Treatment of epididymitis with conservative and surgical methods

Inflammatory flows in the appendages of the testis with pronounced redness, edema, and swelling in the scrotum area are called epididymitis. The development of the process often occurs in males in periods from 15 to 30 years of age and after the 60-year barrier. In childhood, epididymitis in men is recorded due to viral etiology.

It is customary to divide the root causes of the disease into four main types:

Infectious

• nonspecific variant - caused by bacteria, viruses, fungi, chlamydia, mycoplasmas;
• specific - gonococci, treponema pallidum, tuberculin bacillus, chlamydia.

Penetration of an infectious pathogen occurs:

• by blood;
• lymphatic;
• secretory;
• along the urethral and vas deferens.

Necrotic-infectious

• inflammation of the appendage of the appendage leads to the addition of bacterial microflora and occurs due to twisting of the appendage;
• when ligating the ducts (sterilization) - based on inflammation and lack of response to drug treatment.

Stagnant

Occurs with increased blood supply to the internal organs of the scrotum, stagnation of venous blood in the pelvis:

• interrupted sexual contacts;
• constant erections without sex;
• frequently recurring bowel movements;
• masturbation;
• bike rides;
• hemorrhagic bumps.

Traumatic

• mechanical trauma - blows, bruises, falls, pinching;
• postoperative;
• after medical procedures - catheterization, taking tests, etc.

The traumatic factor, according to statistics, accounts for about 10% of all the root causes of this disease.

Predisposing causes of a general and local nature are considered to be:

• decreased autoimmune functionality due to serious illnesses - cancer, diabetes, hepatitis, HIV infection;
• difficulty urinating – cicatricial narrowing of the walls of the urethral canal, prostate adenoma;
• local hypothermia, overheating.

Any of the factors can contribute to the development of epididymitis; the presence of the disease is indicated by specific symptoms.

Symptomatic manifestations

Painful sensations in the groin or scrotal area, in the lateral areas just above the inguinal fold, occur suddenly and reach maximum values ​​within 24 hours.

These manifestations characterize the occurrence of a primary focus of infection located in the vas deferens.

After time, pathogenic microorganisms descend down the paths, passing directly into the appendages themselves.

At the same time, other symptomatic phenomena are possible:

• swelling and pain in the scrotum area - in most cases, the appendage almost doubles in size in a couple of hours;
• radiating pain in the lower back, groin area, iliac region;
• pain when urinating with blood in the urine;
• purulent or mucopurulent discharge from the urethra - the symptom predominates in young men;
• hyperemia of the skin of the scrotum and local increase in temperature in this area;
• low-grade fever, turning into febrile conditions;
• feelings of general weakness and nausea developing against it;
• a feeling of increased pressure or fullness in the testicle area;
• significant enlargement of the inguinal lymph nodes;
• pain during sexual intercourse and subsequent ejaculation;
• pain when walking, defecation and urination;
• increased urge to empty the bladder;
• premature ejaculation with blood in the semen;
• frequent urination.

Any manifestations require consultation with a specialist and treatment appropriate to the symptoms. Refusal of medical care is fraught with the development of complications, including the removal of one of the testicles.

Main indicators of chronic and acute epididymitis

Development option	Acute phase	Chronic phase
Flow time	Up to 1.5 months	More than six months
Pain syndrome	Acute pain syndrome that occurs at rest, with difficulty in any movement and directed to the groin, peritoneum, lumbar region	Mild pain that occurs periodically, intensifying with physical activity and sudden movements. Recoil to the groin, back, and peritoneum areas is weakly expressed.
Condition of the appendage	Increase in size, tense, dense in consistency, painful	Slight enlargement, tension and soreness
Symptoms of intoxication manifestations	Weakness, chills, fever (up to 40 degrees), general malaise	There are no general symptoms of intoxication, occasionally the temperature may rise to 38 degrees
Features of the course	The danger of orchitis (inflammation of the body of the testicle), abscess of the epididymis and the appearance of pus-like fistulas in the scrotum	There is a high probability of developing sterility; both testicles are involved in the process

Based on the listed signs, the degree of development of the disease can be easily determined. Mild symptoms indicate that the disease has become chronic, which complicates its possible cure.

Possible complications of the acute phase of epididymitis

Develops when contacting a medical facility is late or against the background of a late diagnosis of the disease (preliminary incorrect diagnosis):

• testicular abscess - a purulent inflammatory process in the tissues of the testicle, occurring on a limited surface, accompanied by fever, weakness, a state of general malaise, headaches and feverish conditions);
• the formation of tissue adhesions between the scrotum and testicle;
• necrosis – appearing against the background of disruption of normal blood circulation of testicular tissue;
• the appearance of fistulas on the skin of the scrotum;
• development of epididymitis on both testicles (bilateral).

