Orchitis and epididymo-orchitis

By Dr Teo
Aetiology and pathological features

Rare,except a/w mumps

Blood-borne infection
Surgical procedure on the lower urinary tract,e.g. TUR
Organism: Neisseria gonorrhoeae, Escherichia coli and
Chlamydia. In young man, the commonest is
Chlamydia
Tuberculosis
 Clinical features

Preceding Hx of an operation or of dysuria, frequency

and heamaturia
Acute pain in scrotum,swelling
Epididymis:acutely tender and enlarged(although it
maybe difficult to differentiate from the equally
tender testis)
Overlying redness and oedema maybe present
 Investigation

FBC: leucocytosis
Blood culture: helpful to direct antibiotic treatment
Urinalysis: pyuria, organism maybe revealed by
culture
Aspiration of the epididymis
USG: increased blood flow
 Management

Bed rest,scrotal elevation

Tetracycline or erthromycin
Other antiobiotic refer to culture
Partner should also be investigated and treated
Undescended testis
 Epidemiology

Both testes are undescend in 30% of premature

infants
Term:3%
One year:1%
Spontaneous descent after one year is rare
 Aetiology

Failure of migration along the normal line of descent

Ectopic testis:testicle deviates away from the line and
lie in front of the penis in the superficial inguinal
pouch,in the perineum or in the thigh.(reason
unknown)
 Risk factor

Prematurity
Low birth weight
Twin gestation
Down syndrome(fetus) or other chromosomal abnormality
Gestational diabetes mellitus
Prenatal alcohol exposure
Hormonal abnormalities (fetus)
Toxic exposures in the mother
Mother younger than 20
A family history of undescended testes
 Clinical features

An empty scrotal sac or hemiscrotum at 1 year

indicates:
Proximal to the external inguinal ring(undescended)
Truly absent
Retractile-the cremaster muscle reflexly pulls the
organ up towards the inguinal canal
Ectopic
 Complication

Infertility:inevitable in bilateral and common in

unilateral undescent,frequent in those who are
undescent treated.
Torsion
Trauma
Inguinal hernia
Malignant disease
Investigation
USG,CT and laparoscopy

Management
Target is to bring the testicle with its blood supply
into the scrotum as early as possible
Orchidopexy:should be done beyong puberty
Testicular prosthesis can be placed in the scrotum
Testicular torsion
1 Epididymis
2 Head of epididymis
3 Lobules of epididymis
4 Body of epididymis
5 Tail of epididymis
6 Duct of epididymis
7 Deferent duct (ductus deferens or vas
deferens)
 Testicular torsion
Testicular torsion occurs when the spermatic cord(from
which the testicle is suspended) twists, cutting off the
testicle's blood supply(ischemia)
Cause: recognised complication of testicular maldescent
wherein the testis is inadequately affixed to the scrotum
allowing it to move freely on its axis and susceptible to
induced twisting of the cord and its vessels.
Occurs most probably between birth and early adolescence
 Twist VS Untwist

Twist deprives the organ of its blood supply

If untwist does not take place within 6
hours,ischaemia is irreversible,gangrene develops and
the testis either suppurates or atrophies
 Presentation & Finding

Acute severe testicular pain(affected side)

Testis is tender,swollen and hang higher up(compared to
other side)
Poorly localized central abdo pain
Vomitting(sometimes)
Scrotal skin become red,hot and edematous in later stage
Palpation may feel the twisted cord

Pain is increase or no improvement by raising the testis

 Investigation

Urinalysis:sterile,acellular urine
USG:absence of blood supply to the affected testicle
 Management

Surgical emergency
Non-operative
Maybe possible to de-rotate the testis
Surgical
Failure of non-operative reduction require emergency
operation
The testis is de-rotated and fixed
The gangrenous testis is removed