EPIDIDIMYT (epididymitis; annate. epididymis an epididymis + - itis) — an inflammation of an epididymis. Is one of frequent diseases of generative organs at men.
Distinguish a nonspecific and specific epididymite (tubercular, gonorrheal, syphilitic, brucellous).
The Nespetsificheeky epididymite is caused in most cases by pathogenic, the saprophytic, bacterial flora of an urethra is more rare. Contagiums get to an epididymis in seminiferous ways from an urethra hematogenous, more rare in the lymphogenous way or directly from the struck small egg. As a rule, at patients nonspecific E. damage of a prostate gland, seed bubbles, an urethra is at the same time observed. The small egg, its covers, a deferent duct are often involved in inflammatory process. Carry an injury of a scrotum, overcooling, sexual excesses, masturbation, the severed sexual relations to the contributing factors, etc. In some cases E. arises as a complication of an endoscopic research of bodies of uric system. As a rule, process unilateral, more often a disease develops at the age of 20 — 40 years.
On the nature of emergence and the course of process distinguish an acute and hroyichesky nonspecific epididymite.
Acute epididymite. Beginning of a disease acute: body temperature increases to 38 — 40 °, severe pains in a scrotum and inguinal area are observed. The epididymis is increased and condensed, кож^ the corresponding half of a scrotum is edematous and hyperemic, Are noted a leukocytosis with a deviation to the left, the accelerated ROE. The acute period usually lasts 2 — 5 days.
Diagnosis acute E. the hl is based. obr. on a wedge, data.
Treatment is directed to elimination of pains, fight against an infection and prevention of abscessing of an appendage. Recommend a bed rest, an immobilization of a scrotum with the help a suspenzoriya (see), sexual abstinence, the diet excluding hot dishes prohibit reception of alcoholic beverages. Appoint antibiotics of a broad spectrum of activity, make novocainic blockade of a seed cord. At the pains connected with a reactive edema of covers of a small egg the puncture of covers and evacuation of liquid is shown. During the abscessing of an appendage abscess is opened. According to indications make an epididimektomiya or even an orkhiektomiya (see the Small egg, operations).
The chronic epididymite, as a rule, is an outcome acute E. and much less often meets as primary disease. At chronic E. pains insignificant or are absent, the standard temperature, skin of a scrotum is not changed, the epididymis is moderately increased, evenly condensed and delimited from a small egg.
In diagnosis chronic E. in addition to a wedge, signs bacteriological and cytologic researches of urine, a secret of a prostate, ejaculate, and also the excretory urography (see) with the descending tsisto-grafiya (see) ascending at a retrografiya (see), an epididimografiya (see) are of great importance. At a reactive edema of covers of a small egg for simplification of a palpation of an epididymis the puncture of covers and suction of liquid is reasonable.
Differential diagnosis chronic E. with tuberculosis, a tumor of an epididymis, a tumor of a small egg presents considerable difficulties. The most informative in these cases is the biopsy of an epididymis.
Treatment chronic E. consists in prescription of antibiotics of a broad spectrum of activity, anti-inflammatory and resorptional pharmaceuticals (an aloe, a vitreous), an ionophoresis with lidazy or a hydrocortisone on area of the struck appendage. In the absence of effect of conservative therapy and a frequent recurrence of a disease the epididimektomiya is shown (see the Small egg, operations).
Prevention nonspecific E. includes respect for hygiene of sex life, timely treatment of inflammatory diseases of an urethra and prostate, prevention of injuries of a scrotum.
Specific epididymite. Most often the tubercular epididymite meets, gonorrheal is more rare and is much more rare syphilitic and brucellous.
The tubercular epididymite is in most cases combined with a nephrophthisis. Approximately in 24% of cases tubercular
E. comes to light as the first symptom of tuberculosis of bodies of urinogenital system (see Tuberculosis extra pulmonary, tuberculosis of uric and generative organs). The disease develops hl. obr. at the age of 20 — 40 years.