During the transition of the acute phase of the disease to the chronic version, the following changes are observed due to the direct effect of infection on sperm:

• infertility is a common result of bilateral epididymitis, which consists of functional death of the epididymis and testicle, occurring in 60% of patients;
• violation of the secretion of the sex glands;
• disruption of the functionality of the autoimmune system - the resulting antibodies attack the body’s own cellular structures.

Symptomatic manifestations play a leading role in determining the disease. All subsequent measures diagnose the degree of tissue damage and the level of weakening of the body.

Tuberculous epididymitis in men

In some cases, tuberculosis affects not only the lung area, but the entire body. The symptoms of this subtype in the acute phase are indistinguishable from simple epididymitis, with a rapid transition to the chronic phase. If one or both testicles are affected, there is a risk of abscess formation and subsequent fistula.

Specific cheesy masses emanating from the wound are a direct sign of the tuberculous variant of epididymitis. The subtype of the disease is not a direct threat to life, but leads to infertility. Conservative treatment is not effective; surgical intervention is always used.

Diagnostic measures

They are carried out by the attending physician according to the following scheme:

1. General examination of the patient - includes a rectal examination of the prostate, testes, Cooper glands, to determine the presence of a specific infection and determine the causes of epididymitis (prostatitis or prostate adenoma).
2. Laboratory research methods - to determine the intensity and degree of the ongoing inflammatory process:

• general blood analysis;
• blood chemistry;
• general urine analysis;
• semen analysis;
• bacteriological examination;
• smear to determine the causative agent of the disease;
• PCR;
• linked immunosorbent assay.

1. Instrumental techniques:

• Ultrasound of the scrotum - aimed at studying the internal organs of the scrotum, to clarify the nature of the existing lesions;
• MRI refers to studies with high accuracy, with the maximum level of reliability.

After completing all diagnostic measures, the attending physician establishes an accurate diagnosis and the severity of the existing disease.

Data	Lightweight	Average	Heavy
Duration	Up to 3 days	From 3 to 6	Over a week
Symptomatic manifestations	Weak	Average	Maximum
Ultrasound	Heterogeneity of the structure, enlargement of the appendage, increased vascular pattern	The presence of hypoechoic formations, areas of inflammation, further enlargement of the appendage	Determination of foci of destruction, detection of cavities with fluids, maximum size of the appendage
Temperature indicators	Up to 38 degrees	Up to 39 degrees	About 40 degrees

If the temperature rises above 39 degrees, there are manifestations of general intoxication of the body and a high level of enlargement of the appendage, the patient must be hospitalized. After diagnosis, the issue of the need for surgical manipulation is decided.

How to treat epididymitis in men

Includes medical and surgical care. The type of treatment depends on the general condition of the body and accompanying symptoms.

Conservative option

The main indications for prescribing drug treatment are:

• clinical picture of the disease, characterized by mild to moderate severity;
• acute phase of the disease without signs of suppuration in patients of the elderly and senile age group;
• acute epididymitis passing into a latent state;
• epididymitis that occurred due to trauma, without the presence of hematomas.

Treatment includes:

1. Painkillers - include novocaine blockades, anesthetics and antispasmodic drugs.
2. Antibiotic drugs - to destroy the cause of the disease, are selected on a strictly individual basis with a preliminary test for the sensitivity of the microflora to a specific type of antibiotic.
3. UHF therapy - reduces the level of inflammatory processes, increases local immunity.
4. Fixation of the scrotum is performed using a specialized bandage to improve blood flow in the scrotum area and reduce the level of mechanical impact on the appendage.

If there is a tuberculosis variant of the disease, heating is strictly prohibited - to prevent the development of the process and the occurrence of associated complications. Treatment of this variant of the disease is carried out under the supervision of a TB doctor, with the specifics provided for curing any manifestations of tuberculosis.

Surgery

It is carried out if the following indications are present:

• suppuration of the epididymis, testicle;
• the occurrence of an acute phase of epididymitis due to trauma;
• purulent lesion of the inflamed appendage;
• relapse of the chronic phase of the disease;
• negative results of conservative treatment after three days of use;
• testicular torsion;
• dense formations in the body of the appendage, which do not resolve for a long period of time;
• assumption of the presence of epididymitis of tuberculous etiology;
• severe variant of the acute phase of the disease.

Several methods of surgical intervention are used for this pathological process:

1. The incision method - a certain number of incisions are applied to the surface of the body of the appendage and is used to identify and remove foci of abscess. It is used more for diagnosis than for treatment.
2. Puncture of the scrotal cavity is performed under local anesthesia using a needle that makes a local puncture. Surgical manipulation is aimed at reducing internal pressure, accelerating the healing process, and reducing the pain syndrome accompanying the disease.
3. Removal of an appendage affected by inflammation is a radical treatment measure and is carried out under local anesthesia. During the operation, an incision of about 7 centimeters is made parallel to the inguinal canal, then the body of the appendage is removed along with the vas deferens. After the measures taken, the ability to subsequently produce male hormones is retained.
4. Ectomy of the testicle together with the epididymis is recommended for the acute phase of orchitis. An incision is made on the front of the scrotum, followed by removal of the testicle and epididymis. After suturing, drainage is installed for 24 hours. With bilateral epididymitis (bilateral resection), the outcome of the operation is infertility and deficiency of hormone production.
5. Partial removal of the appendage – to stop the development of purulent inflammation, only damaged tissue is removed. An ineffective procedure with frequent relapses and associated complications.

