Disorders Of Epididymis

Epididymis is an important part of male reproductive system. Anatomically, it is a coiled tube like structure that is closely linked to testes and is responsible for carrying and storing sperms. Any injury, infection or inflammatory lesion of epididymis should be treated with great concern as poorly managed cases may permanently affect male fertility.

Below is a brief account of most frequently reported epididymal disorders.

1. Epididymal Cyst:

Epididymal cysts are fluid filled cysts which arises from the duct of testis (also known as spermatocele). Unlike most scrotal swellings, an Epididymal cyst can occur at any age. According to a new study reported in the Turkish Journal of Pediatrics (1), the prevalence of epididymal cysts in young children and adolescents may range from 5 to 20%. It is not dangerous but can be bothering.

Classic Sign And Symptoms Of Epididymal Cyst

Epididymal cyst usually presents as a pea-sized swelling which appears from the top of testis. In some case, the swelling may grow to a larger size. The cyst are often filled with clear fluid or milky secretion which may also contain sperms. Other common sign and symptoms include:

• Feeling of fullness or heaviness in the groin region
• Discomfort in the testicle of the affected side

In some rare cases, the patient may develop bilateral epididymal cysts (2). It is highly recommended to seek immediate management as torsion of epididymal cyst is one of the rare but very serious complication of poorly managed epididymal cyst.

How To Diagnose An Epididymal Cyst?

Since epididymal cyst can be separated from testis, an experienced doctor can easily diagnose it during careful clinical examination.

How To Manage An Epididymal Cyst?

Epididymal cysts are usually removed via a surgical procedure in which an incision is made in the scrotum. While treating young men (who are looking to start their family soon), care must be taken as this surgical procedure can leave a scar tissue which can block the outflow duct of testis (the outflow duct is responsible for the transportation of sperms).

Another option is to drain the cyst via syringe. However, this procedure is not recommended because there is a fair chance of reoccurrence and each time a cyst is drained, there is a greater risk of introducing bacteria and other infectious agents into the sterile cyst.

2. Epididymitis

Epididymitis refers to inflammation of epididymis (which presents with moderate to severe pain and swelling of the groin region). Since epididymis runs around the testes; the pain can also be felt in the testicular region and usually it is difficult to distinguish whether pain and swelling is due to epididymis or testes (or both).

Other common symptoms include:

• Appearance of a lump on the testicles
• Painful penile discharge
• Urgency and increased frequency of urination
• Painful urination
• Swollen inguinal lymph nodes
• Lower abdominal pain or vague discomfort
• Pain during ejaculation or during sexual intercourse
• Blood in semen
• Fever is some rare cases

Classic Causes Of Epididymitis

In most cases, epididymitis is the result of colonization of viral or bacterial agents in the epididymis. In younger men it is mostly seen as a part of sexually transmitted illnesses (such as gonorrhea or Chlamydia or other sexually transmitted infections). While in older men it happens due to bacterial colonization (especially in the setting of chronic and poorly managed urinary tract infections such as E. coli) or other infectious agents such as coxsackievirus (3). Beside microorganisms, it may also occur due to:

• Direct injuries such as cyclist getting injured from the saddle or after vasectomy.
• Use of certain medications (such as Amiodarone) is also believed to aggravate the risk of epididymitis.
• Ascending infections from prostate gland (prostatitis).
• Tuberculosis is also considered as a rare cause of epididymitis.
• In some males, excessive straining or weight lifting can lead to backward flow of urine in the epididymal region; leading to chemical epididymitis.

Epididymitis that lasts longer than 6 weeks or recurs at intervals is referred to as chronic epididymitis; in some cases the cause or pathophysiology of chronic epididymitis is not completely known but optimal management can minimize the risk of long term complications.

How It Is Treated?

Generally, antibiotics up to six weeks can be given to treat the infection but if pain gets severe and there is no improvement then treatment becomes more difficult. It is better to opt for long term antibiotic course instead of surgically removing the painful part of epididymis because pain can come back even after the removal. Moreover, before taking decisions for surgery, men must consider if they want children in future, as removal of epididymis on one side is clinically comparable to having vasectomy on that side.

In poorly managed cases of epididymitis, patient may develop epididymo-orchitis (that is marked by spread of inflammatory process to involve testes as well). It is usually seen in severe cases of sexually transmitted infections.

References

1. Erikçi, V., Hosgör, M., Yildiz, M., Aksoy, N., Okur, Ö., Örnek, Y., & Demircan, Y. (2013). Torsion of an epididymal cyst: a case report and review of the literature. The Turkish journal of pediatrics, 55(6), 659.

2. Akin, Y., Sarac, M., Basara, I., Yucel, S., & Kazez, A. (2014). Bilateral Epididymal Cyst in 14 year-old Boy: a case report. Journal of Health Sciences, 4(1).

3. Vuorinen, T., Österback, R., Kuisma, J., & Ylipalosaari, P. (2014). Epididymitis caused by coxsackievirus A6 in association with hand, foot, and mouth disease. Journal of clinical microbiology, 52(12), 4412-4413.

4. Pilatz, A., Wagenlehner, F., Bschleipfer, T., Schuppe, H. C., Diemer, T., Linn, T., ... & Altinkilic, B. (2013). Acute epididymitis in ultrasound: results of a prospective study with baseline and follow-up investigations in 134 patients. European journal of radiology, 82(12), e762-e768.