{"id":113,"date":"2020-07-21T08:56:35","date_gmt":"2020-07-21T08:56:35","guid":{"rendered":"http:\/\/www.paedsurgeryindelhi.com\/blog\/?p=113"},"modified":"2020-07-21T08:59:12","modified_gmt":"2020-07-21T08:59:12","slug":"painful-scrotal-swelling-part-ii-acute-epididymitis","status":"publish","type":"post","link":"https:\/\/www.paedsurgeryindelhi.com\/blog\/painful-scrotal-swelling-part-ii-acute-epididymitis\/","title":{"rendered":"Painful Scrotal swelling Part II – Acute Epididymitis"},"content":{"rendered":"\n

Acute scrotal pain and swelling is a common urological complaint in the paediatric population. Testicular torsion<\/strong> and torsion of the appendix testis and acute epididymitis (AE or inflammation of the Epididymis \u2013 A tube attached to the testicle that connects the testicle to the vas deferens. If the inflammation spreads to the attached testicle then it is known as Epididymo-orchitis) are the major differential diagnoses.The management of each patient depends on the individual clinical manifestations, laboratory and sonographic findings. We discussed about Testicular torsion and its management in part I of the painful scrotal swelling. Although it has been shown that colour Doppler sonography can identify testicular torsion in boys reliably,surgical exploration remains the gold standard diagnostic tool so as to maximise the chances of testicular salvage in case of testicular torsion.After torsion of the testis and testicular appendix have been excluded, the acute scrotum in paediatric patients is mainly due to AE. <\/p>\n

The exact incidence of AE in the paediatric population is unknown. A bimodal age distribution of epididymitis is known with peak incidence in infancy and mainly the age group of 9\u201312 years (Prepubertal boys). Most cases of epididymitis in sexually active patients (young adults) are due to sexually transmitted organisms.In infancy, AE can be a systemic disease manifestation or it can be associated with an underlying genitourinary abnormality.However, the cause of AE in prepubertal boys remains controversial. It could be a post viral infectious process like recent upper respiratory or gastrointestinal infections. If causing recurrent episodes, it could be due to underlying urological abnormalities or due to voiding dysfunction.<\/p>\n

The first priority in assessing boys with an acutely painful scrotum is to exclude the presence of a testicular torsion. If there is uncertainty, the medical dictum for immediate surgical exploration applies. Once testicular torsion is ruled out on colour doppler, then the management is supportive treatment only as it commonly represents a postviral inflammatory process with a benign course. Antibiotics should only be administered to patients with pyuria, positive urine culture or a known urogenital abnormality.For the others, treatment should be supportive, consisting of bed rest and analgesia such as paracetamol and non-steroidal anti-inflammatory medications (NSAID) and scrotal support. <\/p>\n

For patients with recurrent episodes of AE and\/ or history of voiding problems, Ultrasonography of the renal tracts with post void residual urine, Uroflowmetry (A simple test to assess the flow rate of urine. It is done to assess for voiding abnormalities) and Voiding Cysto-Urethrography or VCUG (A special X-ray in which a dye is injected per urethra to assess the lower tracts for abnormalities) are advised. Patients with a urogenital abnormality are more susceptible to recurrent epididymitis than those with no urogenital abnormality and so management involves addressing the underlying abnormality. Patients with documented voiding dysfunction are managed with bladder retraining and prophylactic antibiotics to prevent recurrence of epididymitis. <\/p>\n\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Acute scrotal pain and swelling is a common urological complaint in the paediatric population. 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