The required treatment method is selected by the clinician depending on the condition of the patient, laboratory data and changes in the affected organ. All measures are aimed primarily at preserving organs; in the event of a possible threat to life, the issue of the need for an ectomy is decided.

Preventive actions

Includes a number of precautions and practical recommendations:

• during epidemics of mumps, carry out preventive measures - timely prescribe antiviral and anti-inflammatory medications;
• to focus special attention on conducting an effective course of antibiotics in urology departments in the periods before and after operations;
• avoid possible hypothermia, which contributes to the occurrence of infectious diseases;
• avoid frequent interrupted sexual contacts, masturbation and arousal that does not lead to sex and ejaculation;
• protect yourself by using specialized protection when practicing traumatic subtypes of sports - wrestling, hockey, football;
• seek help when detecting hemorrhoids, proctitis and when determining sluggish processes - bronchitis, sinusitis, tonsillitis;
• carry out the prevention of safe sexual contacts - use personal protective equipment to avoid infection with sexually transmitted infections;
• promptly treat diseases of the genitourinary system - prostatitis, urethritis, pyelonephritis;
• comply with personal hygiene standards.

Compliance with the general requirements for preventive measures will help to avoid such deteriorations as sterility and removal of important hormone-producing organs.

Source: https://BornInVitro.ru/muzhskoe-besplodie/epididimit-u-muzhchin/

Epididymitis

Epididymitis is an inflammatory process in the epididymis. This organ is directly involved in the formation of sperm. His disease, in the absence of adequate treatment, can lead to the most serious consequences, including infertility.

Most often, epididymitis affects men and adolescents aged 15-30 years, as well as older people over 60 years of age.

What is the cause of epididymitis?

Most often, this disease is caused by infection from the urethra. Penetration of infection into the epididymis occurs when using urinary catheters or inflammation of neighboring organs (urethra, prostate, etc.).

At CELT you can get a consultation with a urologist.

• Initial consultation – 2,700
• Repeated consultation – 1,800

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In addition, the reasons for the development of epididymitis can be:

• complications after infectious mumps (so-called mumps);
• hypothermia;
• constant difficulty urinating;
• complications of tuberculosis.

Indications

Surgical treatment is indicated in the following cases:

• Abscess of the epididymis or testicle.
• Accumulation of pus.
• Lack of results from antibiotic treatment.
• Acute form of the disease.
• Infertility due to obstruction of the appendage.

Contraindications

It is not recommended to perform surgery in case of exacerbation of chronic diseases and allergic reactions to medications and painkillers.

How does epididymitis manifest?

The most common symptoms of this disease are swelling, pain and swelling of the scrotum, as well as redness on the affected side.

Epididymitis also manifests itself:

• the appearance of bloody impurities in the semen;
• temperature rise to 38-39 degrees Celsius;
• discomfort and pain in the groin and lower abdomen;
• pain and burning during ejaculation or during urination;
• discharge from the opening of the urethra;
• increased pain in the scrotum during movement or defecation;

Testicular anatomy

The testicle is a paired oval-shaped glandular organ that is responsible for the production of testosterone and sperm. The weight of the testicles rarely exceeds 30 grams. They are located inside the scrotum and are covered with white tissue, which visually divides the organ into 300 small parts.

All parts have approximately 2-3 seminal canals. They contain Sertoli cells, which are responsible for the production of healthy sperm. Between the channels are Leydig cells, which stimulate the production of testosterone.

In order for sperm to leave the testicles, it travels a long way through the efferent, convoluted, straight and accessory canals.

Complications of epididymitis

Untimely initiation of treatment will lead to a large accumulation of pus in the appendage, which causes an increase in body temperature to 40 degrees and severe headache. The scrotum becomes more sensitive and smooth. Next, the inflammation spreads to the testicles, which provokes the appearance of orchitis. In the future, a person may become infertile, as the canals are blocked by scar tissue.

Severity of acute epididymitis

The transition of the pathology to the acute stage is accompanied by pronounced symptoms. There are 3 stages in total: mild, moderate, severe:

• Mild – lasts up to 3 days. An ultrasound reveals an enhanced vascular pattern, and a blood test shows an increase in leukocytes to 12,000.
• Moderate – lasts up to 6 days and has severe symptoms, including an increase in body temperature to 39 degrees Celsius and pain. Ultrasound examination reveals inflammation and hypoechoic neoplasms up to 10 mm.
• Severe – lasts more than 7 days and is accompanied by severe symptoms. A blood test shows a leukocyte count of up to 25,000, which indicates a strong inflammatory process (body temperature rises to 40 degrees Celsius). The accumulation of pus is maximum, the epididymis is significantly enlarged.

