TABLE 912 Etiology and Treatment of Epididymitis and Epididymoorchitis

Admission criteria for epididymitis include fever with elevated white blood cell count and subjective toxicity, all of which can be indicative of epididymal or testicular abscess formation. A urologist will dictate inpatient management, which should include: (1) absolute bedrest for the first 24 to 48 h, with scrotal elevation and ice application (10 to 15 min every 4 to 6 h) to the involved testis/epididymis; (2) nonsteroidal anti-inflammatory drugs (NSAIDs); (3) intravenous antibiotics based on etiology (Iable.91-2); and (4) narcotics for pain control, with concomitant stool softeners. These measures will prevent further progression of the inflammatory process. Once the bedridden patient is pain-free, he should begin ambulation with a scrotal supporter, being careful not to lift heavy objects or strain when having a bowel movement, both of which will increase intraabdominal pressure and exacerbate the inflammatory cycle. Any significant deviation from this plan will prolong the recovery period. Outpatient management is identical to inpatient management except that oral antibiotics are prescribed initially for 10 to 14 days. A urologist will need to reevaluate the patient in five to seven days and then ultimately decide when the patient may return to work based on his job description, i.e., a sedentary worker would be able to return sooner than a laborer.

ORCHITIS Isolated orchitis, or inflammation of the testicle, is quite rare. It usually occurs in conjunction with other systemic diseases, such as mumps, other viral illnesses, or syphilis. Orchitis usually presents as bilateral testicular tenderness and swelling over a few days' duration. Treatment is symptomatic and disease-specific with urologic follow-up.

TESTICULAR MALIGNANCY Any asymptomatic testicular mass, firmness, or induration is the hallmark of testicular carcinoma. Jen percent of tumors will present with pain secondary to acute hemorrhage within the tumor. Metastatic testicular tumors can be insidious and must be suspected in any male with unexplained supraclavicular lymphadenopathy, abdominal mass, or chronic nonproductive cough that appears resistant to antibiotic or other supportive therapy. Testicular examination may be diagnostic. While not a urologic emergency, any unexplained testicular mass must be approached as a tumor, with urgent urologic referral.

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