Defeat can be unilateral or bilateral. Originally the prostate is surprised, then process retrogradno extends to an epididymis. In a tail part of an appendage the dense limited node is usually formed. Chronic tubercular E. the long time without dynamics can proceed, but more often process progresses, the small egg and its covers are involved in it, a reactive edema develops. The epididymis forms a uniform conglomerate with a small egg and skin of a scrotum, under skin there is specific abscess with education is long not healing fistulas of a scrotum and the subsequent partial or full sequestration of an epididymis. Often changes at the same time appear in a deferent duct on the party of defeat.
Possibly and acute current tubercular E., at Krom the disease develops as an acute nonspecific epididymite.
2 — 3 days later the acute phenomena begin to abate, and on 7 — the 10th day process accepts sluggish character.
In typical cases diagnosis tubercular E. does not present difficulty. On the party of defeat the hilly, increased epididymis, a dense chetkoobrazny deferent duct, the fistula connected with an appendage is defined; in a prostate dense nodes, sites of retraction are palpated, on its surface melkouzelkovy tuberosity is noted. Recognition of a chronic tubercular epididymite at early stages is much more difficult. It is necessary to consider existence of tubercular changes in other bodies and results of tuberkulinovy tests (see the Tuberculinodiagnosis). Produce for identification of mycobacteria of tuberculosis repeated bacterial. researches of urine, secret of a prostate, ejaculate. Changes on excretory Urogramum and an uretrogram-ma, characteristic of a nephrophthisis and a prostate, allow to assume a tubercular epididymite. In not clear cases important diagnostic information can be obtained at a biopsy of an epididymis.
Differential diagnosis is carried out with a tumor and syphilis of an epididymis. Both in that and in another cases process begins with a small egg; purulent fistulas on a scrotum are absent; at syphilitic E. the diagnosis is confirmed put
telny Wassermann reaction (see Wasserman reaction), at tumoral defeat metastasises can be revealed.
Treatment tubercular E. consists in purpose of antituberculous remedies (see) within
2 — 3 months, in the subsequent carry out an epididimektomiya. At distribution of process on a small egg the epididimektomiya is combined with a resection of a small egg; in cases of total defeat of a small egg make an orkhiektomiya. Sometimes for prevention of distribution; process recommend a preventive vasectomy (see Vasoresection) on the opposite side. Patients tubercular E. are under observation of the phthisiatrician and urologist in an antitubercular clinic (see).
The gonorrheal epididi-m and t is, as a rule, a complication of a gonorrheal urethritis. Gonorrheal E. it is characterized same morfol. changes and wedge, manifestations, as well as nonspecific E. The diagnosis is based on data of the anamnesis, provocation of process by introduction of a gonovaccine and other methods of a research applied to diagnosis of gonorrhea (see). Treatment is same, as at a nonspecific epididymite; apply also specific immunotherapy.
Syphilitic e p ides and d and m and the t develops as a complication of a gummous orchitis in the tertiary period of syphilis (see). Gummas are exposed to disintegration or fusion, often merge among themselves, gradually replacing fabric of a small egg and its appendage. In diagnosis an important role is played by positive Wassermann reaction. In doubtful cases resort to a puncture or operational biopsy. Treatment specific (see Syphilis).
Brucellous epidi-d and m and the t usually is a complication of a brucellous orchitis. After transition of process from a small egg to its appendage of border between them are indiscernible. In an acute stage the nonspecific inflammation, hypostasis of interstitial fabric is observed; in chronic — the sclerosis of a stroma and an atrophy of a parenchyma develop, the granulomas consisting of epithelioid and colossal cells form. Severe pain and a hyperesthesia of skin of the corresponding half of a scrotum are noted. Diagnosis brucellous E. is based on data of the anamnesis, Wright, Haddlson, Byurne's positive serological tests (see the Brucellosis). Treatment is carried out by antibiotics, apply a specific immunotherapy, the anesthetizing pharmaceuticals, physical therapy.
Forecast. Function of an epididymis after postponed E. it is recovered not always; at bilateral defeat often there comes infertility (see).
Bibliography: Gekhman B. With? Nespets
fichesky epididymite, M., 1963, bibliogr.; Reznik B. M. Tuberculosis of men's generative organs, M., 1972; The Reference book on urology, under the editorship of N. A. Lopatkin, page 125, M., 1980; Allgemeine und spezielle Urologie, hrsg. w. G-. W. Heise u. a., Bd 4, S. 19, Lpz., 1979. A. JI. Shapiro.