Epididymitis is an infectious or non-infectious inflammation of the epididymis. The epididymis is a spiral-shaped tube that is located along the posterior surface of the testicle and connects it to the vas deferens.

The disease can develop at any age, even in children. Epididymitis often develops in men during sexual activity.

Typically, the infection first affects one testicle, but over time it can affect the second one.

Causes of epididymitis

There are four main factors that contribute to the development of the disease:

1. Infectious:
   a) Nonspecific infection
   • mushrooms (albino candida, etc.);
   • bacteria;
   • viruses.

   b) Specific infection

   The infection can enter the epididymis through the blood vessels, urethra, lymphatic vessels and secretory route.
   Important!Bacterial infection is the causative agent of the disease in more than 80% of cases.

2. Infectious-necrotic:
   a) The appendage may become inflamed due to torsion of the appendage of the appendage, which facilitates the attachment of bacterial flora.
   b) The development of granulomatous epididymitis can provoke the introduction of sperm into the tissue of the epididymis.
3. "Stagnate"
   Epididymitis can develop due to stagnation of blood in the spermatic cord and veins of the small pelvis. The cause may also be excessive blood filling of the scrotal organs.
   Possible reasons:
   • frequent cycling;
   • sexual excesses;
   • masturbation;
   • interruption of sexual intercourse;
   • persistent;
   • frequent ejaculation without sexual intercourse.
4. Traumatic
   In 9% of cases, epididymitis can develop as a result of trauma to the scrotal organs, as well as after surgery or exposure to medical instruments.
   General factors for the development of the disease:
   • decrease after serious illnesses or complex operations;
   • overheating or hypothermia;
   • obstructed urine flow;
   • side effects of medications;
   • promiscuity.

Classification of epididymitis

According to the nature of the inflammation, the disease can be specific And nonspecific

Classification by pathogen type:

• mycoplasma;
• viral;
• chlamydial;
• bacterial;
• fungal.

Traumatic epididymitis is divided into three groups:

• actually traumatic;
• post-instrumental;
• postoperative.

Classification by process localization:

• unilateral;
• bilateral.

Classification by stream:

• acute epidemic;
• chronic epidymitis;
• recurrent.

Symptoms of epididymitis

Acute form

The first symptom of the disease is acute pain in the ovary, which can radiate to the perineum, groin or sacral area. The disease develops rapidly and reaches its peak within a day after the first symptoms appear.

The scrotum gradually swells and the skin turns red. Within 4 hours, the size of the testicle may increase significantly.

The following symptoms may also occur:

After 2-5 days, all of the above symptoms become less pronounced.

Attention!At the first signs of an acute form, you should immediately consult a doctor, otherwise the disease will become chronic.

Chronic form

If treatment for the acute form of the disease is not started in a timely manner, it develops into a chronic form. In total, epididymitis can last for more than six months. If in the acute form the symptoms appear immediately, then in the chronic form there are practically no symptoms. The skin of the scrotum does not change color, and the testicle does not change shape. A man may feel discomfort only during an exacerbation of the disease.

With the chronic course of the disease, the epididymis can increase several times and become denser. When palpated, painful sensations occur. The vas deferens becomes wider in diameter, and the spermatic cord thickens.

Diagnosis of the disease

If the symptoms mentioned above appear, you should immediately contact a urologist. He will prescribe qualified treatment. The patient may be sent to the hospital for a more complete examination.

First of all, the doctor interviews and examines the patient.. A rectal examination of the prostate, Cooper's glands and seminal vesicles is performed. This method will detect the presence of infection and establish possible causes, such as prostate adenoma and prostatitis.

Laboratory diagnostics will help determine the degree and intensity of inflammation. It includes:

1. :
   • With bacterial flora, an increased level of leukocytes is observed; a decrease in leukocytes indicates a viral infection.
   • An increase in monocyte levels indicates a specific infection (brucellosis, tuberculosis, etc.).
2. :
   • A high level of creatine also indicates.
   • Increased levels of C-reactive protein.
   • The level of gamma globulins increases.
3. 
   Leukocytes in the urine indicate that diseases of the urinary system are also present.
4. Spermogram With inflammation in the seminal vesicles and prostate gland, an increase in the number of leukocytes will be observed.

Identification of the causative agent of epididymitis:

Instrumental diagnostic methods:

• . This study will help to assess the condition of the epididymis and testicular tissue as accurately as possible.
• . Allows you to quickly and accurately determine the nature of the lesions. But it cannot always accurately determine the stage of inflammation and detect microabcesses.

Complications of epididymitis

Full recovery is guaranteed only with proper and timely treatment. In this case, the disease does not affect sexual activity and reproductive ability in any way.

Important!The later treatment begins, the greater the likelihood of complications. The chances of a favorable treatment outcome are significantly reduced.

Possible complications:

• development of a severe infectious process;
• scrotal abscess;
• formation of fistulas in the skin of the scrotum;
• transition of the disease to a chronic form;
• formation of adhesions between the testicle and scrotum;
• development of bilateral epididymitis;
• disruption of the blood supply to the testicle with subsequent hardening of its tissues.

Important!In 40-60% of cases, the epididymo-orchitis inflammatory process leads to functional death of the epididymis and testicle, which leads to. Often found in bilateral epididymitis.

Mechanisms of infertility development:

• the effect of infection on spermatozoa;
• the secretion of the sex glands is disrupted;
• the tubules through which sperm move are affected, which prevents the normal maturation and removal of sperm;
• immune mechanisms are disrupted, as a result of which antibodies are formed against their own structures.

Treatment of epididymitis

Diet and regimen

During an exacerbation of the disease, it is very important to follow all the doctor’s recommendations and maintain strict bed rest. It is also necessary to ensure the elevated position and immobility of the scrotum. This can be done using a rolled up towel or special swimming trunks.

First aid involves applying cold compresses or ice wrapped in a cloth to the scrotum. They are applied for a couple of hours at intervals of half an hour. This will help relieve pain and swelling.

Eliminate fried and spicy foods, pickles, smoked foods and spices from your diet. You need to drink a lot of fluid.

Drug therapy

Comprehensive treatment is carried out, which includes:

• antibacterial therapy;
• absorbable drugs;
• vitamins;
• anti-inflammatory drugs.

Prescribed depending on sensitivity to antibiotics and the causative agent of the disease. As a rule, two antibiotics are prescribed at the same time.

Patients under 40 years of age (if epididymitis is caused by sexually transmitted infections) are prescribed a combination of Rocephin or Ceftriaxone (intramuscular or intravenous) with Azithromycin. The course is 5 days. Ceftriaxone can be combined with Doxycycline tablets, or with Sumamed. A course of antibiotics is prescribed for 10 days. The doctor prescribes doses individually for each patient. Both partners are treated.

