Chronic epididymis
What is chronic epididymis?
Chronic epididymitis is always preceded by acute inflammation.
In around 20 percent of acute epididymis, which usually arise from bacterial colonization, change into a chronic form. The bacteria migrate via the ureter via the seminal duct to the epididymis and do not disappear completely for many weeks.
If the illness lasts longer than six weeks, one speaks of chronic epididymitis.
Causes of epididymitis
As with the acute form of epididymitis, the causes can be bacterial colonization as well as viruses, fungi or parasites. In addition, non-infectious causes are possible, such as an injury, various autoimmune diseases or the drug amiodarone.
However, sometimes no cause of epididymitis is found. If the inflammation is chronic, it should also be examined whether the patient has a weak or defective immune system.
In addition, the question arises whether the pathogens are particularly resistant to the immune system or the drugs administered.
Read more on the topic: Causes of epididymitis
Why does epididymitis become chronic?
There are various reasons why an acute epididymis becomes chronic. On the one hand, a weak immune system could be a reason why the pathogens cannot be completely killed off. Illnesses such as a severe flu, various vitamin deficiency diseases, but also HIV and many different cancers can lead to a weak immune system.
Autoimmune diseases can also be another reason for a chronic course. These are based on an overactive immune system that attacks healthy endogenous tissue and changes it in an inflammatory manner. Last but not least, particularly robust pathogens can also be responsible for the transition from acute epididymid inflammation to chronic one.
These are difficult to detect and render harmless by the immune system or by drugs. Examples of this are chlamydia, gonococci or, very rarely, tuberculosis bacteria.
Also read our topic: Duration of epididymitis
Diagnosis of epididymitis
In general, the combination of symptoms is the first suspicion of an illness.
This suspicion is then confirmed or rejected with the help of various investigations. The diagnosis is thus made in a very similar way to acute epididymitis, except that here the duration of the symptoms or the recurring evidence is longer than six weeks.
On the one hand, on the physical examination, redness, swelling and pain indicate an epididymitis. On the other hand, there is often a positive “Prehn sign”. The pain decreases when the testicle is lifted. To strengthen the diagnosis, the bacterial pathogen can be detected by means of a urine culture and swabs from the urethra.
An ultrasound image almost always shows an enlarged epididymis and an accumulation of fluid around the testicle. To rule out other causes, Doppler ultrasound can be used to measure the blood flow, which is often intensified.
More on this: Urinalysis
What are the symptoms of chronic epididymis?
The main symptoms of chronic epididymis often do not differ from the acute form. Usually there is testicular pain with particularly tender epididymis.
With some chronic forms this symptom decreases over time or never appears. Often there is swelling and reddening of the testicles. These symptoms are caused by an often accompanying accumulation of fluid in the scrotum and by increased blood flow.
Some patients also report pre-existing or simultaneous pain in the urethra or urination. This suggests inflammation of the urethra, which may have acted as a trigger for epididymitis. The sometimes considerable inflammation can lead to a fever in the case of advanced chronic epididymis. If necessary, the regional lymph nodes in the groin swell due to the inflammation and also become tender on pressure.
The causes of swelling of the testicles are often other than epididymitis. Read more about this on our website: Testicle is enlarged and swollen
Further information: These symptoms will help you recognize epididymitis
Treatment of inflammation of the epididymis
Similar to acute epididymis, the patient should be given a drug that controls the inflammation, such as diclofenac. If the pain persists, however, a nerve block of the nerves in the spermatic cord has to be resorted to.
In general, it is important to ensure that the testicle is cooled and elevated as often as possible.
If a bacterial infection is the cause, the inflammation should be treated with an antibiotic. The choice of drug depends on the pathogen and its possible resistance to certain antibiotics. If in doubt, this should be tested in a laboratory before use. If the infection is due to a sexually transmitted germ, treatment of the partner should also be considered.
If these drug therapy options have already been exhausted without success or if they do not have a long-lasting effect, surgery should be carried out as therapy. The inflamed epididymis is removed. If, in addition to the chronic infection of the epididymis, there is also considerable inflammation with a possible abscess of the testicle, the diseased testicle should also be removed. Wound healing disorders and recurring inflammation occur less often than with the sole removal of the epididymis.
Also read: Abscess on the testicle- what are the risks?
Duration and prognosis of chronic epididymis
Chronic epididymitis in particular can last for a very long time, over months, and therefore requires frequent medical checks.If all drug therapies have been exhausted without long-term or definitive success, the epididymis should be surgically removed.
Complications can arise, such as wound infections and healing disorders or loss of the testicle. Without an operation, however, the permanent inflammatory processes can lead to a scarred occlusion of the epididymis or the adjacent vas deferens. As a result, the sperm produced do not get outside, which results in reduced fertility if both epididymis are closed or sterility if both epididymis are closed.
Fortunately, this complication is very rare. Nevertheless, long-lasting epididymis should be treated intensively and the success of the therapy should be checked frequently in order to avert dangerous processes.
Also read our topic: Infertility in men
