chronic epididymitis
Introduction
Introduction to chronic epididymitis Chronic epididymitis (chronicepididymitis) may be delayed by acute epididymitis (acuteepididymitis), or it may be without acute phase, which is caused by long-term mild infection. Some cases are secondary to chronic bacterial prostatitis, and pathogenic bacteria and infection pathways are similar to acute epididymitis. basic knowledge Proportion of disease: male incidence rate is about 0.0003% - 0.0004% Susceptible people: male Mode of infection: non-infectious Complications: chronic epididymitis male infertility
Cause
Causes of chronic epididymitis
(1) Causes of the disease
It is generally believed that the pathogen of chronic epididymitis is retrograde through the vas deferens, and it is thought to be invaded by the lymphatic system. The clinical process is chronic, the epididymis is enlarged, the mass is hard or accompanied by nodules, and the tenderness is light, due to the anatomy of the epididymis. Characteristics, epididymis is prone to swelling after infection, tissue formation and even nodule formation.
(two) pathogenesis
Chronic epididymitis is generally an irreversible end-stage of severe acute epididymitis. Chronic epididymitis hardens the entire epididymis due to fibrosis. Histologically, extensive scars and epididymal ducts are occluded, and tissues are infiltrated by lymphocytes and plasma cells.
Prevention
Chronic epididymitis prevention
Prevention is mainly to thoroughly treat prostatitis and urinary tract infections. Antibiotic treatment of type I prostatitis is necessary and urgent. Once clinical diagnosis or blood and urine culture results are obtained, antibiotics should be applied immediately. It is recommended to use antibiotics intravenously at the beginning. After the symptoms such as fever of the patient are improved, oral medication is recommended for at least 4 weeks. Acute bacterial prostatitis with urinary retention can use the suprapubic bladder puncture to sputum drainage of urine, but also the use of thin tube catheterization, but the time of indwelling catheter should not exceed 12 hours. Patients with abscess formation may take fine needle puncture drainage guided by rectal ultrasound, transurethral resection of prostate abscess or drainage through perineal puncture.
Complication
Chronic epididymitis complications Complications chronic epididymitis male infertility
For example, chronic epididymitis is bilateral and can lead to male infertility. Symptoms of chronic epididymitis vary greatly. Patients may have local discomfort, bulge or scrotal pain. The pain may be radiated to the lower abdomen and the ipsilateral thigh. Sometimes there are acute symptoms. It can occur on one side or both sides, and it can also manifest as symptoms ranging from mild to intermittent discomfort to severe and persistent pain. The examination may touch the epididymis of the affected side, enlarge, harden, or only touch a lump on the epididymis, no tenderness or tender tenderness. Due to differences in inclusion criteria for chronic epididymitis, some of the literature describes signs that the epididymis is palpated normally or enlarged and hardened; the epididymis may increase or decrease over time. Some patients have chronic prostatitis or chronic testicular pain, but there is no latter syndrome in patients with longer course. Certain activities such as ejaculation can aggravate the patient's symptoms.
Symptom
Chronic epididymitis symptoms Common symptoms Swelling scrotum scrotal pain scrotum falling nodules epididymis stones
Often with a history of acute epididymitis or acute orchitis, scrotal pain, falling or bulging, pain can be radiated to the lower abdomen and thigh roots, physical examination can increase the length of the epididymis, harder, with nodular formation and mild Tenderness, the affected side of the vas deferens is rough.
In addition to according to medical history, signs, depending on pathology.
Examine
Chronic epididymitis examination
General examination of prostatic fluid (conventional prostate examination) generally refers to the appearance of the prostate and microscopic examination. The main purpose of microscopic examination of prostatic fluid is to see the presence or absence of cells, the number of phospholipids and trichomoniasis, sperm, tumor cells (need to be stained), amyloid and presence or absence of fine white blood cells or pus cells.
B-ultrasound (B-ultrasound is a kind of ultrasonic examination, is a non-surgical diagnostic examination, is an emerging discipline, has become an indispensable diagnostic method in modern clinical medicine.): visible enlarged epididymis The internal echo is uneven.
Diagnosis
Diagnosis and identification of chronic epididymitis
Different from the following diseases
1. Epididymal tuberculosis: manifested as epididymis induration, pain. The patient has a history of urinary tuberculosis, and the vas deferens is thickened and hardened, showing a bead-like change. Epididymal nodules are mostly located in the tail, hard and irregular, and sometimes adhere to the scrotal skin, ulceration and form a sinus sinus. Acid-fast bacilli can be found by microscopic examination of secretions.
2. Semen cyst: also manifested as nodule in the epididymis, but the nodules are mostly located in the head of the epididymis, the surface is smooth, no tenderness. B-super visible epididymal head has a cystic mass.
3. Filariasis in the scrotum: manifested as epididymal nodules with scrotal pain. However, the patient has a history of filament infection, and there are often several nodules in the scrotum, mostly at the lower end of the spermatic cord and the head of the epididymis.
4. Epididymal tumor: also manifested as epididymal mass, sometimes scrotal pain. However, the mass is mostly located at the tail of the epididymis, the surface is not smooth, the boundary is unclear, and the texture is hard. A surgical histopathological examination can confirm the diagnosis.
