What is a swollen epididymis?
The epididymis sits at the upper pole of the testes and consists of the narrowly wound epididymal duct, which can be four to six meters long in total. They play a decisive role in the formation of sperm by enabling the mobility of the sperm through a variety of processes. Swelling of this structure can be due to several causes, each of which presents with different symptoms. Depending on the underlying cause, a therapy is indicated, after which a good prognosis can usually be assumed.
What can that be?
In the most frequent cases an isolated swelling of the epididymis is due to an inflammation of the epididymis, a so-called epididydimitis. While in young men a sexually transmitted infection is often the underlying cause, in older men epididymitis often occurs as part of normal urinary tract infections, which are more frequent due to residual urine. In small children, no pathogen can usually be detected.
However, differential diagnosis must also take into account other spatial requirements. These include in particular a spermatocele. In this case, a narrowing of the spermatic duct causes the epididymis duct to bulge, which can fill with sperm fluid and thus increase in size.
In most cases, a spermatocele is asymptomatic. Furthermore, a torsion of the testis, i.e. a rotation of the testis with a resulting pinching of the supplying vessels, can lead to a swelling of the testis and the epididymis. However, swelling of the epididymis can also be due to malignant neoplasms, which must be excluded in the course of the diagnosis. These tumors are characterized by a painless space requirement of the epididymis.
Diagnosis
The diagnosis of epididymal swelling first includes a detailed medical history. In young men, the possibility of infection with sexually transmitted diseases must be considered in particular. In older patients the indication of frequently recurring urinary tract infections can be groundbreaking.
In all cases, a urine culture is used for clarification to detect possible bacterial infections. If sexually transmitted diseases are suspected, a smear of the urethra is necessary. In addition, increased inflammation values in the blood can be detected.
In the physical examination, a decrease in pain when the scrotum is lifted (Prehn’s sign) indicates an inflammation, whereas no improvement is reported in case of testicular torsion. In order to distinguish possible benign masses from tumors, an ultrasound of the testis is performed, which allows an exact assessment of the structural changes. In addition, an involvement of the testis can be assessed.
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