How is epididymitis diagnosed?

At the CELT medical center you can undergo a comprehensive examination to identify epididymitis.

Typically it includes:

• general urine and blood tests;
• Ultrasound of the scrotum using Doppler ultrasound;
• PCR tests to detect infections (including chlamydia and gonorrhea);
• urine culture for the presence of pathogenic microflora;
• Magnetic resonance imaging of the scrotum.

What is the treatment for epididymitis?

A urologist deals with the elimination of pathology. In the acute stage and rising temperature, hospitalization is carried out with strict maintenance of bed rest. Locally apply cold compresses to the scrotum and fix it in its normal position.

The diet is normalized, spicy and sour foods are excluded. Next, physiotherapy, antibiotics and vitamins are taken. If pus has formed, then an opening and cleaning is performed.

In extreme cases, the appendage is removed to prevent the spread of infection.

Therapy for this disease should be carried out under the close supervision of a urologist. The doctors at the CELT clinic have extensive practical experience and an impressive amount of knowledge, which means they will help you get rid of this pathology in the shortest possible time.

Therapeutic treatment is prescribed if:

• There are no accumulations of pus.
• There is no exacerbation of pathology.
• No hematomas formed.
• Tests reveal mild or moderate stage of epididymitis.

The duration of treatment is from 1 to 4 weeks, depending on the infection or virus that triggered the development of the disease. The specialist performs tests for reaction to antibiotics, after which he selects a drug based on the client’s individual characteristics. 2 antibiotics or antimicrobial drugs may be prescribed at once for synergy and better results.

Lack of results with conservative treatment and severe stage of epididymitis are the main indications for surgical intervention. There are 5 types of operations:

• Orchiectomy is the complete removal of the testicle and epididymis in the most severe cases.
• Epididymectomy - removal of the inflamed appendage.
• Puncture from the scrotum - allows you to normalize the pressure in the scrotum and eliminate pain.
• Partial resection of the appendage – resection of an area with a large accumulation of pus.
• Incision - opening microabscesses and cleaning the appendage.

The choice of surgical treatment is made by the attending physician based on the medical history and data obtained during diagnosis.

Prevention of epididymitis

The main rule is regular testing and diagnosis of the genitourinary system. If you suspect inflammation of the prostate, bladder, testicles and appendages, you should immediately undergo diagnostics. Visit a urologist 1-2 times a year to exclude the development of pathology.

Our services

The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7 (495) 788 33 88

Source: https://www.celt.ru/napravlenija/urologija/zabolevanija/jepididimit/

Epididymitis

Update date: 05/14/2019

Epididymitis is an inflammation of the appendage of the testis, which is characterized by the occurrence of hyperemia, swelling and inflammatory processes in the scrotum area. In most cases (about 85%), the underlying cause of the disease will be a bacterial infection. Epididymitis in men can develop at different ages. However, men aged 20 to 40 years are more likely to suffer from epididymitis.

It is extremely important to diagnose the disease in a timely manner and begin its treatment, since otherwise severe complications are possible. In this case, all necessary tests must be taken before starting antibiotics. Emergency medical care will be required if the patient feels sharp, severe pain in the scrotum area. After hospitalization, treatment should be carried out under the supervision of a urologist.

Complications caused by the disease include:

• infertility, the causes of which may be autoimmune processes or damage to the tissue of the spermatic cord;

development of chronic epididymitis;

• abscess in the scrotum;
• the appearance of fistulas on the skin of the scrotum;
• bilateral epididymitis;
• the appearance of scars on the tissues of the spermatic cord, which negatively affects the process of sperm maturation and, in particularly difficult cases, leads to infertility.

You can prevent the occurrence of inflammation of the epididymis by using the following preventive measures:

1. Timely treatment of diseases of the genitourinary system;
2. In case of injury to the scrotum, it is necessary to see a doctor until its functions are completely restored;
3. Safe sex with a regular partner;
4. Prevention of local weakening of immunity in case of hypothermia;
5. It is very important to detect epididymitis at an early stage of its development and begin emergency treatment.

During the research, five groups of causes of epididymitis were identified.

1. Infectious: the disease can be caused by both specific infections (syphilis, tuberculosis, gonorrhea) and nonspecific (E. coli and staphylococcus bacteria, influenza and herpes viruses, mycoplasma, fungi and chlamydia);
2. Infectious-necrotic: inflammation can occur due to torsion of the appendage of the epididymis, as well as the introduction of sperm into its tissue;
3. About 9% of cases of inflammation of the epididymis are caused by traumatic factors: injuries to the scrotal organs, operations such as adenomectomy, exposure to medical instruments such as a bougie, catheter, cystoscope;
4. The development of the disease in some cases also occurs due to stagnation of blood in the veins of the spermatic cord and small pelvis, possible causes of which may be frequent erections without subsequent sexual intercourse, hemorrhoids, interrupted sexual intercourse;
5. Predisposing factors for the development of epididymitis may be decreased immunity due to severe illness, obstructed urine flow, hypothermia, or, conversely, overheating.