Patients who do not have sexually transmitted diseases are prescribed a 2-week course of treatment with Ciprofloxacin, Trimethoprim, Zanotin, Tsipranol and Levofloxacin, Sulfamethaxazole.

If treatment does not produce the desired results, the doctor may prescribe other medications or change the course of treatment. Along with antibacterial drugs, painkillers, anti-inflammatory drugs, and vitamins are prescribed.

For non-infectious epididymitis, anti-inflammatory therapy is prescribed by a urologist. If epididymitis has developed as a result of taking Amiodarone, a consultation with a cardiologist is necessary to change the drug or reduce the dose.

After drug therapy, physiotherapeutic treatment is prescribed: UHF, diathermy, etc.

Surgery

Surgery is indicated for acute and chronic epididymitis in the following cases:

For surgical treatment, the following types of operations are used:

• notch method;
• removal of testicle with epididymis;
• puncture of the scrotal cavity;
• removal (resection) of part of the appendage;
• removal of the appendage.

The operation is chosen depending on the course of the disease and the presence of complications.

Folk remedies for the treatment of epididymitis

The following traditional medicines are used to treat the disease:

Attention!Treatment with folk remedies is an addition to the main one. Consult your physician before using any recipe.

Disease prevention

• Compliance with personal hygiene rules.
• Practice safe sex (using a condom) to prevent sexually transmitted diseases.
• Beware of testicular injuries;
• Frequent sexual intercourse, masturbation and arousal that does not end with ejaculation can lead to inflammation of the appendages.

Inflammation of the epididymis in men is called in medicine. It is a fairly common disease in the modern world. Due to its characteristics, such inflammation is very dangerous for any man, as it can lead to irreversible consequences, including. This is especially true for the chronic form of epididymitis, which is characterized by the appearance of a number of severe complications and, if the problem is ignored, the spread of the process to nearby organs.

As a result, male reproductive function can weaken until it disappears completely. Despite the fact that medicine is developing more and more every year, the number of patients with chronic epididymitis is growing. This is due, first of all, to the social factor - many men are embarrassed to visit a urologist and are afraid to talk about their intimate problems.

But it should be remembered that there is nothing more important than health, and this is especially true for the male genital organs. Therefore, if the slightest symptoms appear, you should not ignore them and you should immediately seek advice from a urologist.

Very often, chronic epididymitis is not an independent disease, but is combined with inflammation of the testicle.

This condition is called epididymitis orchioepididymitis, which is much more severe and causes more serious complications. According to statistics, chronic epididymitis develops in 15% of men who have suffered an acute form of the disease.

Chronic epididymitis is the outcome of acute epididymitis. This happens when a man ignores this disease. The causes of epididymitis can be specific and nonspecific. As for nonspecific factors, they are as follows:

1. Infectious. Most often these are bacteria. In older patients, in more than half of all cases the disease causes. Epididymitis may also occur due to lesions. As for children, staphylococci occupy the leading place, and E. coli is in second place. Proteus, as in adults, is in third place. Viruses, paramyxoviruses and others can also become infectious agents in this disease.
2. Infectious-necrotic. In this case, epididymitis can occur if it occurs in the rudimentary formations of the epididymis, or if sperm enters the stroma of the testicle and epididymis.
3. Abacterial, or stagnant. Such epididymitis appears due to frequent masturbation, overly active sex life, and diseases of the rectum.
4. Traumatic. Epididymitis as a result of trauma occurs in 8% of cases. Most often these are scrotal injuries.

In many cases, a combination of several causative factors, such as trauma and infection, is possible, which is typical for epididymitis that occurs after endourethral manipulation. Specific causes of epididymitis:

• Gonorrhea;

Another type of epididymitis is typical for children - resulting from abnormalities in the development of the genitourinary system. In such cases, infected urine can be thrown into the vas deferens, resulting in the development of an inflammatory process in the epididymis.

Chronic epididymitis - symptoms

The chronic form of epididymitis is characterized by periods:

1. Remissions;
2. Exacerbations.

During the period of remission, the man does not show any complaints, his health is good. But after exposure to unfavorable factors, such as hypothermia or alcohol consumption, an exacerbation of the disease is possible, which is characterized by a number of symptoms:

• Painful scrotum, pain radiates to the groin area. Moreover, in contrast to the acute form, with chronic epididymitis the pain will be less pronounced.
• The pain may intensify with movement, physical activity, or palpation of the appendage.
• The epididymis thickens, despite the fact that there may be no pain at all.
• Possible increase in body temperature up to 38 0 C. But most often it remains normal.

Differences between acute and chronic form

The main difference between and is the duration of the disease. Acute epididymitis is considered in cases when it has passed from the onset of the disease no more than 6 weeks. The chronic form develops after the sixth week of illness. There are also differences in symptoms.

First of all, this concerns pain. In acute cases, it is very intense, radiating to the groin area, lower back, and abdomen. It is sharp and sharp, a man feels it in a calm state, and when trying to make any movements, there is an increase in pain that makes any human movement difficult. In chronic epididymitis, the pain has a different character:

1. She is fickle;
2. Aching character;
3. It intensifies with physical activity, but does not impede movement;
4. Rarely radiates to the groin or lower back.

As for the epididymis itself, in acute epididymitis it:

• Very painful;
• It is impossible to touch it;
• Greatly increased in size;
• Dense to the touch;
• Tense.

In chronic epididymitis, these symptoms are much less pronounced, the appendage is slightly enlarged, its pain and tension are weakly expressed. The general condition of a patient with acute epididymitis deteriorates significantly, a temperature appears that can reach 40 0 ​​C, severe intoxication with chills and general malaise. Unlike acute, chronic epididymitis is characterized by the absence of such pronounced general symptoms. With this form of the disease, fever may rise up to 38 0 C, but not higher. A feature of the acute course of the disease is that there is a high risk of the following complications:

1. Inflammation of the testicle;
2. Abscess of the appendage;
3. Purulent fistulas in the scrotum.

For chronic epididymitis, this is typical to a lesser extent, since with such a course other complications often arise. Usually, with this form of the disease, the process spreads to both appendages, which is less typical for the acute course.

Complications

The most serious complication of severe epididymitis is infertility. The mechanism of its occurrence is as follows: a chronic process leads to the formation of adhesions in the epididymis. The result is obstruction. Considering that chronic epididymitis most often affects both testicles, then such obstruction leads to complete male infertility. Other complications of chronic epididymitis may include:

• Fistula on the skin of the scrotum;
• Abscess of the appendage;
• Infarction of the epididymis and testicle;
• Necrosis of the epididymis and testicle;
• Formation between the scrotum and testicle;
• Inflammation of the testicle.

