Chronic epididymitis is a clinical diagnosis based on chronic epididymal pain lasting for at least three months. It is a common, possibly the most common, cause of scrotal pain.
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.
Patients present with chronic point tenderness of their epididymis +/- a palpable mass or swelling 1,2.
One classification of chronic epididymis is 1-4:
- inflammatory chronic epididymitis: mass/swelling present
- obstructive chronic epididymitis
- post-vasectomy pain syndrome
- chronic epidymyalgia: mass/swelling absent; cause unknown
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.
- 1. Nickel JC. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. (2003) Reviews in urology. 5 (4): 209-15. Pubmed
- 2. Christopher R. Chapple, William D. Steers. Practical Urology: Essential Principles and Practice. (2011) ISBN: 9781848820340
- 3. Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh. The SAGES Manual of Groin Pain. (2015) ISBN: 9783319215877
- 4. Michael Sabia, Jasjit Sehdev, William Bentley. Urogenital Pain. (2017) ISBN: 9783319457949
- 5. Alan J. Wein, Louis R. Kavoussi, Andrew C. Novick, Alan W. Partin, Craig A. Peters. Campbell-Walsh Urology. (2011) ISBN: 9781455722983
- 6. Nickel JC, Siemens DR, Nickel KR, Downey J. The patient with chronic epididymitis: characterization of an enigmatic syndrome. (2002) The Journal of urology. 167 (4): 1701-4. Pubmed
- 7. J. G. Calleary, Junaid Masood, J. T. Hill. Chronic epididymitis: is epididymectomy a valid surgical treatment?. (2009) International Journal of Andrology. 32 (5): 468. doi:10.1111/j.1365-2605.2008.00880.x - Pubmed