Chronic epididymitis is a clinical diagnosis based on chronic epididymal pain lasting for at least six weeks 8. It is a common, possibly the most common, cause of scrotal pain.
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Epidemiology
One study found the median age at presentation is 46-49 years with an average duration of symptoms prior to presentation of ~5 years 1,6.
Clinical presentation
Patients present with chronic point tenderness of their epididymis +/- a palpable mass or swelling 1,2,8.
Pathology
One classification of chronic epididymis is 1-4:
- inflammatory chronic epididymitis: mass/swelling present
- infective
- post-infective, e.g. after acute epididymitis
- granulomatous, e.g. tuberculous, sarcoidosis
- drug-induced, e.g. amiodarone
- syndromic, e.g. Behcet's disease
- idiopathic
- obstructive chronic epididymitis
- congenital
- post-vasectomy pain syndrome
- chronic epidymyalgia: mass/swelling absent; cause unknown
Radiographic features
Ultrasound
Ultrasound may be normal in a large number of patients. When abnormal, findings of epididymitis, epididymal cyst, or epididymal mass may be present 7.
Treatment and prognosis
Initial treatment consists of a trial of antibiotics as well as scrotal support, anti-inflammatories, and analgesia including nerve blocks. Chronic epididymitis is generally considered "self-limited" albeit with a chronic course; refractory cases may require surgical resection of the epididymis 5.
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