Treatment

After a urologist has diagnosed chronic epididymitis, treatment should be carried out immediately in order to avoid the development of complications. During treatment, the patient must observe general measures:

1. Stay exclusively on bed rest;
2. Follow a gentle diet;
3. Drink plenty of liquid (it is advisable to include juices, fruit drinks, compotes in your diet);
4. Eliminate bad habits.

To treat chronic epididymitis caused by bacteria, it is advisable to use antibiotics.

Most often, broad-spectrum antibacterial drugs are prescribed together with sulfonamides. If the causative agent was a virus, antiviral drugs are prescribed. During the period of remission, you can attend physiotherapy:

• Ultraviolet radiation;
• Warming up;
• Potassium iodide electrophoresis.

In addition to conservative therapy, it is possible to use surgical treatment methods:

1. Resection of the appendage;
2. Epididectomy (removal of the appendage);
3. Orchiectomy (performed when the testicle is involved in the pathological process and its purulent melting occurs).

In any case, treatment should only be prescribed by a urologist. You should never self-medicate for chronic epididymitis. This is fraught with the development of severe irreversible consequences. Therapy should be carried out in a specialized hospital under the dynamic supervision of specialists.

Prevention

The main preventive measure for this disease is the identification of acute epididymitis and its quality treatment. The same applies to any other acute diseases of the urinary system, since infection from them can get into the appendage. At the same time, it is necessary to follow general recommendations:

• Maintain personal hygiene;
• Do not have an overly active sex life;
• Sex should be protected;
• If minor deviations from the norm appear in the genitals, immediately seek advice from a specialist;
• To live an active lifestyle;
• To refuse from bad habits;
• Eat properly.

By doing them, your masculine power will be with you for many years.

Epididymitis is an inflammation of the spiral tube (epididimis) at the back of the testicle. The disease is most often caused by a bacterial infection, including sexually transmitted infections. Chronic epididymitis is quite rare, but has more serious consequences than the acute form of this pathology. Fortunately, the disease is successfully treated.

What is chronic epididymitis

Epididymitis is inflammation of the epididymis. It is located on the testis (testicle) itself and can be felt as a small ridge (spiral tube) on the back of it. The epididymis of the testis is normally softer than the testicle itself and does not exceed 1/2–1/3 of its size in length. With this disease, swelling may be observed in the area of ​​inflammation of the scrotum.

Testicles in men are called the gonads - a paired organ that is located in the scrotum and produces sperm and testosterone.

The male reproductive system is a set of organs with reproductive function, an important part of which is the testicle and its appendage

The disease affects men of all ages, but it most often occurs between the ages of 14 and 35 years.

Epididymitis that lasts longer than six weeks or recurs (recurs) is considered chronic. Its symptoms increase gradually, and the cause is often difficult to identify. At the same time, the testicle itself can become inflamed (this disease is called orchitis). This is why the term epididymo-orchitis is commonly used.

Inflammation from the epididymis often spreads to the testicle

Due to the anatomical features of the structure of the genitourinary system, left-sided epididymitis most often occurs in men. Cases of bilateral and right-sided inflammation are much less common. Unfortunately, the chronic form of the pathology most often affects the appendages of both testes. It is bilateral chronic epididymitis that can cause infertility in a man, since as a result of long-term inflammation, adhesions can form inside the epididymis, complicating or blocking the passage of sperm.

Causes

The most common cause of chronic epididymitis is sexually transmitted infections (STIs), especially gonorrhea and chlamydia. But the disease can also be caused by other factors, for example:

• urinary tract infections (UTI);
• infectious inflammation of the prostate gland;
• undergone medical procedures in the scrotum area;
• injuries to the testicles and scrotum.

According to the Centers for Disease Control and Prevention (CDC) in the United States, gonorrhea and chlamydia are the most common causes of epididymitis in men aged 35 years or younger.

Provoking factors

A man may be at increased risk of developing epididymitis if he:

• Not circumcised. A number of scientists believe that the foreskin in men is susceptible to frequent microtraumas (wounds), which pose a risk of contracting various bacterial and viral infections. In this sense, circumcised men (and these are traditionally Jews and Muslims) are more protected from infection inside the genitourinary tract.

  One of the advantages of circumcision in men is considered to be a lower risk of infection compared to the presence of a foreskin.

• Practices unprotected sex. Sexually transmitted infections, or venereal infections, are the main cause of epididymitis. They cause inflammation in the urethra, sometimes moving along the vas deferens to the epididymis or testicles.
• Has structural changes in the urinary tract.
• Has an enlarged prostate, which puts pressure on the bladder and increases the risk of developing infections due to chronic stagnation of urine.
• Uses a urinary catheter. A urinary catheter, like surgical procedures, carries an increased risk of developing a bacterial infection.
• He takes a heart drug called Amiodarone.

  One of the rare side effects of Amiodarone is inflammation of the epididymis.

Pediatric epididymitis

Children get epididymitis just like adults, although the inflammation is likely to have a different cause. Common causes of inflammation of the appendages in children include:

• direct trauma;
• UTIs that extend to the urethra and epididymis;
• reflux (reflux) of urine into the appendages;
• twisting or kinking of the epididymis.

Symptoms

Epididymitis may begin with a few minor symptoms. But if they are not responded to in time, the condition usually worsens. Chronic epididymitis is accompanied by a long (more than 6 weeks) history of pain, which intensifies and subsides, but does not disappear completely.

Patients with chronic epididymitis may notice:

• low-grade fever;
• pain in the pelvic area (lower back);
• a feeling of pressure or fullness in the testicles;
• soreness and sensitivity of the testicles;
• redness and warmth in the scrotum (usually unilateral);
• enlarged lymph nodes in the groin;
• pain during sexual intercourse and ejaculation;
• pain during urination or defecation;
• urgent and frequent urination;
• abnormal discharge from the penis;
• blood in sperm.

With a long-term chronic course of epididymitis, the scrotum can harden and become insensitive, while external signs of swelling do not always appear, unlike the acute form.

Chronic epididymitis refers to inflammation characterized by persistent testicular pain in the absence of scrotal swelling.

Typical symptoms of epididymitis in children include:

• discharge from the urethra;
• discomfort in the pelvis or lower abdomen;
• pain or burning during urination;
• redness or tenderness of the scrotum (usually unilateral);
• elevated temperature.

You should consult a doctor immediately if you have discharge from the penis or pain during urination.

Diagnosis of epididymitis

Epididymitis is diagnosed by a urologist or andrologist. First, the doctor performs a physical examination of the patient, paying attention to:

• appearance of the scrotum;
• presence of swelling or redness;
• enlarged lymph nodes in the groin area.

The urologist will ask in detail about the symptoms and the time of their occurrence, clarify information about the presence of discharge from the urethra, and if the answer is positive, take a sample for bacteriological analysis for STIs. Such a study is necessary to determine the pathogen and its sensitivity to antibiotics for further treatment.

Differentiation of pathology

Some facts are important for the differential diagnosis of the disease, for example:

• gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days or weeks (as opposed to hours, which is typical for spermatic cord torsion);
• high temperature and chills (in 25% of adults and 71% of children) - indicate an acute form of inflammation of the appendages;
• Epididymitis usually does not have symptoms such as nausea or vomiting (unlike testicular torsion).

Photo gallery: testicular diseases that require differentiation in epididymitis

Varicocele - pathological dilatation of the veins of the spermatic cord Hydrocele - hydrocele of the testicle, accumulation of fluid between its own membranes Orchitis - inflammation of the testicle Testicular cancer is a malignant tumor that begins to develop directly in the testis Spermatocele - cyst of the epididymis containing spermatozoa

Laboratory diagnostics

Although epididymitis is usually associated with an infectious process, identifying the specific pathogen based on external signs is difficult. The patient will need to undergo the following tests if epididymitis is suspected:

• a general blood test will show whether there is inflammation in the body (with epididymitis, the level of leukocytes and the erythrocyte sedimentation rate increase);
• general urinalysis - reveals the presence of bacteriuria (but bacteria are found in the urine only in 50% of patients) or pyuria (pus in the urine);
• bacterial culture of urine sediment - the procedure involves submitting urine to place it on a nutrient medium in order to obtain the growth of colonies and their further identification; the analysis is necessary to check for the presence of a urinary tract infection or STI.

If a sexually transmitted disease is confirmed as the cause of epididymitis, the doctor gives an additional referral for tests for HIV and syphilis.

Instrumental techniques

It happens that for differential diagnosis (primarily, differences from spermatic cord torsion), it is necessary to use other imaging research methods:

Treatment

Treatment of epididymitis involves treating the underlying infection and reducing symptoms. In case of chronic recurrent course of the disease, bed rest is indicated during exacerbations. Treatment is usually successful, but long-term. Sometimes it may take several weeks for the soreness or discomfort to completely disappear. Most cases of epididymitis are completely cured within 3 months.

According to research results, the most common medical treatments for chronic epididymitis are antibiotics and anti-inflammatory drugs.

Drug therapy

Pharmacological treatment consists of drugs from the following groups:

1. Antibiotics (Doxycycline, Ciprofloxacin and others depending on the pathogen). Taking medications from this group is indicated for 4–6 weeks for chronic epididymitis. When treating epididymitis caused by chlamydia and gonococcus, it is also necessary to simultaneously treat the sexual partner for these infections.
2. Analgesics. They have an analgesic effect. The group includes drugs available over the counter (Ibuprofen) as well as prescription drugs (Codeine or Morphine).
3. Anti-inflammatory drugs (Piroxicam, Ketorolac). Reduce swelling and other inflammatory phenomena.

Photo gallery: medications for the treatment of epididymitis

Doxycycline is a broad-spectrum antibiotic prescribed immediately after diagnosis Ibuprofen has analgesic and antipyretic effects Piroxicam is a non-steroidal anti-inflammatory drug that helps overcome the symptoms of epididymitis.

Surgery

In some cases, invasive treatment may be required.

One of the serious complications of epididymitis is an intrascrotal abscess (an accumulation of pus), which must be opened and drained surgically. The patient is urgently hospitalized in the urology department for surgery. The intervention is performed under local anesthesia through open access:

1. Opening all the cavities of the abscess with a longitudinal incision, the surgeon empties them and washes them with an antiseptic.
2. The wound is packed to separate the abscess from the surrounding tissues. Since the body perceives the tampon as a foreign body, it begins to produce fibrin on the surfaces of the tissues that come into contact with it. Then the formation of young connective tissue occurs.
3. The tampon is removed after 7–8 days, when the body begins to reject it on its own.
4. The wound is stitched up.
5. After surgery, antibiotic therapy is administered.
6. Regular dressings are performed until the wound heals.

A scrotal abscess that is operated on in a timely manner usually ends favorably

In the long term, complications may arise in the form of:

• dysfunction of the testicle and its epididymis;
• loss of patency of the vas deferens;
• insufficiency of male sex hormones;
• infertility.

In case of necrosis of epididymal tissue, an epididymectomy (removal of the epididymis) is performed, and if the destructive process has affected the testicle itself, then a decision is made to perform orchiectomy (amputation) of one testicle, especially if the second remains healthy.

A dangerous rare complication of an abscess is rapid necrosis of the scrotal tissue - Fournier's gangrene. The negative scenario in the form of death in the case of gangrene reaches 80%.

Surgery may also be required to correct any physical defects (such as urinary tract obstruction) that may be causing epididymitis.

During the treatment of chronic epididymitis, doctors recommend:

In cases of STIs, the patient and his sexual partner should abstain from sexual intercourse for a week after finishing the course of antibiotics and confirming recovery.

Treatment of pediatric epididymitis

Treatment for pediatric epididymitis will depend on the underlying cause of the disease. In most cases, the condition can resolve on its own with rest and painkillers such as Ibuprofen. If a bacterial infection similar to that coming from a UTI is confirmed, antibiotics are prescribed. Children are also advised to drink more water and avoid the urge to urinate for a long time.

Folk remedies

There are many plants that are useful in the treatment of epididymitis, they have a natural antibacterial effect and are also a natural pain reliever:

1. Horsetail tea. This herb has numerous antibacterial properties that prevent further spread of the disease. Herbal tea must be taken once a day to get a noticeable effect. To brew a medicinal drink, take 2 teaspoons of herbs per 250 ml of boiling water.
2. Cranberry juice. The combination of acids (malic, citric, benzoic) in this berry can kill bacteria that cause infection. Preparation and use:
   • mash 0.5 kg of berries, pour the resulting juice into a separate bowl, after straining it;
   • pour 1.5–2 liters of boiling water over the cake;
   • bring to a boil, stir and leave to brew for 30 minutes;
   • strain, add drained cranberry juice;
   • drink 2-3 glasses a day, maybe with the addition of honey.
3. Raw garlic. For a natural antibiotic effect, you can use a few cloves of raw garlic to season your dinners. It is advisable to crush them before use, since this releases allicin, an organic compound that has a bactericidal effect.
4. Oregano (oregano). This natural medicine is rich in essential oil with a high content of carvacrol. Such oils are superior in their bactericidal properties to many existing antibiotics. To obtain the desired effect, it is enough to add oregano daily as a seasoning to various meat and mushroom dishes, sauces, and gravies.

