Epididymitis is divided into acute epididymitis, chronic epididymitis and tuberculous epididymitis.
1. Acute epididymitis
The most common pathogenic bacteria are Escherichia coli, followed by Proteus, Staphylococcus, Enterococcus and Green Pseudomonas, Chlamydia trachomatis, etc. can also cause acute epididymitis. Pathogenic bacteria often enter the epididymis retrogradely through the vas deferens. In addition, bacteria that invade the epididymis can also cause epididymitis through lymphatic or menstrual blood infection, but this is rare.
Acute epididymitis is prone to occur in the following clinical situations:
① Long-term indwelling urethral catheter and intraurethral instrument examination can induce prostate infection, followed by acute epididymitis;
② After prostatectomy, especially transurethral resection of the prostate, since the ejaculatory duct opens in the prostate fossa, urethral pressure can cause urine to flow backward into the ejaculatory duct during urination. 8 to 12 weeks after prostatectomy Urinary stream often contains a certain number of bacteria;
③ Some patients complain that there is a history of scrotal injury before acute epididymitis, but not all patients with scrotal trauma develop acute epididymitis.
Epididymitis can occur on one or both sides, with one side being more common. Acute epididymitis often occurs from the tail of the epididymis. The epithelium of the epididymis is edematous, desquamated, and purulent secretions appear in the lumen. It then infiltrates through the interstitium to the body and head of the epididymis, and may form micro-abscesses. In the late stage, scar tissue forms and blocks the epididymal lumen, so bilateral epididymitis often causes infertility.
Acute epididymitis has an acute onset, causing discomfort and obvious pain in the patient\’s scrotum, which can radiate to the ipsilateral groin area and lower abdomen, affecting activities, and is often accompanied by chills and high fever, with the body temperature reaching 40 ℃. Physical examination revealed that the epididymis on the affected side was swollen and significantly tender. If it spreads to the testicles, the boundary between the testicles and the epididymis is unclear, which is called epididymo-orchitis. When the inflammation is severe, the scrotal skin will be red and swollen, and the spermatic cord on the ipsilateral side will become thickened and tender.
2. Chronic epididymitis
It is more common clinically. In some patients, acute epididymitis is not effectively treated or treated incompletely and becomes chronic. Most patients have no history of acute attacks and often have chronic prostatitis.
The lesions are mostly limited to the tail of the epididymis, with inflammatory nodules; the entire epididymis can also be sclerotic due to fibrous hyperplasia; scar formation and epididymal duct occlusion can be seen on tissue sections, while in the vas deferens, prostate and seminal vesicles There may be chronic inflammatory changes.
The patient\’s symptoms are mild and may include a feeling of scrotal swelling, and the pain may radiate to the lower abdomen and the inner thigh on the same side; the epididymis on the affected side is slightly swollen and hardened, with induration and localizedThere is no obvious tenderness in the vagina; the vas deferens on the ipsilateral side may be thickened, and there is occasionally a history of acute attacks. If it is bilateral chronic epididymitis, oligospermia may cause infertility.
3. Tuberculous epididymitis
Tuberculous epididymitis, also known as epididymal tuberculosis, is the most common male genital tract tuberculosis. It is generally believed that epididymal tuberculosis is a part of urinary tuberculosis; epididymal tuberculosis is often accompanied by prostate tuberculosis or seminal vesicle tuberculosis. Mycobacterium tuberculosis usually travels from the kidneys to the prostate, seminal vesicles, and then to the epididymis; some are also caused by blood-borne infection. The main sequelae of epididymal tuberculosis are incomplete or complete obstruction of the epididymal duct and proximal vas deferens, which can manifest as oligospermia or no sperm, leading to infertility.
Epididymal tuberculosis generally develops slowly. The diseased epididymis gradually swells, forming epididymal induration. There is no pain or slight pain. When the epididymis is obviously swollen, it can adhere to the scrotum, forming a cold abscess and then rupture through the scrotal skin. Ulceration, discharge of pus and caseous necrotic tissue, forming sinus tracts. In severe cases, the boundaries between the epididymis and testicles are unclear, and the vas deferens becomes thickened and changes in a bead shape. Bilateral epididymal tuberculosis can present with azoospermia, leading to infertility.
This article is provided by Baidu Reading and is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao