chronic epididymitis

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
  • 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 .