Orchitis is an inflammation condition of testicles one or both in males generally caused by viral or bacterial infection.
Orchitis is a rare, acute inflammmatory response of one or both testes as a complication of systemic infection or as an extension of an associated epididymitis caused by bacterial, viral, spirochetal Or parasitic organism.
Etiology
1.Mumps causes isolated orchitis
2.Sexual intercourse without condoms
3.History of STIS
4.Viral infection
5.Bacterial infections causes :- N. Gonorrhoeae, chlamydia trachomatis, e-coli, klebsiella pneumoniae.
Pathophysiology :-
Clinical manifestations :-
Testicular swelling and redness
Tenderness in the scrotum
Painful urination
Painful ejaculation
Blood in the semen
Abnormal discharge
Enlarged prostate
Fever
Dysuria and burning micturation
Penile discharge
Diagnostics evaluations of orchitis
History collection
Physical examination
Rectal examination - Soft boggy prostate
Urinalysis and urine culture
Color doppler ultrasonography
Blood test - To asses the PSA( Prostate specific antigen) level
Management :-
Treatment of orchitis is based on whether the causative organism is bacterial and viral.
1. Bacterial orchitis - Antibiotic therapy, supportive comfort measures
2. Viral orchitis - supporrive treatment of rest, elevation of the scrotum, ice pack to reduce scrotal edema, analgesic agents, antiinflammatory drugs.
3.Mumps vaccination
2.EPIDIDYMITIS
Epididymitis is an infection of the epididymus, which usually spreads from an infected urethra, bladder, or prostate.
Risk factors
1. Personal history of STIs
2.Past prostate infections or UTIs
3.Lack of circumcision
4.History of enlarge prostate
Pathophysiology
Causative oraganism - E- coli if there is urinary retention and C. trachomatis, N. Gonorrhoeae.
The infection moves in an upward direction, through the urethra and the ejaculatory duct and then along the vas deferens to the epididymis.
Clinical manifestations :-
1.Low grade fever
2.Chills
3.Heaviness in affected testicles
4.Tenderness on testicles
5.Scrotal pain and swelling
6.lower abdominal pain
7.urethral discharges - Blood in semen, pus(pyuria), bacteria(bacteriuria).
8.Presence of pain during intercourse and ejaculation.
9.Dysuria
Assessment and Diagnostic finding
1.Urinalysis
2.Complete blood cell count
3.Gram stain of urethral drainage
4.Urethral culture
5.Deoxyribonucleic acid probe
6.Syphilis and HIV testing
7.Retrograde urethrography
Management
1.Reduction of physical activity
2.Scrotal support and elevation
3.ice - pack
4.Anti inflammatory agents
5.Analgesics
6.Sitz bath
7.Antibiotic therapy
Surgical intervention :-
Epididymectomy :- Excision of epididymis from testis.
Prophylaxis :-
1. Practicing safe sex
2.Treatment of sexual partner as a contact with epididymitis
3.Repeat screening of STIs - 2 months after initial testing for re-infection
4.Abstain from sex until the individual and sex partners have completed treatment.
3.TESTICULAR TORSION
Torsion of the testis is rotation of the testis, which twists the blood vessels in the spermatic cord and therefore impedes the arterial and venous supply to the testicle and surrounding structure in the scrotum.
Types of testicular torsion
1.Intravaginal torsion:-
Is the more common type, occurring most frequently at puberty.
It results from anomalous suspension of the testis by a long stalk of spermatic cord, resulting in complete investment of the testis and epididymis by the tunica vaginalis.
This anomaly has been likened to a bell-clapper.
2.Extravaginal torsion :-
Most often occur in newborn without the 'bell clapper' deformity .
It is thought poor or absent attachment of the testis to the scrotal wall , allowing rotation of the testis, epididymis and tunica vaginalis as a unit and causing torsion of the cord at the level of the external ring.
Clinical manifestations
1. Light headedness
2. Swelling of the scrotum
3. Testicular tenderness
4.Abdominal or pelvic pain
5. Nausea and vomiting
6.severe pain (because of decreased blood supply)
7.loss of cremasteric reflex on the affected side.
Diagnostic evaluation
1.History taking and physical examination
2.Doppler ultrasound
3.Testicular scan
4 . Urine analysis
Treatment
Scrotum orchipexy
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