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Topic: Urology

Expert: Arthur Goldstein, M.D.
Date: 9/14/2008
Subject: testicle pain

Question
Doc,

6 weeks ago, I had bilateral Epididymitis caused by trauma- frequent twisting
and flipping of the testicles. Both my Epididymis were inflamed and i was
given ibuprofen only due to no infection just inflammation. All this was
confirmed by a doppler ultrasound.

99 percent of the pain went away after 2-3 weeks, now i just have a small
dull ache once and a while and i think that is due to frequently re adjusting
my scrotum due to the hot summer weather

My Question is this, What are the complications for traumatic Epididymist
that i might face? Im really nervous about testicular atrophy, is that a
possibility?

Also by always readjust my scrotum, will this cause aggravation and more
damage ?

thanks
Doc

Answer
Topher, although "traumatic epididymitis" can occur, it most often is due to scrotal surgical procedures. However, it can be due to self induced or other injuries of the scrotum. I must state, however, that I have never seen a documented case that was not of surgical origin. Bilateral traumatic epididymitis is even rarer. There is no finding on a Doppler ultrasound that is definitively diagnostic or specific for traumatic epididymitis. In my experience, most discomfort in the testes is referred from inflammation of the prostate gland, so called prostatitis. This aching may be perceived as a testicular or epididymal problem but is usually is not. Most cases of epididymitis are bacterial in origin and come from the prostate via spread down the vas deferens. My suspicion is that your present occasional discomfort most likely is referred from the prostate. Bacterial epididymitis should be treated with antibiotics but sometimes the acute symptoms may resolve without antibiotics.

A variable amount of scarring can occur as the epididymitis heals. If the scar is excessive, obstruction of the epididymitis could occur but to make you sterile, it would have to occur bilaterally. In the rare instance where this happens, there is corrective bypass surgery available. Atrophy is unusual. To follow is a "macro" on epididymitis that should be of interest to you.

During sexual arousal the prostate gland manufactures fluid that accounts for about 2/3 of the volume of ejaculate. The seminal vesicles are paired structures located behind the prostate gland that also manufacture fluid. Sperm from the testicles (which account for only 1-2% of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, prostatic fluid is discharged into the urethra (urinary canal) where it mixes with discharge from the ejaculatory ducts forming the semen. The semen volume is in the 2-6 cc range. The epididymis is the tubular structure located behind the testicle that drains sperm from  the testis to the vas deferens and eventually out the ejaculatory ducts. Inflammation or infection of the prostate gland (prostatitis) often will spread down the vas and into the epididymis causing inflammation in this area (epididymitis). This is the most common cause of epididymitis although it may also occur without prostatitis. Typical signs of epididymitis are swelling of the scrotal skin with loss of the normal skin folds (rugae), redness of the skin, enlargement of the epididymis and testicle, and local tenderness and pain that is eased by elevation of the testicle. The discomfort associated with prostatitis can sometimes be referred into the epididymis without actually an inflammation being present in the epididymis. In this case, the epididymis and scrotum are normal although slightly tender.

Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, and withdraw at the time of ejaculation are just some of the factors that may predispose prostatitis & epididymitis. Epididymitis is treated with antibiotics, warm baths, scrotal supporter and mild pain relievers. Probably the best antibiotics to use are from the fluoroquinolone group, such as Cipro and Levaquin. Usually the pain is gone in a few days but the swelling may persist for several weeks. Treatment should be instituted by a urologist after a proper and prompt evaluation. The urologist should follow the patient until the inflammation has totally resolved and the testicle has returned to normal. The reason for this is that occasionally, a tumor of the testicle may present clinically as epididymitis. In this case, the inflammation and swelling initially obscure the true diagnosis. A lack of response to treatment may be due to bacterial resistant to the antibiotic being used, the formation of a testicular abscess (which may be detected on ultrasound), or a misdiagnosis of torsion of the testicle. The latter, however, is almost always unilateral & not bilateral.

I hope this information clarifies the situation for you. If you symptoms persist, consultation with a urologist is suggested. Good luck.

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