Epididymitis may be due to an ascending infection along the vas deferens. Predisposing factors are bladder outflow obstruction due to an enlarged prostate or urethral stricture, bladder or urethral inflammation (cystitis and urethritis), a urethral catheter or intermittant self catheterisation or endoscopy trauma. Epididymitis may also be due to hematogeneous and lymphogeneous spread of infection. The most common causative organisms are E. coli, proteus, pseudomonas and enterococci. In younger patients Chlamydia trachomatis and Gonococcus may be more common. Typical symptoms are swelling, redness and pain in the scrotum radiating up into the groin. If the infection is severe and possibly accompanied by abscess formation, fever, chills and a general feeling of illness may also be experienced.
Antibiotic therapy should be started immediately after a urine sample has been taken for bacterial culture and resistance studies. Additional measures are local cold application, elevation of the testes - the support relieves pain. Analgesics may also be given. In the early stages local anaesthesia given in the area of the vas deferens may fasten the remission of symptoms. In uncomplicated cases symptoms usually resolve completely within about 2 - 3 weeks. Spread in of infection into the testis itself is very rare. If abscess or fistula formation occurs, this will need to be drained surgically or require surgical removal of the epididymis.
In approximately 15 to 20 percent of cases bacterial epididymitis will become chronic, with painful or painless infiltration of the epididymis and vas deferens. This can lead to spermatocele or hydrocele formation. Persisting symptoms are an indication for surgical epididymis resection.