The disease can occur in chronic and acute forms. Each form of the disease is characterized by the same basic symptoms, which include pain, swelling of the appendage and fever. However, the symptoms of epididymitis manifest differently depending on the form of the disease.

Acute epididymitis

This form of the disease is characterized by acute, highly intense pain that makes any movement difficult. Often the pain radiates to the abdomen, groin area and back. The appendage is inflamed, significantly increased in size, compacted and very painful.

The patient has a fever of up to 40 °C, chills, general weakness and malaise. With acute epididymitis, complications and the development of other diseases against its background are also possible: orchitis (inflammation of the testicle), as well as suppuration of the epididymis, which can cause the appearance of purulent fistulas in the scrotum, as well as an abscess of the epididymis.

The duration of the disease is no more than six weeks.

Chronic epididymitis

With chronic epididymitis, the patient feels pain in the testicle, which increases significantly during movements or physical activity. The appendage is slightly enlarged in size, and also slightly painful and tense.

Unlike the acute form, during the chronic form, symptoms of intoxication do not appear - the temperature practically does not rise above 38 °C. Often this form of the disease develops due to specific infections such as gonorrhea or syphilis. Against the background of inflammation, the likelihood of infertility is very high.

The duration of chronic epididymitis is more than six months.

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Treatment of epididymitis can be conservative or surgical. If the patient has mild to moderate severity of the disease, there are no signs of suppuration, there is no hematoma, conservative treatment is prescribed. For this purpose, antimicrobial therapy is used, which eliminates the causes of the disease - infections.

Properly selected medications help get rid of inflammation quickly and painlessly. Depending on the infection that caused the disease, the following drugs or their combination are used: penicillins, sulfonamides, tetracyclines, fluoroquinolones.

Other methods of conservative treatment include UHF therapy, novocaine blockade, and scrotal fixation.

In case of abscess or suppuration of the epididymis, ineffectiveness of conservative treatment, or testicular torsion, surgical methods are used. The most common types of operations include removal of all or part of the appendage, puncture of the scrotal cavity, orchiectomy, and the incision method.

The most radical method is, of course, epididymectomy - complete removal of the appendage. As a result, even extremely severe complications such as testicular tissue necrosis or sepsis can be prevented, but the reproductive function of the testicle will be impaired.

In case of complications that are life-threatening (acute orchitis, tumor, abscess or testicular tuberculosis), orchiectomy is used - the testicle is removed along with the epididymis. However, this method leads to infertility.

If there is no extensive infection, the most appropriate surgical method will be puncture of the scrotal cavity. The prognosis for treatment when using this method is as favorable as possible.

The least traumatic method is the incision method, which can be called more diagnostic than therapeutic. It allows you to effectively detect and open small ulcers and perform testicular decompression in a timely manner.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice. Consult your doctor for diagnosis and treatment.

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Source: https://www.medcentrservis.ru/disease/ehpididimit/

Operation epididymectomy: what is it, types, indications, consequences

Men and boys often develop complications in the form of inflammatory lesions of the epididymis due to injuries or infectious pathologies. Epididymitis requires mandatory treatment, because when the disease is advanced, the patient develops serious complications, for the treatment of which surgery is used - epididymectomy.

What kind of operation is this?

This is a surgical intervention aimed at removing the affected epididymis.

Such surgical manipulation is prescribed for various types of lesions of the testicular appendage, for which conservative therapy is not effective.

Since epididymitis in children is quite rare, such surgical intervention is rarely performed on such patients. In addition, in children, the appearance of epididymitis is noticeable immediately, the disease does not start, and therefore it can be cured using completely conservative methods.

Indications

Indications for removal of the epididymis in patients of any age are:

• The presence of a chronic form of epididymitis with frequent relapses;
• Painful and dense, long-lasting infiltrates in the tissues of the appendage;
• The presence of chronic epididymitis with suspicion of its tuberculous nature;
• Confirmed tuberculous epididymitis;
• Lack of effectiveness in the treatment of acute epididymitis, because there is a threat of developing an abscess, necrotizing inflammation of the testicle itself, which leads to the death of the organ.

Contraindications

Obstacles to performing epididymectomy are:

• Severe odds of somatic pathologies;
• Recent heart attack;
• Infectious pathologies of a general nature;
• Decompensated diabetes;
• Problems with blood clotting.

Typically, the decision to perform an epididymectomy is an emergency one, so the surgeon assesses the significance of existing contraindications in relation to the risk of surgical intervention individually for each patient.

If such a need arises, then before the operation the patient is treated for an existing somatic disease.

