Epididymis are swollen - what's behind it?
What is a swollen epididymis?
The epididymis sits at the upper pole of the testicles and consists of the tightly wound epididymal duct, which can be four to six meters long. They play a crucial role in the formation of sperm by enabling the sperm to move through a variety of processes. A swelling of this structure can be attributed to several causes, each with different symptoms. Depending on the underlying cause, therapy is indicated, after which one can usually assume a good prognosis.
What could that be?
In the most common cases, isolated swelling of the epididymis is due to inflammation of the epididymis called epididydimitis. While young men are often caused by a sexually transmitted infection, older men often experience epididymitis as part of normal urinary tract infections, which often occur due to residual urine. Usually no pathogen can be detected in young children.
In terms of differential diagnosis, however, additional space requirements must also be taken into account. This includes a spermatocele in particular. In this case, a constriction of the vas deferens leads to a bulging of the epididymal duct, which can fill with sperm fluid in the course and thus increase in size. In most cases, a spermatocele is asymptomatic.
Furthermore, testicular torsion, i.e. a twisting of the testicle with a resulting clamping of the supplying vessels, can lead to swelling of the testicle and the epididymis. However, swelling of the epididymis can also be due to malignant neoplasms, which must be ruled out as part of the diagnosis. These tumors are characterized by a painless mass of the epididymis.
Read more about the topic at:
- Epididymal cysts
- Chronic epididymis
diagnosis
The diagnosis of epididymis swelling first includes a precise anamnesis. In the case of young men, the possibility of infection with sexually transmitted diseases must be addressed in particular. In older patients, the indication of frequently recurring urinary tract infections can be important.
For clarification, a urine culture is created in all cases with which possible bacterial infections can be detected. If a sexually transmitted disease is suspected, a swab of the urethra is necessary. In addition, increased levels of inflammation in the blood can be detected in cases of inflammation.
Physical examination suggests a decrease in pain when lifting the scrotum (Prehn sign) indicates inflammation, whereas testicular torsion does not report any improvement. In order to differentiate possible benign masses from tumors, an ultrasound of the testicle is performed, which enables a precise assessment of the structural changes. It can also be used to assess whether the testicle is involved.
How can I feel the epididymis?
Palpation of the testicle and epididymis is easiest to do while standing. The penis is lifted a little with one hand and the testicle can be felt with the free hand. It is important to assess the testicles individually. The epididymis is located on the upper pole of the testicle and is easier to feel from the back of the scrotum. It usually feels a little softer than the testicles themselves. During the examination, attention should be paid to pain, tenderness, fluid retention and induration.
Concomitant symptoms
Depending on the underlying cause, different symptoms can be associated with swelling of the epididymis. A spermatocele and tumors are usually characterized by a lack of symptoms, in particular painlessness.
On the other hand, inflammation can lead to reddening, swelling and overheating of the scrotum. The pain here is mostly lateral. Since most of the inflammation originates in the urinary tract, patients often report painful urination and a feeling of residual urine. There is also an increase in pain during sexual intercourse.
Read more on the subject at: Epididymis pain
Depending on the causative agent, systemic symptoms such as fatigue, fever or lymph node swelling can also occur. Sexually transmitted diseases are often associated with other symptoms. Chlamydia and gonorrhea lead to purulent discharge in the morning, while syphilis leads to the development of painless, nodular ulcers.
Read more on the subject at: These are the symptoms you can tell if you have epididymitis
treatment
Treatment for epididymal swelling can vary widely depending on the underlying cause. Inflammation of the epididymis in the context of sexually transmitted diseases or classic urinary tract infections require antibiotic therapy. Depending on the pathogen, different preparations are used here.
Mild pain relievers such as ibuprofen or paracetamol are prescribed for pain management. In the case of sexually transmitted diseases, the sexual partner must always be treated in order to avoid reinfection. In older patients with frequent urinary tract infections, the cause should be clarified.
When diagnosing a spermatocele, there is usually no indication for therapy, as it is a benign mass without symptoms. Epididymis tumors are always removed by surgical treatment and, depending on the tumor stage, treated further.
No pain
If epididymal swelling occurs without pain, this is in the majority of cases due to epididymal cysts, spermatoceles. Surgical removal of these structures is only indicated in the event of functional restrictions due to the size of the mass.
In the case of painless masses, however, a tumor clarification must always take place. Since most testicular tumors grow rapidly, early detection and surgical removal is critical to the prognosis.
Duration / forecast
As a rule, a good prognosis can be assumed for epididymal swelling. Inflammations usually respond well to antibiotic therapy and heal without consequences. Only in rare cases is sterility due to adhesions and subsequent displacement of the vas deferens. In the case of epididymal cysts, an uncomplicated course without consequential damage can be assumed. In the case of malignant tumors, the prognosis depends largely on the exact type of tumor and its stage.
