Epididymitis

Presentation

A male child, adolescent, or adult complains of dull to moderately severe unilateral scrotal pain developing gradually over a period of hours to days and possibly radiating to the ipsilateral lower abdomen or flank. In adult or adolescent males, there may be a history of recent urinary tract infection, urethritis, prostatitis, or prostatectomy (allowing ingress of bacteria), strain from lifting a heavy object, or sexual activity with a full bladder (allowing reflux of urine). Foley catheter drainage, intermittent catheterization, and other forms of urinary tract instrumentation predispose to infection and epididymitis. Drugs, such as amiodarone, also may cause epididymitis (chemical epididymitis), which affects the head of the epididymis only. There may be fever or urinary urgency or frequency. Nausea is unusual.

The epididymis (located posterolateral to the testis) is tender, swollen, warm, and difficult to separate from the firm, nontender testicle. Over time, increasing inflammation can extend up the spermatic cord and fill the entire scrotum, making examinations more difficult, with testicular tenderness, as well as producing frank prostatitis or cystitis. The rectal examination therefore may reveal a very tender, boggy prostate.