Photo gallery: components of folk remedies for epididymitis

Horsetail tea for epididymitis is drunk once a day The combination of natural acids in cranberry juice has an antimicrobial effect Oregano (oregano) essential oil contains the substance carvacrol, which slows down the growth of certain bacteria. Garlic has natural antimicrobial properties

Physiotherapy

Physiotherapy methods are used as auxiliary methods outside the period of exacerbations. These include:

• UHF therapy - treatment with a high-frequency electromagnetic field (oscillation frequency 40.68 MHz or 27.12 MHz);
• diathermy - deep heating of tissues with high-frequency currents (electrotherapy method);
• mud therapy.

Dietary nutrition for chronic epididymitis

A beneficial diet for treating epididymitis includes consuming foods that can reduce inflammation. Foods that may be helpful in reducing inflammation include:

• spinach;
• blueberries;
• strawberries

Since patients with chronic epididymitis usually suffer from urinary problems, they need to eat foods such as celery and parsley that relieve these symptoms.
Typically, epididymitis is caused by a bacterial infection. To treat the cause, patients should eat more fresh vegetables and fruits rich in vitamin C. This is beneficial for boosting immunity. Foods rich in vitamin C include:

Foods high in vitamin C increase the body's anti-inflammatory function

Consequences and prognosis

Most cases of epididymitis are successfully treated with antibiotics. But chronic epididymitis is more difficult to overcome than acute epididymitis, and the pain associated with it lasts longer. In most cases, there are no long-term sexual or reproductive problems. But the infection may recur in the future.

Complications are rare and may include:

• fistulas (fistulas) in the scrotum;
• epididymo-orchitis;
• testicular abscess;
• necrosis of testicular tissue;
• infertility.

A potential consequence of severe infection is sepsis, or blood poisoning.

Prevention

Sexually active men can reduce their risk of contracting sexually transmitted infections by using condoms during sexual intercourse and having sex with a regular partner. If symptoms of pain and discomfort in the scrotum do not go away within four days, you need to make an appointment with a urologist.

Any man who experiences urethral discharge, scrotal swelling, or testicular pain should refrain from sexual activity and seek immediate medical attention to prevent transmission of the infection to others and avoid long-term complications.

It is important to treat acute epididymitis in a timely manner to minimize the risk of relapse. In particular, you should definitely complete a full course of antibacterial therapy, even if an apparent improvement in your condition occurs before the end of treatment.

Chronic epididymitis is a condition that should always be monitored by a urologist or andrologist. If left untreated, inflammation can lead to serious complications, including scrotal abscess, urethro-scrotal fistulas, testicular necrosis and infertility.

Epididymitis in men is a disease associated with inflammatory processes in the epididymis. In a child, it mainly develops after an injury, and in men, it is usually infectious in nature. Most often, inflammation is diagnosed in men aged 20 to 40 years. As a result of epididymitis, the processes of storage and transportation of sperm are disrupted, which can lead to the development of infertility.

The following factors can cause the development of epididymitis:

1. Infectious. It was infection in the genitals that, in more than 80% of all identified cases, led to an inflammatory process in the appendages or testicles. There are specific and nonspecific infections that provoke pathology. Nonspecific include: viruses, bacteria, mycoplasmas, etc. Specific infections include syphilis and tuberculosis. The infection can penetrate to the testicles through the urethra, blood, secretions and lymph. In children, epididymitis can be a consequence of influenza, mumps, or another infection.
2. Infectious-necrotic. Inflammation of the appendage can begin as a result of its torsion and the addition of a bacterial infection. If a sperm penetrates into the tissue of the epididymis, the man develops granulomatous epididymitis.

Urologist Nikolai Konstantinovich Solovyov talks about the causes and symptoms of the disease:

1. Stagnant. It is preceded by stagnant processes in the pelvic organs, in particular in the testis. Chronic constipation, hemorrhoids, sexual excesses, the practice of interrupted coitus and active cycling can lead to this.
2. Traumatic epididymitis is detected in approximately 9% of cases. This can be caused by mechanical impact on the scrotum, surgery or instrumental medical procedures.

Factors that can provoke inflammation of the epididymis include:

• Impaired urine flow.
• Decreased immunity.
• Promiscuous sexual contacts.
• Hypothermia or, conversely, overheating of the genital area.
• Side effects of certain medications.

Classification

Depending on the nature of the inflammatory process, specific and nonspecific epididymitis are distinguished.

Male testicle and epididymis

Based on the type of pathogen that led to inflammation, epididymitis occurs:

1. Bacterial.
2. Viral.
3. Fungal.
4. Chlamydial.
5. Mycoplasma.

Traumatic pathologies are divided into:

• Traumatic.
• Postoperative.
• Post-instrumental.

Based on the course of the pathology, they are:

1. Acute epididymitis on the left or right.
2. Subacute epididymitis unilateral or bilateral.
3. Recurrent.
4. Chronic epididymitis.

Depending on the location where inflammation occurs, epididymitis can be:

• Unilateral.
• Bilateral.

Symptoms

The first sign that inflammation of the epididymis in a man has begun is acute pain that can radiate to the groin, sacrum or perineum. Epididymitis is characterized by rapid development and can reach a peak within a day.

Gradually, the skin on the scrotum becomes red and swollen.

Other signs of pathology include:

1. Blood in the urine.
2. Enlarged inguinal lymph nodes.
3. A sharp increase in body temperature.
4. Increased pain during movement or during bowel movements.

1. Nausea, possible vomiting.
2. Chills.
3. Frequent urination.
4. Nonspecific discharge from the urethra.

After 3-5 days, the symptoms subside, but the disease does not disappear and requires mandatory treatment. If this is not done, then epididymitis becomes chronic, which is characterized by the absence of signs of the disease. Lack of treatment for an acute process can lead to scarring of the inflamed area, which leads to irreversible infertility.

During chronic epididymitis, the epididymis becomes dense and can greatly increase in size. This can be noticed by palpation, which causes pain. At the same time, the spermatic cord and vas deferens also thicken.

The average duration of chronic epididymitis is 6 months, during which periodically a man experiences mild manifestations of the inflammatory process in the epididymis, which can intensify during physical activity. Sometimes the patient may not even suspect that he is developing a dangerous disease. In this case, both testicles are affected at once. Very often the disease leads to irreversible infertility.

Based on the severity of epididymitis, there are 3 stages of the inflammatory process in the epididymis:

• Mild (lasting several days). It is characterized by mild symptoms and a slight increase in temperature.
• Average (5-6 days). In this case, the temperature rises to 39 degrees, signs of intoxication are significant. In this case, entire foci of inflammation appear, in which the surrounding tissues are involved.
• Severe when the symptoms of epididymitis are most severe. The patient has a fever, the appendage becomes large as a result of severe swelling of the surrounding tissues, and there are foci of destruction.

Diagnostics

Any signs of an inflammatory process in the appendage are a reason to contact a urologist, who can prescribe the correct treatment for epididymitis.

