ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. N45ArtikelübersichtNebenhodenentzündung
- Causes and risk factors
- Examinations and diagnosis
- Disease course and prognosis
The epididymitis (epididymitis) arises in most cases as a concomitant of bacterial inflammation of the prostate or urinary tract. It rarely occurs in isolation as the sole inflammation of the epididymis, as the pathogens spread along the vas deferens. The epididymitis usually occurs only from puberty on.
The epididymitis can be acute or chronic.
Testes and epididymis
The epididymis counts - as well as the penis and the testicles - to the outer sexual organs of the man. The testicles and epididymis lie together in the scrotum (scrotum). The testicles produce the semen and the sex hormones. At the upper pole of the testicle, the fresh seed is passed into the epididymis and stored there. The vas deferens emerges from the epididymis and then flows into the area of the prostate gland into the urethra.
Although testicles and epididymides are close together and are closely related, orchitis is not the same as epididymitis. The latter is much more common. In some cases, however, the inflammation affects both testes and epididymides. In this case we speak of epididymorchitis.To the table of contents
The symptoms of an epididymitis similar to those of an orchitis (Orchitis): Usually it comes relatively suddenly to a painful, partially palpable swelling of the scrotum, what doctors call "acute scrotum". The surrounding skin shows typical signs of inflammation such as overheating and redness. The epididymal pain can radiate into the groin and lower abdomen. The accompanying symptoms include fever up to 40 ° C as well as vomiting and nausea.
The chronic epididymitis may also be characterized by a painless swelling. The epididymitis caused by chlamydia can be relatively symptom-poor.To the table of contents
Epididymal inflammation: causes and risk factors
The most common causes of epididymitis include bacterial inflammation of the urinary tract and the prostate. As a rule, the pathogens from the urethra or the prostate reach the epididymis via the vas deferens. One then speaks of an "ascending (ascending) infection".
Men with bladder bladder dysfunction, urogenital malformations and a permanent urinary bladder therefore have a particularly high disease risk. In children, malformations of the urinary tract are responsible for the bacteria getting into the epididymis. In some cases, a testicular torsion, that is a twisting of the testicles, leads to an epididymal inflammation. Epididymis are in many cases but not isolated inflamed, but together with the adjacent sections of the seminal and urinary tract.
Which pathogens trigger the inflammation?
A testicular inflammation is usually triggered by viruses - not so the epididymitis. Cause here are usually bacteria. This is often the case of Chlamydia trachomatis (rare Neisseria gonorrhea) among men under 35 (sexually active). Intestinal bacteria such as Escherichia coli, Enterococci, Klebsiella or Pseudomonas aeruginosa as well as staphylococci are responsible for epididymitis in men over the age of 35 years.
Epididymitis is rarely caused by a spread of bacteria via the bloodstream (especially pneumococci and meningococci), as part of a tuberculosis disease or through trauma: If urine flows into the seminal veins, chemical irritation of the epididymis may occur causes an inflammatory process.
Other possible causes
The rarer viral inflammation of the epididymis is usually from the mumps virus. In this case, the testes are often affected, with the epididymitis may precede the orchitis. Before adolescence, adeno- and enteroviruses can trigger a so-called post-infection, as a post-infection epididymitis.
Autoimmune processes are also considered as a cause of epididymitis.
Fungi (Candida, Coccoidioides, Histoplasma etc.) and worms (Schistosoma, Wucherichia or Echinococcus) are rare causes of epididymitis in Germany.
In addition, there is an isolated description of epididymitis, which were triggered by drugs such as amiodarone (remedy for arrhythmia).To the table of contents
Epididymitis: examinations and diagnosis
If you suspect an epididymitis you should contact a urologist. The doctor will first talk in detail with you about your complaints and possible underlying diseases (medical history.) Possible questions are for example:
- Since when do the complaints exist?
- Did the symptoms start suddenly?
- Do you have discharge from the penis or pain when urinating?
- Are you already aware of diseases of the urinary tract (including urinary tract infections)?
- Do you have intercourse?
Epididymitis: physical examination
Following is the physical examination. The doctor will first examine the scrotum for recognizable signs of inflammation (overheating, redness) and check whether the epididymis is swollen.
Then the doctor raises the scrotum. If this reduces the symptoms (Prehn sign positive), this speaks for epididymitis. With a testicle inflammation and a testicular torsion (rotation of the testicle around its own axis) the complaints on the other hand by the lifting of the scrotum do not get better. This distinction is very important because testicular torsion is an emergency that needs to be operated on within a few hours. In testicular torsion, however, an inflammation of the epididymis may also occur as a concomitant. If testicular torsion can not be excluded during the examination, an operative exposure of the testicle is necessary. If an abscess (encapsulated collection of pus) has already formed in the area of the epididymis, it can be palpated as a fluctuating swelling.