Preparing for an epididymectomy

Before the epididymectomy procedure, the patient must be examined by a specialist urologist or andrologist. The affected tissues are palpated, the medical history is ascertained, the degree of spread of inflammation to surrounding tissues is assessed, etc.

• It is imperative to undergo ultrasound diagnostics of the scrotum;
• Submit urethral discharge for microscopic laboratory examination;
• Undergo Doppler ultrasound;
• If there is a suspicion of cancer, a biopsy is indicated;
• Urine and blood tests;
• Tests for hepatitis, HIV, syphilis;
• To assess the possibility of using general anesthesia, electrocardiography, chest x-ray and anesthesia consultation are prescribed.

In general, the preoperative examination plan is prescribed individually depending on the presence/absence of somatic diseases, the type of anesthesia used, etc.

On the evening before epididymectomy, the patient is prohibited from eating. It is necessary to do an enema in advance in order to completely cleanse the intestines of feces. Hair from the perineal and genital areas must be shaved.

Execution technique

The operation is performed using several techniques.

The Vasiliev method of subcapsular epididymectomy is performed under local anesthesia:

• A longitudinal 5-7 cm incision is made at the base of the scrotum, which is located parallel to the suture strip at a distance of three centimeters from it.
• The surgeon dissects the skin tissue of the scrotum and the membrane of the testicle.
• The testicle is brought out into the incision, its affected appendage is exposed.
• A novocaine injection is administered under the adnexal head and body.
• The superior adnexal ligament is incised, and the adnexa itself is carefully everted out of the shell.
• Such isolation of the affected adnexal tissues involves only the intersection of the vascular canals supplying the organ in the tail and head.
• Then the vas deferens is bandaged and cut off and the appendage is taken out.
• The adnexal membranes carefully cover the bed of the removed epididymis by suturing them to the testicle.
• A rubber hose is inserted into the lower part of the incision and the wound is sutured.

Technique for performing epididymectomy

Epididymectomy using this technique ends by lifting the scrotum and applying a pressure bandage in this position.

A modified epididymectomy technique is also used, in which a 2.5-cm incision is made along the anterior scrotal wall. Purulent masses and effusion are aspirated through an incision in the testicular membrane. The incision is carefully continued closer to the adnexal head. In the direction of the tail, you need to cut the tissues extremely carefully so as not to damage the festering tissues of the tail.

Then the testicle is isolated and the operation itself begins. A clamp is inserted and a window is made that allows access to the posterior appendage. This stage is considered the most key, because after it the particularly dangerous part of the intervention ends. Then the adnexal head is carefully cut off and the entire appendage is isolated up to its tail.

• Usually the duct is isolated from the tissues of the spermatic cord, ligated and cut off.
• Excision of the epididymal tail in the direction of the duct prevents damage to the testicular parenchyma, after which the tail and surrounding fibrous tissue of the epididymis are quite easily removed.
• Then sutures are applied, and the testicle is sutured to the scrotum to avoid twisting.

Complications

Most often, after epididymectomy, patients encounter complications such as tissue swelling and bleeding, leading to scrotal interstitial hematoma. High-quality ligation of large arterial tracts, coagulation of blood vessels and drainage of the wound will help to avoid such a complication.

If the scrotal volume begins to increase and signs of a developing infection appear, then the hematoma is opened. In other clinical situations, hematomas and swelling go away on their own.

Sometimes after removal of the epididymis there may be consequences in the form of scarring and testicular atrophy, but these are long-term complications and occur in isolated cases.

Postoperative period

In the first postoperative days, the patient is given anesthetic injections. An antibacterial prophylactic course lasting 5-7 days is indicated. If the appendage has been affected by oncological processes, then after epididymectomy a course of chemotherapy is prescribed.

After 24 hours, the rubber graduate is removed from the wound when the first dressing is performed. Sutures are removed within 7-10 days.

After the intervention, doctors recommend wearing a suspensor, which will provide the scrotum with a taut condition. The length of hospital stay is determined by the patient's condition.

While recovery continues, the patient is prohibited from having sexual intercourse and should avoid physical activity.

Source: http://gidmed.com/urologiya/lechenie-urolog/hirurgicheskoe/epididimektomiya.html

Surgery for epididymitis

Epididymectomy is a surgical treatment method during which the epididymis is removed. The inflammatory process that develops in the area of ​​the epididymis occurs for various reasons, but, as a rule, this occurs as a result of injury or against the background of infectious pathologies.

As a rule, the cause of the development of this disease is infectious diseases. They are divided into:

• bacteria that are sexually transmitted: ureaplasma, mycoplasma, chlamydia, trichomonas, etc.
• intestinal infections: hemophilus influenzae, enterococcus, etc.

In addition, this pathology can occur due to injury or after various surgical procedures.