Before making a final diagnosis and prescribing a course of treatment, the doctor will conduct an examination and ask the patient about the symptoms that he has experienced. A rectal examination is necessary, which will make it possible to identify prostatitis, adenoma, etc.

To determine the degree of inflammatory process in the appendages, a laboratory analysis will be performed:

1. Blood. In the case of a bacterial nature of epididymitis, the level of leukocytes will be exceeded, and the presence of a virus will be indicated by their decrease. A large number of monocytes indicates the presence of a specific infection (tuberculosis, etc.). The doctor will also be interested in accelerating the ESR. Additionally, a biochemical blood test is performed.
2. Urine. The presence of leukocytes in it indicates pathologies of the urinary system.
3. Sperm. If the prostate or seminal vesicles contain a lot of leukocytes, this indicates their inflammation.

To identify the pathogen, the following is carried out:

• Bacteriological examination of urine, semen or prostate secretions.
• Immunological diagnostic methods.

Instrumental diagnostics includes:

1. Ultrasound of the scrotum. Such an examination makes it possible to accurately determine what type of lesion is present. But sometimes, ultrasound does not detect small foci of pus or determine at what stage the inflammatory process in the epididymis is located.
2. MRI makes it possible to visually examine parenchymal organs. Due to its high information content, magnetic resonance imaging allows one to assess the condition of the tissues of the appendages and testicles. However, due to the high cost, it is performed infrequently.

Possible complications

Only if the disease was identified at the initial stage and high-quality therapy was carried out, it is possible to completely cure it, without negative consequences for the body.

It was noted that the later the patient consulted a doctor and began treatment, the higher the risk of complications, which include:

• Severe infectious process.
• The appearance of fistulas in the scrotum.
• Abscess development.
• Chronic epididymitis.
• Bilateral epididymitis.
• Adhesions that may appear between the scrotum and testicle.
• Poor circulation in the testicular area.
• The development of epididymo-orchitis, which in half of the cases leads to infertility.
• Decreased sexual desire and erectile dysfunction, which is a consequence of decreased production of sex hormones in patients with bilateral epididymitis.

It can become a complication of epididymitis as a result of:

1. Disturbances in the secretion of the sex glands.
2. Impact of infection on sperm.
3. Damage to the tubules, as a result of which sperm cannot mature and be released normally.
4. Immune mechanism disorders.

Treatment

If any symptoms of epididymitis appear, a man should immediately consult a doctor. The treatment of the inflammatory process in the testicles and appendages is carried out by a urologist or andrologist. Treatment of this disease should be comprehensive and aimed, first of all, at eliminating inflammation in the epididymis and restoring their functioning. Usually the patient is treated at home, hospitalization is necessary only in severe cases.

During an exacerbation of epididymitis, it is important for the patient to adhere to bed rest. It is necessary to ensure that the scrotum is still and slightly raised. To do this, you can use special underwear or a rolled towel.

To relieve tissue swelling and reduce pain, you can apply cold compresses to the sore spot. It is also important at this time to exclude salty, fried, spicy foods, spices and herbs from the diet. The patient should drink as much fluid as possible.

Drug therapy

Epididymitis, the treatment of which must be comprehensive, cannot be cured without the use of medications:

• Antibiotics.
• Medicines with anti-inflammatory effect.
• Vitamin and mineral complexes.

Antibiotic therapy is carried out based on the sensitivity of the pathogen to them. Usually the doctor prescribes 2 antibacterial drugs belonging to different groups for treatment at once.

If the examination revealed that the cause of epididymitis was a sexually transmitted infection, the patient will be prescribed Ceftriaxone or Rocephin simultaneously with the drug Azithromycin. The course of treatment is at least 5 days. In addition, Ceftriaxone can be combined with Sumamed or Doxycycline. In this case, the course of treatment will be 10 days. The dosage of drugs is selected individually for each patient. It is important to undergo treatment at the same time as your sexual partner.

Ceftriaxone is a third-generation broad-spectrum cephalosporin antibiotic. The average price of 1 bottle is 30 rubles

If the patient has not been diagnosed with a sexually transmitted infection, he is prescribed Ciprofloxacin, Levofloxacin, Trimethoprim, Sulfametaxazole, etc. The course of treatment is 14 days.

The antiviral therapeutic course consists of taking interferons. To reduce pain, the patient is prescribed Papaverine and Analgin. In case of acute pain, a novocaine blockade may be performed.

If inflammation of the appendages in a man is non-infectious, then the patient should use non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac) and absorbable drugs (Longidaza, etc.).

If the treatment does not give the desired result, the patient undergoes a course adjustment and is prescribed other medications. Along with antibiotics, you need to take anti-inflammatory drugs, painkillers and vitamin-mineral complexes.

If the inflammation of the epididymis is non-infectious, the patient is prescribed treatment with anti-inflammatory drugs.

If the cause of epididymitis is a man taking Amiodarone, he should contact a cardiologist who will recommend reducing the dosage or replacing the medication.

After completing the course of drug therapy, the patient is prescribed physiotherapy (UHF, electrophoresis, etc.).

If, simultaneously with epididymitis, the body temperature rises sharply (up to 39 degrees) and there are symptoms of acute intoxication of the body (headache, nausea, vomiting, etc.), and the appendages are greatly enlarged, the doctor decides to hospitalize the patient and continue therapy in a hospital setting . In particularly difficult cases, the man will require surgical intervention.

Surgery

There are several types of surgery for epididymitis:

1. Scrotal puncture. This operation is ineffective in cases of extensive infection.
2. Notch method. This operation is considered rather diagnostic, since it does not make it possible to eliminate the inflammatory process in the testicles or their appendages.
3. Partial removal of the epididymis. After such an operation, relapses and complications often occur, so it is considered ineffective.

1. Complete removal of the epididymis. In this case, the testicle is not able to fully perform its reproductive function.
2. Removal of the testicle along with the epididymis. After the intervention, the man’s production of male sex hormones, in particular testosterone, sharply decreases (with unilateral lesions) or completely stops (with bilateral lesions), which leads to infertility.

The doctor will decide which type of surgical intervention to choose, based on the nature of the disease and the presence of complications.

Typically, surgery can be prescribed for:

• Tuberculous epididymitis.
• The occurrence of suppuration in the appendage.
• Infertility, the cause of which was obstruction of the appendage.
• Frequent exacerbation of epididymitis.

• Abscess of the testicle or epididymis.
• Torsion of the testicle or epididymis.
• Orchiepididymitis.
• Lack of results of conservative treatment of the acute phase of epididymitis.

