Testicular inflammation

More common to have inflammation in the epididymis than the testes

Of the three major inflammatory states;

• Gonorrhoea and tuberculosis invariably arise in the epididymus
• Whereas syphilis affects the testes first

 

Mumps

• Systemic viral disease which most commonly affects school children whereby testicular involvement is uncommon
• In postpubertal patients orchitis is seen in 20-30% of males
• Most commonly the acute interstitial orchitis develops one week after the onset of swelling of the parotid glands
• Rarely orchitis may precede the parotid gland swelling or be unaccompanied by parotid gland involvement

 

Gonorrhoea

• Causes an epididymitis
• May form abscesses which can be destructive
• Can spread to the testes to produce a suppurative orchitis

 

Tuberculosis

• Invariably begins in the epididymis and may spread to the testes
• There may also be an associated tuberculous prostatitis and seminal vesiculitis
• Results in a caseating granulomatous inflammation

 

Non-specific epididymitis and orchitis

• Generally due to infections of the urinary tract, reach the epididymis and the testes either through the vas deferens or the lymphatics of the spermatic cord
• In children epididymitis is associated with congenital genitouninary abnormalities and infection iwht gram-negative rods
• In sexually active men younger than 35 it is most often caused by Neisseria or Chlamydia
• In men over 35 it is most often caused by urinary tract organisms such as E. Coli and Pseudomonas
• Can result in scarring which leads to sterility

 

Granulomatous (Autoimmune) Orchitis

• In middle aged men causes unilateral testicular enlargement
• It presents as a moderately tender testicular mass which may be associated with systemic fever
• It may be painless however and it is important to differentiate it from a testicular tumour

Vascular disturbances

 

Torsion

• Twisting of the spermatic cord may cut off the venous drainage and arterial supply of the testes
• Generally the thick walled arteries remain patent however resulting in vascular engorgement an venous infarction
• There are two types of tortion;
• Neonatal torsion – occurring either in utero or shortly after birth. It is not associated with any anatomical defect
• Adult torsion – generally occurs in adolescence. It is associated with a bilateral anatomic defect whereby the testes have increased mobility (bell-clapper abnormality). Results in sudden pain and can occur without any inciting injury. It is a urological emergency and requires to be untwisted within 6hr of torsion onset
• To prevent subsequent torsion in the contralateral testis, the unaffected testis is surgically fixed to the scrotum (orchiopexy)