Chronic epidymyalgia

Chronic epididymitis is a clinical diagnosis based on chronic epididymal pain lasting for at least three months. It is a common, possibly the most common, cause of scrotal pain.

Epidemiology

One study found the median age at presentation is 46-49 years with an average duration of symptoms prior to presentation of ~5 years .

Clinical presentation

Patients present with chronic point tenderness of their epididymis +/- a palpable mass or swelling .

Pathology

One classification of chronic epididymis is :

• inflammatory chronic epididymitis: mass/swelling present
  • infective
  • post-infective, e.g. after acute epididymitis
  • granulomatous, e.g. tuberculous, sarcoidosis
  • drug-induced, e.g. amiodarone
  • syndromic, e.g. Behcet's disease
  • idiopathic
• obstructive chronic epididymitis
  • congenital
  • post-vasectomy pain syndrome
• chronic epidymyalgia: mass/swelling absent; cause unknown

Radiographic features

Ultrasound

Ultrasound may be normal in a large number of patients. When abnormal, findings of epididymitis, epididymal cyst, or epididymal mass may be present .

Treatment and prognosis

Initial treatment consists of a trial of antibiotics as well as scrotal support, anti-inflammatories and analgesia including nerve blocks. Chronic epididymitis is generally considered "self-limited" albeit with a chronic course; refractory cases may require surgical resection of the epididymis .

Siehe auch:

• Epididymitis
• epididymal calcification

und weiter:

• Orchitis
• skrotale Verkalkungen
• Skrotolith
• Epididymoorchitis