Acute Epididymitis: Causes, Diagnosis, and Management, Apuntes de Urología

¡Descarga Acute Epididymitis: Causes, Diagnosis, and Management y más Apuntes en PDF de Urología solo en Docsity! Acute epididymitis is the most common cause of scrotal pain in adults in the outpatient setting. More advanced cases may present with testicular pain, swelling, and tenderness (epididymo- orchitis). As the evaluation and management of acute epididymo-orchitis is similar to that of acute epididymitis [3], we will refer only to acute epididymitis in this section. Etiology Acute epididymitis is most commonly infectious in etiology but can also be from noninfectious causes such as trauma and autoimmune diseases. Noninfectious causes generally present as subacute or chronic epididymitis . N. gonorrhoeae and C. trachomatis are the most common organisms responsible for acute epididymitis in men under the age of 35. Escherichia coli, other coliforms, and Pseudomonas species are more frequent in older men, often in association with obstructive uropathy from benign prostatic hyperplasia. Men of any age who engage in insertive anal intercourse are also at increased risk for acute bacterial epididymitis from exposure to coliform bacteria in the rectum. Other less common organisms responsible for acute epididymitis include Ureaplasma species, Mycoplasma genitalium. Clinical features and diagnosis The clinical features of acute epididymitis include localized testicular pain with tenderness and swelling on palpation of the affected epididymis, which is located posteriorly on the testis. More advanced cases present with secondary testicular pain and swelling (epididymo-orchitis). Scrotal wall erythema and a reactive hydrocele may be present. A positive Prehn sign (manual elevation of the scrotum relieves pain) is more often seen with epididymitis than testicular torsion. The cremasteric reflex is positive. In rare cases, acute epididymitis can cause serious illness. It is characterized by severe pain and swelling of the surrounding structures, often accompanied by fever, rigors, and lower urinary tract symptoms (frequency, urgency, and dysuria). It may be seen in conjunction with acute prostatitis (epididymo-prostatitis), particularly in older men who may have underlying prostatic obstruction or have undergone recent urologic instrumentation or catheterization. The diagnosis of acute epididymitis is made presumptively based on history and physical examination after ruling out other causes requiring urgent surgical intervention. In all suspected cases, a urinalysis, urine culture, and a urine nucleic acid amplification test (NAAT) for N. gonorrhoeae and C. trachomatis should be performed, although urinalysis and urine culture are often negative in patients without lower urinary tract symptoms. Identification of a pathogen on urine or urethral swab testing supports the presumptive diagnosis. With the exception of mumps, isolated orchitis without epididymitis is very uncommon in adults and so epididymo-orchitis should be the primary diagnosis to consider when an adult appears to have orchitis. However, in non-immune adults, mumps and other “childhood” viruses can rarely cause orchitis. Management