used:

• Antibiotics. The most commonly prescribed fluoroquinolones are effective if the disease is caused by E. coli or chlamydia.
• Non-steroidal anti-inflammatory drugs. They are used to relieve pain and relieve inflammation. Antispasmodics, analgesics and novocaine blockade are also used to eliminate pain.
• Antituberculosis drugs. Prescribed for the tuberculosis form of the disease (and only with timely detection). Treatment is quite long - can reach 1 year (with a suppressed immune system).

The treatment regimen is determined solely by the attending physician. The choice of drugs depends on the causative agent of the disease: sore throat, influenza, tuberculosis, sexually transmitted infections, etc.

How does epididymitis manifest?

The most common symptoms of this disease are swelling, pain and swelling of the scrotum, as well as redness on the affected side.

Ultrasound of the scrotum

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Epididymitis also manifests itself:

• the appearance of bloody impurities in the semen;
• temperature rise to 38-39 degrees Celsius;
• discomfort and pain in the groin and lower abdomen;
• pain and burning during ejaculation or during urination;
• discharge from the opening of the urethra;
• increased pain in the scrotum during movement or defecation;

Testicular anatomy

The testicle is a paired oval-shaped glandular organ that is responsible for the production of testosterone and sperm. The weight of the testicles rarely exceeds 30 grams. They are located inside the scrotum and are covered with white tissue, which visually divides the organ into 300 small parts. All parts have approximately 2-3 seminal canals. They contain Sertoli cells, which are responsible for the production of healthy sperm. Between the channels are Leydig cells, which stimulate the production of testosterone. In order for sperm to leave the testicles, it travels a long way through the efferent, convoluted, straight and accessory canals.

Infertility after epididymitis

An inflamed epididymis cannot be responsible for the metabolism, maturation, accumulation and movement of germ cells, which occurs normally. It is in the epididymis that sperm accumulate for maturation, which becomes impossible when inflammation develops in them. As a result, problems with reproductive health and the inability to fertilize a woman occur. If the process is long, then connective tissue grows in the epididymis, which obstructs the lumen of the vas deferens and an obstructive form of infertility occurs when sperm cannot pass through the canals and fertilize the partner. In this case, you only have to resort to testicular puncture to obtain germ cells and carry out conception using in vitro fertilization.

Severity of acute epididymitis

The transition of the pathology to the acute stage is accompanied by pronounced symptoms. There are 3 stages in total: mild, moderate, severe:

• Mild – lasts up to 3 days. An ultrasound reveals an enhanced vascular pattern, and a blood test shows an increase in leukocytes to 12,000.
• Moderate – lasts up to 6 days and has severe symptoms, including an increase in body temperature to 39 degrees Celsius and pain. Ultrasound examination reveals inflammation and hypoechoic neoplasms up to 10 mm.
• Severe – lasts more than 7 days and is accompanied by severe symptoms. A blood test shows a leukocyte count of up to 25,000, which indicates a strong inflammatory process (body temperature rises to 40 degrees Celsius). The accumulation of pus is maximum, the epididymis is significantly enlarged.

Diagnosis of inflammation of the epididymis in men

At the initial appointment, the doctor asks the patient the necessary questions, collecting anamnesis. In particular, the doctor is interested in:

• nature of complaints;
• past infectious diseases;
• injuries and operations in the scrotum area;
• sexual activity;
• presence of bad habits;
• lifestyle and working conditions.

Then the urologist-andrologist conducts:

• examination, assessing the condition of the genital organs;
• digital rectal examination of the prostate gland.

Based on the results obtained, if acute or chronic inflammation of the epididymis is suspected, the following are prescribed:

• seeding of urethral discharge on the UPM;
• culture of prostate secretion on UPM;
• PCR for urogenital infections;
• microscopy of urethral discharge;
• clinical blood test;
• Ultrasound examination of the scrotal organs. Ultrasound, being a completely safe and highly informative method, allows you to carefully study the structure of the genital organs and identify pathological processes. The additional use of Doppler makes it possible to assess blood flow, which, in particular, helps to distinguish epididymitis from testicular torsion, which has similar symptoms;

Additionally, studies such as TRUS and microscopy of prostate secretions can be performed.

After recovery, a spermogram is prescribed. Analysis of the ejaculate allows us to identify a violation of the process of spermatogenesis, as well as the presence of leukocytes and pus in the seminal fluid.

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Diagnostic measures

If a man or boy exhibits some symptoms of epididymitis, he should immediately make an appointment with a highly qualified specialist. The urologist will diagnose and accurately establish a diagnosis for further treatment. In some cases, patients need to be hospitalized. The path to recovery directly depends on what period of the disease you went to the hospital. This will help not only to heal more effectively, but also to avoid many complications.

The most common way to diagnose epididymitis is a medical examination, during which the patient describes his complaints. Examination of the prostate, glands and vesicles will help identify the presence of infection. Based on such an examination, the doctor will prescribe a number of research techniques, such as:

• General and biochemical blood test. If the level of leukocytes and monocytes in the blood is elevated, this may be the cause of tuberculosis or brucellosis. An increase in ESR indicates inflammatory processes in the body. Kidney failure is manifested by an excess of keratin. Epididymitis is characterized by an increase in gamma globulins and c-reactive protein.
• Laboratory examination of urine. Thanks to this analysis, urinary tract diseases are detected.
• A swab from the urethra. Determination of the internal environment of the organ, detection of STIs. Direct microscopy methods help identify the causative agent of epididymitis. The taken material is examined under a microscope, and the material is also placed in a special environment favorable for the propagation of the pathogen. The material used is smears, secretions, urine, semen, and fluid from the prostate gland.
• Ultrasound with Doppler of the pelvic organs, as well as conventional ultrasound of the scrotum. Designed to quickly locate the affected area. The procedure is quick and painless, one of the leading in diagnosing this disease.
• CT or MRI. This method will help to examine the lesion as accurately as possible and determine the condition of the scrotal organs, see the onset of an abscess on the screen and determine the stage of inflammation.