Since resection or complete removal of the epididymis or testicle leads to infertility, the operation is mainly performed on men over 50 years of age.

ethnoscience

It is important for a patient diagnosed with epididymitis to understand that it is impossible to cure the pathology using only folk remedies. However, they can be used in conjunction with medications, which will make it possible to speed up recovery. Treatment at home for testicular epididymitis using folk remedies is based on the use of:

1. An infusion of birch leaves, celandine, steelweed root, cinquefoil and juniper cones. All components are mixed in equal proportions. Next, 4 tablespoons of the dry mixture are poured into 1 liter of boiling water and left to cool completely. After this, the infusion is filtered and taken 1 glass three times a day.
2. An infusion of corn silk, birch buds, bean pods and violets, mixed in equal quantities. 2 tablespoons of this mixture are poured into 1 liter of boiling water and infused for 20 minutes. After this, the infusion is filtered and taken three times a day, 3 tablespoons.
3. Infusion of horsetail, tansy and lingonberry leaves. Dried herbs are taken in equal quantities and mixed. 2 tablespoons of the mixture are poured into 2 cups of boiling water and left for at least 30 minutes. After this, the medicine is filtered and taken 1 glass 2 times a day.

Before you start using any folk remedy, it is important to consult with your doctor, as they may have contraindications.

Prevention

Epididymitis is a rather dangerous disease that can lead to sexual dysfunction or male infertility. Therefore, urologists strongly recommend that men follow preventive measures that will avoid the inflammatory process in the epididymis. To do this you need:

• Avoid the possibility of injury to the testicles.
• Observe hygiene rules.
• Avoid the possibility of contracting sexually transmitted infections. To do this, you need to give up questionable sexual relationships and always use a condom in case of contact with a casual partner.

Pediatric surgeon and urologist Karaman Sergeevich Abramov will talk about the intimate hygiene of boys:

• The appendages can become inflamed due to frequent arousal (masturbation, sexual intercourse), which ultimately does not end with ejaculation.
• Avoid hypothermia of the genitals.
• Promptly treat any diseases (infectious and non-infectious) of the genitourinary system or pelvic organs.
• If it is necessary to conduct an instrumental examination of the genitourinary system, all manipulations should be carried out by a qualified doctor.

Epididymitis is a serious disease that can lead to the development of male infertility. Therefore, it is important for a man to immediately seek medical help when the first signs appear.

Inflammatory flows in the appendages of the testis with pronounced redness, edema, and swelling in the scrotum area are called epididymitis. The development of the process often occurs in males in periods from 15 to 30 years of age and after the 60-year barrier. In childhood, epididymitis in men is recorded due to viral etiology.

It is customary to divide the root causes of the disease into four main types:

Infectious

• nonspecific variant - caused by bacteria, viruses, fungi, chlamydia, mycoplasmas;
• specific - gonococci, treponema pallidum, tuberculin bacillus, chlamydia.

Penetration of an infectious pathogen occurs:

• by blood;
• lymphatic;
• secretory;
• along the urethral and vas deferens.

Necrotic-infectious

• inflammation of the appendage of the appendage leads to the addition of bacterial microflora and occurs due to twisting of the appendage;
• when ligating the ducts (sterilization) - based on inflammation and lack of response to drug treatment.

Stagnant

Occurs with increased blood supply to the internal organs of the scrotum, stagnation of venous blood in the pelvis:

• interrupted sexual contacts;
• constant erections without sex;
• frequently recurring bowel movements;
• masturbation;
• bike rides;
• hemorrhagic bumps.

Traumatic

• mechanical trauma - blows, bruises, falls, pinching;
• postoperative;
• after medical procedures - catheterization, taking tests, etc.

The traumatic factor, according to statistics, accounts for about 10% of all the root causes of this disease.

Predisposing causes of a general and local nature are considered to be:

• decreased autoimmune functionality due to serious illnesses - cancer, diabetes, hepatitis, HIV infection;
• difficulty urinating – cicatricial narrowing of the walls of the urethral canal, prostate adenoma;
• local hypothermia, overheating.

Any of the factors can contribute to the development of epididymitis; the presence of the disease is indicated by specific symptoms.

Symptomatic manifestations

Painful sensations in the groin or scrotal area, in the lateral areas just above the inguinal fold, occur suddenly and reach maximum values ​​within 24 hours. These manifestations characterize the occurrence of a primary focus of infection located in the vas deferens. After time, pathogenic microorganisms descend down the paths, passing directly into the appendages themselves.

At the same time, other symptomatic phenomena are possible:

• swelling and pain in the scrotum area - in most cases, the appendage almost doubles in size in a couple of hours;
• radiating pain in the lower back, groin area, iliac region;
• pain when urinating with blood in the urine;
• purulent or mucopurulent discharge from the urethra - the symptom predominates in young men;
• hyperemia of the skin of the scrotum and local increase in temperature in this area;
• low-grade fever, turning into febrile conditions;
• feelings of general weakness and nausea developing against it;
• a feeling of increased pressure or fullness in the testicle area;
• significant enlargement of the inguinal lymph nodes;
• pain during sexual intercourse and subsequent ejaculation;
• pain when walking, defecation and urination;
• increased urge to empty the bladder;
• premature ejaculation with blood in the semen;
• frequent urination.

Any manifestations require consultation with a specialist and treatment appropriate to the symptoms. Refusal of medical care is fraught with the development of complications, including the removal of one of the testicles.

Main indicators of chronic and acute epididymitis

Development option	Acute phase	Chronic phase
Flow time	Up to 1.5 months	More than six months
Pain syndrome	Acute pain syndrome that occurs at rest, with difficulty in any movement and directed to the groin, peritoneum, lumbar region	Mild pain that occurs periodically, intensifying with physical activity and sudden movements. Recoil to the groin, back, and peritoneum areas is weakly expressed.
Condition of the appendage	Increase in size, tense, dense in consistency, painful	Slight increase, tension and soreness
Symptoms of intoxication manifestations	Weakness, chills, fever (up to 40 degrees), general malaise	There are no general symptoms of intoxication, occasionally the temperature may rise to 38 degrees
Features of the course	The danger of orchitis (inflammation of the body of the testicle), abscess of the epididymis and the appearance of pus-like fistulas in the scrotum	There is a high probability of developing sterility; both testicles are involved in the process

Based on the listed signs, the degree of development of the disease can be easily determined. Mild symptoms indicate that the disease has become chronic, which complicates its possible cure.

Possible complications of the acute phase of epididymitis

Develops when contacting a medical facility is late or against the background of a late diagnosis of the disease (preliminary incorrect diagnosis):

• testicular abscess - a purulent inflammatory process in the tissues of the testicle, occurring on a limited surface, accompanied by fever, weakness, a state of general malaise, headaches and feverish conditions);
• the formation of tissue adhesions between the scrotum and testicle;
• necrosis – appearing against the background of disruption of normal blood circulation of testicular tissue;
• the appearance of fistulas on the skin of the scrotum;
• development of epididymitis on both testicles (bilateral).

