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Acute epididymitis mostly occurs in young males. Organisms may reach the epididymis
by retrograde spread from the prostatic urethra and seminal vesicles or less commonly,
through the blood stream.
Predisposing factors include urinary tract infection,
urethral instrumentation and sexually transmitted infection. E. coli and Chlamydia
in patients with a history of urethral discharge are the organisms most frequently
- bacterial infections are the most common aetiology for epididymitis
men <= 35 years of age, ascending infection from the urethra by sexually transmittable
pathogens, namely Chlamydia trachomatis and Neisseria gonorrhoeae, are aetiologically
- in older men with a history of bladder outlet disturbances
- Enterobacteriaceae, particularly Escherichia coli, represent the dominant
- tuberculous epididymitis caused by mycobacteria must
be considered as a differential diagnosis
may be indistinguishable from testicular torsion. Epididymo-orchitis denotes secondary
involvement of the testis.
Possible complications include testicular atrophy
and fibrotic obstruction of epididymal tubes leading to impaired fertility.
pathogenetic factors include (1):
- systemic diseases like Behcet's disease
- drug-induced sequelae (amiodarone),
injury of the epididymal duct following vasectomy and the reflux of sterile urine
into the epididymes
Last reviewed 01/2018