Content

• 1 Indications
• 2 Preparation
• 3 Methodology
• 4 Recovery
• 5 Editor

Indications

Surgical intervention is prescribed in cases where conservative medicine methods show unsuccessful results. Epididymectomy is a common operation, therefore it is performed in a medical institution, while the patient is hospitalized.

Source: epididymitis

Basically, damage to the epididymis or epididymitis affects the adult male population of the globe, but cases of this pathology also occurring in children cannot be excluded.

If epididymitis occurs in young boys, surgical intervention is performed in very rare cases, since the development of pathology can be noticed at an early stage, when drug treatments still produce positive results.

At the initial stage of the disease, antibiotics, non-steroidal anti-inflammatory drugs, and immunomodulators are used. If drug treatment methods do not show positive dynamics, the doctor decides to refer the patient for examination followed by removal of the epididymis.

Epididymectomy is not performed for the following pathologies:

• history of infarction;
• diabetes;
• problems with blood clotting;
• somatic diseases.

Preparation

Preparatory manipulations for surgical intervention to remove the epididymis are mandatory.

The patient is referred to an andrologist or urologist for a detailed examination.

First of all, using the palpation method, the specialist examines how strongly the inflammatory process can affect the surrounding tissues, determines the presence of any diseases in the anamnesis, etc.

After consultation, the doctor prescribes a number of tests for the patient that will help carry out the surgical procedure more successfully and avoid various complications:

• ultrasound examination of the scrotum;
• analysis of discharge from the urethral canal;
• dopplerography;
• if there is a suspicion of the appearance of neoplasms, a biopsy is prescribed;
• general blood and urine analysis;
• blood for hepatitis;
• blood on RW;
• blood for HIV;
• an electrocardiogram and chest x-ray to evaluate the condition of the patient's heart and lungs.

In addition, great attention is paid to consulting an anesthesiologist in order to avoid unforeseen troubles during the operation.

On the eve of surgery, the patient stops eating. At this time, he may be prescribed an enema to completely cleanse the intestines of feces, and the hair in the intimate area is shaved off.

Methodology

Surgery is performed under general anesthesia. After the patient falls asleep, an incision is made in the area of ​​the inguinal canal, the length of which is 5-9 cm. The skin tissue is opened, exposed, and then the damaged area is removed.

After removing the affected area, interrupted kegut sutures are applied. If during surgical procedures the surgeon sees that the inflammatory process has affected the testicle, it is also removed.

Source: GidMed.com

Recovery

In the first days after the operation, the patient experiences severe pain, so painkillers are administered to him. In addition, to prevent the development of infection, antibiotics, anti-inflammatory and antibacterial drugs are prescribed. If the affected appendage has been affected by oncological processes, a course of chemotherapy is administered.

The first dressing is performed 24 hours after surgery. The stitches are removed after a week or a week and a half. After such an operation, experts strongly recommend that the patient wear a special suspension (bandage), which can provide the scrotum with a taut condition.

For a whole month, the man is completely prohibited from physical activity, as well as sexual activity. A month after leaving the hospital, the patient will have to visit a specialist for a follow-up examination.

Source: https://uran.help/surgery/operatsiya-pri-epididimite.html

How to cure epididymitis

Content

Epididymitis is an acute or chronic inflammation of the testicular appendages. Epididymitis, the symptoms and treatment of which will be described below, is usually diagnosed in men aged 14 to 35 years. The disease is caused by the gonorrhea virus, chlamydia, or bacterial infection.

What causes epididymitis?

Infections (gonorrhea, chlamydia) are the most common cause of epididymitis in middle-aged men.

But boys who are not sexually active and older men are more likely to develop epididymitis due to a bacterial infection.

Anyone who has treated urinary tract infections more than once should know that pathogens can get from the urinary canal into the appendages.

Less common reasons:

• Use of the drug amiodarone. In rare cases, amiodarone (an antiarrhythmic heart medicine) causes inflammation of the testicular appendages. Epididymitis caused by amiodarone can be easily treated with traditional methods.
• Tuberculosis.
• Getting a small amount of urine into the appendages. Sometimes, as a result of physical overexertion, urine enters the epididymis, causing chemical epididymitis.

Symptoms of the disease

Signs of epididymitis can often be noticed no later than two weeks after infection.

Main symptoms:

• tender, swollen, red testicles;
• urination, which is accompanied by pain;
• frequent urge to go to the toilet “in a small way”;
• ejaculation, which is accompanied by pain;
• chills;
• swelling of the inguinal lymph nodes;
• shooting pains in the pelvic area;
• purulent discharge after urination;
• presence of blood in urine and semen.

Why is it important to go to the hospital?

The history of epididymitis sometimes develops very rapidly, so in no case should you ignore pain in the testicles or swelling of the scrotum. A whole list of other diseases can cause testicular pain.

Most diseases require immediate treatment. For example, testicular torsion causes symptoms similar to epididymitis and requires very surgical intervention.

Only a doctor can diagnose the disease and tell you how to treat epididymitis at home.