During the transition of the acute phase of the disease to the chronic version, the following changes are observed due to the direct effect of infection on sperm:

• infertility is a common result of bilateral epididymitis, which consists of functional death of the epididymis and testicle, occurring in 60% of patients;
• violation of the secretion of the sex glands;
• disruption of the functionality of the autoimmune system - the resulting antibodies attack the body’s own cellular structures.

Symptomatic manifestations play a leading role in determining the disease. All subsequent measures diagnose the degree of tissue damage and the level of weakening of the body.

Tuberculous epididymitis in men

In some cases, tuberculosis affects not only the lung area, but the entire body. The symptoms of this subtype in the acute phase are indistinguishable from simple epididymitis, with a rapid transition to the chronic phase. If one or both testicles are affected, there is a risk of abscess formation and subsequent fistula.

Specific cheesy masses emanating from the wound are a direct sign of the tuberculous variant of epididymitis. The subtype of the disease is not a direct threat to life, but leads to infertility. Conservative treatment is not effective; surgical intervention is always used.

Diagnostic measures

They are carried out by the attending physician according to the following scheme:

1. General examination of the patient - includes a rectal examination of the prostate, testes, Cooper glands, to determine the presence of a specific infection and determine the causes of epididymitis (or prostate adenoma).
2. Laboratory research methods - to determine the intensity and degree of the ongoing inflammatory process:

• general blood analysis;
• blood chemistry;
• general urine analysis;
• semen analysis;
• bacteriological examination;
• smear to determine the causative agent of the disease;
• linked immunosorbent assay.

1. Instrumental techniques:

• – aimed at studying the internal organs of the scrotum, to clarify the nature of the existing lesions;
• MRI refers to studies with high accuracy, with the maximum level of reliability.

After completing all diagnostic measures, the attending physician establishes an accurate diagnosis and the severity of the existing disease.

Data	Lightweight	Average	Heavy
Duration	Up to 3 days	From 3 to 6	Over a week
Symptomatic manifestations	Weak	Average	Maximum
Ultrasound	Heterogeneity of the structure, enlargement of the appendage, increased vascular pattern	The presence of hypoechoic formations, areas of inflammation, further enlargement of the appendage	Determination of foci of destruction, detection of cavities with fluids, maximum size of the appendage
Temperature indicators	Up to 38 degrees	Up to 39 degrees	About 40 degrees

If the temperature rises above 39 degrees, there are manifestations of general intoxication of the body and a high level of enlargement of the appendage, the patient must be hospitalized. After diagnosis, the issue of the need for surgical manipulation is decided.

How to treat epididymitis in men

Includes medical and surgical care. The type of treatment depends on the general condition of the body and accompanying symptoms.

Conservative option

The main indications for prescribing drug treatment are:

• clinical picture of the disease, characterized by mild to moderate severity;
• acute phase of the disease without signs of suppuration in patients of the elderly and senile age group;
• acute epididymitis passing into a latent state;
• epididymitis that occurred due to trauma, without the presence of hematomas.

Treatment includes:

1. Painkillers - include novocaine blockades, anesthetics and antispasmodic drugs.
2. Antibiotic drugs - to destroy the cause of the disease, are selected on a strictly individual basis with a preliminary test for the sensitivity of the microflora to a specific type of antibiotic.
3. UHF therapy - reduces the level of inflammatory processes, increases local immunity.
4. Fixation of the scrotum is performed using a specialized bandage to improve blood flow in the scrotum area and reduce the level of mechanical impact on the appendage.

If there is a tuberculosis variant of the disease, heating is strictly prohibited - to prevent the development of the process and the occurrence of associated complications. Treatment of this variant of the disease is carried out under the supervision of a TB doctor, with the specifics provided for curing any manifestations of tuberculosis.

Surgery

It is carried out if the following indications are present:

• suppuration of the epididymis, testicle;
• the occurrence of an acute phase of epididymitis due to trauma;
• purulent lesion of the inflamed appendage;
• relapse of the chronic phase of the disease;
• negative results of conservative treatment after three days of use;
• testicular torsion;
• dense formations in the body of the appendage, which do not resolve for a long period of time;
• assumption of the presence of epididymitis of tuberculous etiology;
• severe variant of the acute phase of the disease.

Several methods of surgical intervention are used for this pathological process:

1. The incision method - a certain number of incisions are applied to the surface of the body of the appendage and is used to identify and remove foci of abscess. It is used more for diagnosis than for treatment.
2. Puncture of the scrotal cavity is performed under local anesthesia using a needle that makes a local puncture. Surgical manipulation is aimed at reducing internal pressure, accelerating the healing process, and reducing the pain syndrome accompanying the disease.
3. Removal of an appendage affected by inflammation is a radical treatment measure and is carried out under local anesthesia. During the operation, an incision of about 7 centimeters is made parallel to the inguinal canal, then the body of the appendage is removed along with the vas deferens. After the measures taken, the ability to subsequently produce male hormones is retained.
4. Ectomy of the testicle together with the epididymis is recommended for the acute phase of orchitis. An incision is made on the front of the scrotum, followed by removal of the testicle and epididymis. After suturing, drainage is installed for 24 hours. With bilateral epididymitis (bilateral resection), the outcome of the operation is infertility and deficiency of hormone production.
5. Partial removal of the appendage – to stop the development of purulent inflammation, only damaged tissue is removed. An ineffective procedure with frequent relapses and associated complications.

The required treatment method is selected by the clinician depending on the condition of the patient, laboratory data and changes in the affected organ. All measures are aimed primarily at preserving organs; in the event of a possible threat to life, the issue of the need for an ectomy is decided.

Preventive actions

Includes a number of precautions and practical recommendations:

• during epidemics of mumps, carry out preventive measures - timely prescribe antiviral and anti-inflammatory medications;
• to focus special attention on conducting an effective course of antibiotics in urology departments in the periods before and after operations;
• avoid possible hypothermia, which contributes to the occurrence of infectious diseases;
• avoid frequent interrupted sexual contacts, masturbation and arousal that does not lead to sex and ejaculation;
• protect yourself by using specialized protection when practicing traumatic subtypes of sports - wrestling, hockey, football;
• seek help when detecting hemorrhoids, proctitis and when determining sluggish processes - bronchitis, sinusitis, tonsillitis;
• carry out the prevention of safe sexual contacts - use personal protective equipment to avoid infection with sexually transmitted infections;
• promptly treat diseases of the genitourinary system - prostatitis, pyelonephritis;
• comply with personal hygiene standards.

Compliance with the general requirements for preventive measures will help to avoid such deteriorations as sterility and removal of important hormone-producing organs.