Page 166 - Urological Health

If your urologist is unsure of whether you have testicular torsion, you may need an ultrasound to assess
the testicle blood flow. If there is no blood circulating into the testicle then you likely have testicular
torsion.

2. Infection of the testis (orchitis) or the epididymis (epididymitis)

Epididymitis is the inflammation of the epididymis. Symptoms
include: acute onset of unilateral testicular pain and swelling,
tenderness of the epididymis and vas deferens, and occasionally
redness and swelling of the overlying scrotum skin (see Figure 2). The
term epididymo-orchitis is mostly used when the epididymis and the
testes are inflamed.
In men not yet 35 years old, sexually transmitted infection (STI)
accounts for most cases of epididymitis (47% Chlamydia trachomatis
and 20% Neisseria gonorrhoeae). In men over 35, 75% of cases are
caused by a urinary tract infection (coliforms or pseudomonas);
Chlamydia trachomatis or Neisseria gonorrhoeae are rare. Infection
in this age group is typically the result of an abnormality within the
genitourinary system.

If you have epididymitis, your testicular pain may come with:
• Testicular and/or scrotal tenderness, typically in the area
of the epididymis, though it can become more
generalized and involve the whole testicle as the illness
progresses
• Testicular and/or scrotal swelling and redness on the
affected side
• Fever
Figure 2. Epididymitis and orchitis
• Urethral discharge

• Lower urinary tract symptoms (LUTS), such as burning,
urgency, or frequency.

Your evaluation will include:
• Collection of specimens to identify Chlamydia trachomatis or Neisseria gonorrhoeae by
urethral swab or in urine
• Urinalysis and urine culture.
If it can be arranged without delay, a scrotal ultrasound may be useful to know whether the problem
is epididymitis or testicular torsion. In cases with epididymitis, the testicle blood flow would be
increased.

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