1. epididymitis:
The most common disease is epididymitis. The epididymis is painful and very swollen, and the skin of the scrotum is red. The pain often radiates to the groin area. Moderate, rarely high fever often occurs. In most cases, the affected person feels generally ill and groggy.
If a urinary tract infection is present at the same time, pain during urination and a constant urge to urinate are also present. Epididymitis is usually caused by bacteria that migrate from the urinary tract, the prostate or the testicles into the epididymis.
In younger men, it is mainly sexually transmitted germs such as chlamydia or the gonorrhea (“gonorrhea”) pathogens that trigger epididymitis. In older men with an enlarged prostate, the bladder often does not empty completely. Bacteria easily multiply in the residual urine that remains in the bladder. The great pressure with which those affected empty their bladders creates excess pressure, through which the bacteria travel up the urethra and vas deferens into the epididymis.
The most common pathogens are Escherichia coli, enterococci, Proteus mirabilis, Klebsiella and Pseudomonas aeruginosa. Wearing a bladder catheter for a long period of time also promotes epididymitis. Bacteria penetrate relatively easily through the thin catheter tube, which leads directly into the urinary bladder, and enter the epididymis via the vas deferens.
Children and adolescents rather rarely have epididymitis. Here, twisting of the testicles (testicular torsion) is often the cause of pain and discomfort in the testicular area. If you suspect this, consult a doctor immediately; testicular torsion must be operated on immediately, otherwise the testicle will die due to lack of blood flow.
Although epididymitis is often bacterial, bruising or blows to the epididymis also cause an inflammatory reaction.
Therapy: Antibiotics inhibit bacterial growth. The pain, which can be considerable, is treated with anti-inflammatory painkillers. Bed rest, elevation of the testicle and cooling are also helpful. Wearing tight underpants is also comfortable for most sufferers. It can take up to 6 weeks for epididymitis to heal completely.
Complications: If epididymitis is not treated consistently, it becomes chronic, eventually spreading to the other epididymis or even to the testicles (epidymorchitis). In the case of bilateral epididymitis, occlusion of the epididymal tubules or the vas deferens is possible – which leads to infertility (occlusive azoospermia) and, if the patient wishes to have children, may have to be remedied by surgery. Very rarely, in particularly severe chronic cases, the epididymis is surgically removed completely (epididymectomy).
2. von Hippel-Lindau disease:
This very rare, hereditary disease usually occurs between the second and fourth decades of life. Tumors form on a wide variety of organs, most commonly the eyes and the central nervous system. However, the reproductive organs can also be affected. In men, for example, benign tumors, so-called cystadenomas, may form on the epididymis. These can be felt as a rough, cherry-sized swelling above the testicles or diagnosed by ultrasound. These benign tumors are only operated on if, for example, they block the vas deferens and thus lead to infertility.
3. mumps (goat’s peter):
In 20 to 30% of all boys, orchitis, an inflammation of the testicles, occurs in connection with a mumps disease – very rarely it also spreads to the epididymis.