Treatment of epididymitis

Epididymitis is potentially treatable with antibacterial medications if diagnosed early. Since infections are the most common cause of acute epididymitis, antibiotics play a significant role in the rapid recovery of the patient.

A course of ceftriaxone, doxycycline, levofloxacin, or ofloxacin may be prescribed, depending on the bacteria causing the disease. The course lasts approximately ten days, during which the infection will be completely cured and the symptoms will completely disappear. It is important that the patient completes the entire course of antibiotics, even if the signs of epididymitis completely disappear on the third day.

In addition, at the end of the course, you need to take a urine test to make sure that the infection has completely disappeared.

For chronic epididymitis, a six-week course of antibiotics is prescribed. All recent sexual partners should also take antibiotics and limit unprotected sexual contact until the patient has fully recovered. Physiotherapy for chronic epididymitis is indicated in the form of diathermy, laser therapy, and mud therapy.

Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, can be prescribed as painkillers to reduce swelling and pain. Longidase suppositories are also actively prescribed for epididymitis, an enzymatic drug that has a resolving, decongestant, and immunomodulatory effect.

When diagnosing a pathology, it is important to know how and how to relieve swelling in epididymitis. In addition to antibacterial treatment, folk remedies help well in this case.

Among these are a pear tincture in alcohol, an infusion of cornflowers, cranberry juice, an infusion of herbs for the treatment of chronic and acute epididymitis (birch buds, violet root, celandine, juniper berries, anise fruits, dandelion root, shepherd's purse shoots, parsley).

Surgical methods of treatment

In the vast majority of cases, epididymitis can be easily cured with medication. However, patients who have ignored painful symptoms for a long time and have not consulted a doctor may be referred for surgery.

Source: https://eepididimit.ru/kak-vyilechit-epididimit.html

Epididymitis

The most common cause of epididymitis is a bacterial infection. The development of the disease can also be triggered by sexually transmitted infections. There are acute and chronic epididymitis.

In the absence of timely treatment, the infection can spread to the testicle, and then orchitis (inflammation of the testicle) occurs.

EPIDIDYMITIS: CAUSES OF APPEARANCE

Doctors talk about the following possible causes of the disease:

• A bacterial infection enters the scrotal cavity.
• Sexually transmitted diseases (most often gonorrhea and chlamydia).
• Infections of the genitourinary system.
• Poorly performed medical manipulations on the genitals (surgeries, placement of a urinary catheter).
• Tuberculosis (sometimes epididymitis develops in patients with tuberculosis).

EPIDIDYMITIS: SYMPTOMS OF THE DISEASE

The disease begins suddenly (over several hours or days) with the appearance of severe pain in the testicles, which radiates to the lower abdomen. There is also an increase in temperature and a deterioration in the general condition of the patient. The scrotum increases in size and acquires a reddish tint.

A man may experience pain or discomfort during urination, sexual intercourse or ejaculation, and blood may appear in the seminal fluid. When palpating the inguinal lymph nodes, their enlargement is observed.

If acute epididymitis is not treated in a timely manner, the disease becomes chronic. Chronic epididymitis is more subtle, the symptoms are not pronounced. The patient feels periodic aching pain in the scrotum, swelling in the scrotal area gradually increases.

EPIDIDYMITIS: DIAGNOSIS OF THE DISEASE

The doctor will ask the patient a few questions, conduct a visual and rectal examination, and order blood and urine tests. If necessary, the urologist will prescribe an ultrasound and tests to detect sexually transmitted infections.

If testicular torsion is suspected, NMRI (nuclear magnetic resonance) is used to clarify the diagnosis.

EPIDIDYMITIS: TREATMENT OF PATHOLOGY

For epididymitis, the patient is prescribed bed rest, wearing a jockstrap (to fix the scrotum in an elevated position), cold compresses to the affected area (it needs to be changed every half hour to avoid frostbite).

After identifying the causative agent of the disease, a course of antibiotics is prescribed. Improvement usually occurs 2-3 days after starting treatment, but you cannot stop taking antibiotics on your own.

If the disease is caused by an STI, the urologist will prescribe medications to treat the underlying disease that led to epididymitis. Both sexual partners must undergo treatment.

If epididymitis is not adequately treated, suppuration may occur. In this case, the patient is indicated for a surgical operation during which the entire appendage or part of it is removed (epididymectomy).

If you experience any unpleasant sensations in the testicular area, changes in the scrotum (enlargement, swelling), we advise you to contact the specialists of our clinic. Extensive experience of doctors, professionalism of medical staff, modern equipment, comfortable conditions for examination and treatment - all these advantages will allow you to recover from epididymitis quickly and effectively.

We will do everything possible to ensure that you get rid of pain and discomfort as quickly as possible, restore your sexual health and become confident again. We are waiting for you!

Source: https://nazimova.com/services/urologiya/konsultatsiya-urologa-konservativnye-metody-lecheniya/epididimit/