When diagnosing, it is necessary to conduct an examination and check the tests of the sexual partner without fail, even in the complete absence of symptoms. Based on these data, the urologist prescribes treatment; it can be at home or inpatient.

What is the treatment for epididymitis?

A urologist deals with the elimination of pathology. In the acute stage and rising temperature, hospitalization is carried out with strict maintenance of bed rest. Locally apply cold compresses to the scrotum and fix it in its normal position. The diet is normalized, spicy and sour foods are excluded. Next, physiotherapy, antibiotics and vitamins are taken. If pus has formed, then an opening and cleaning is performed. In extreme cases, the appendage is removed to prevent the spread of infection.

Therapy for this disease should be carried out under the close supervision of a urologist. The doctors at the CELT clinic have extensive practical experience and an impressive amount of knowledge, which means they will help you get rid of this pathology in the shortest possible time.

Modern medicine uses conservative and surgical methods to treat inflammation of the epididymis. Conservative methods are relevant in the absence of suppuration and high intoxication, when the symptoms are not so pronounced. Blockage of the seminiferous tubules, accumulation of pus, increased body temperature and acute pain during ejaculation are the main indications for surgery.

Causes of inflammation

Inflammation of the appendages in men: the causes can be very diverse.

All causes of the disease are usually divided into 4 factors:

1. The infectious factor is associated with the penetration of nonspecific (bacteria, viruses, fungi, mycoplasma or chlamydia) or specific (gonorrhea, syphilis and tuberculosis) infection into the epididymis through the blood, lymphatic vessels or through the urethra and seminal product. There is another way for infection to enter the epididymis - infection from distant areas due to sore throat, sinusitis and furunculosis.
2. The infectious-necrotic factor is caused by torsion of the appendage of the epididymis, as well as as a result of sterilization (sperm cells penetrate into the tissue of the epididymis, causing inflammation).
3. The stagnation factor is associated with impaired blood flow in the pelvic organs - blood stagnation, or as a result of excessive blood filling. The cause of “stagnation” can be interrupted sexual intercourse, masturbation with an erection, constipation, hemorrhoids, excessive sexual activity, as well as prolonged cycling.
4. The traumatic factor is directly related to injury to the scrotal organs, after surgery, as well as after medical manipulations on the reproductive organs, such as catheterization, bougienage or cystoscopy.

Inflammation of the epididymis in men is associated with one of the factors:

• decreased immunity due to severe pathology - HIV, diabetes, hepatitis, oncology
• disruption of urine outflow is a favorable condition for the development of bacterial infection
• hypothermia
• overheating of the scrotal organs.

Conservative treatment of acute and chronic epididymitis

Therapeutic treatment is prescribed if:

• There are no accumulations of pus.
• There is no exacerbation of pathology.
• No hematomas formed.
• Tests reveal mild or moderate stage of epididymitis.

The duration of treatment is from 1 to 4 weeks, depending on the infection or virus that triggered the development of the disease. The specialist performs tests for reaction to antibiotics, after which he selects a drug based on the client’s individual characteristics. 2 antibiotics or antimicrobial drugs may be prescribed at once for synergy and better results.

Main classification

The classification of epididymitis according to the nature of the disease is divided into 2 types - acute and chronic stage. According to the degree of damage - one-sided (left or right) and two-sided (damage to two epididymis at once). Depending on the nature of the inflammatory reaction, there are:

• Specific form. The inflammatory process is caused by syphilis, tuberculosis or gonorrhea.
• Non-specific form. It occurs due to the action of bacteria, chlamydia, fungi, and viruses (influenza, herpes, etc.).

The infection enters the appendage in different ways: through the blood (hematogenous route), through the lymphatic vessels (lymphogenous), through the urethra (canalicular). There is also a secretory pathway, which is characteristic of specific infections. In this case, there are various causes of inflammation of the appendages. In addition to the infectious factor, there are others:

• Infectious-necrotic. Twisting of the appendage of the appendage leads to the occurrence of an inflammatory process, as well as the proliferation of pathogenic bacteria. Penetration of sperm into the epididymal tissue causes the development of granulomatous epididymitis. This pathology is characterized by a lack of response to antibacterial therapy.
• Stagnant. This factor is caused by various reasons: constipation, interrupted sexual intercourse, frequent masturbation, hemorrhoids, frequent erections without ejaculation.
• Traumatic. Appears due to injuries to the scrotum, after surgery or after the use of specialized medical instruments (catheters, use of an endoscope for cystoscopy, etc.).

Men should be wary of taking certain types of medications that can lead to the development of drug-induced epididymitis. Typically, this disease is caused by taking Amiodarone, a drug that is used to treat pathologies that cause irregular heart rhythms. Accordingly, the higher the dosage, the more the risk of damage to the appendages increases.

Surgical treatment of acute and chronic epididymitis

Lack of results with conservative treatment and severe stage of epididymitis are the main indications for surgical intervention. There are 5 types of operations:

• Orchiectomy is the complete removal of the testicle and epididymis in the most severe cases.
• Epididymectomy - removal of the inflamed appendage.
• Puncture from the scrotum - allows you to normalize the pressure in the scrotum and eliminate pain.
• Partial resection of the appendage – resection of an area with a large accumulation of pus.
• Incision - opening microabscesses and cleaning the appendage.

The choice of surgical treatment is made by the attending physician based on the medical history and data obtained during diagnosis.

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