Epididymitis after vasectomy

Vasectomy is the cutting of the vas deferens, it is a contraceptive method popularly known as sterilization. Various complications can occur during vasectomy. One of the most common (in up to 6% of patients) is an inflammation of the epididymis after sterilization.

After the sperm have been cut through the vas deferens, they cannot enter the ejaculate. Instead, the formed sperm are broken down in the epididymis. If the number of sperm produced is now higher than can be disposed of via the epididymis, an inflammation can occur.

Symptoms

The inflammation of the epididymis begins with sudden pain in the area of the epididymis, which can radiate into the groin region. The pain can be triggered by pressure and touching the testicle. Typically, the pain is reduced when the testicle is lifted (positive Prehn’s sign).

In addition, there is a severe swelling and reddening of the epididymis, which then becomes difficult to separate from the testis. The area of the epididymis hurts when touched and under pressure. Furthermore, fever, chills and problems with urination may occur.

In about 15% of cases, an acute inflammation can lead to chronic inflammation. In this case a permanent, painful swelling of the epididymis develops. Further complications are the formation of an abscess with spreading of the inflammation to the testicles (epididymorchitis) in about 5% of those affected.

An important differential diagnosis in children and young men is the torsion of the testis around its supplying vessels (testicular torsion). If this is not recognized, the affected testis may die. In this case the pain occurs extremely fast and suddenly, the testicle shows a raised position and no decrease of pain when the testicle is lifted (negative Prehn?s sign). There is no fever and the urine is inconspicuous. Testicular torsion is an emergency that requires immediate treatment.

Diagnosis

The most important procedure to detect inflammation of the epididymis is ultrasound of the testis and the adjacent structures (sonography).An enlarged epididymis can be seen and in the special Doppler ultrasound examination, with which the blood flow can be shown particularly well, an increased blood flow of the epididymis. An abscess formation or a twisting of the testis (testicular torsion) can already be excluded by ultrasound. This examination can also be used to monitor the progress of the inflammation.

In a urine sample taken there is an increased number of white blood cells (leukocytes), rarely the pathogen can also be detected in the urine. By applying a urine culture, the pathogen and resistance can be determined. This is important for selecting the right antibiotics for therapy. If the cause is suspected to be a sexually transmitted disease, the pathogen can be found by a smear of the urethra. If, despite all the diagnostic procedures performed, there are doubts about the existence of an epididymitis, the testicle and the epididymis must be surgically exposed to exclude a twisting of the testis (testicular torsion)!