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Disorders of Scrotal Contents: Orchitis,

Epididymitis,Testicular Torsion,Torsion of

the Appendages, and Fournier’s Gangrene

Parviz K. Kavoussi and Raymond A. Costabile

Orchitis

Definition and Etiology

Orchitis is defined as inflammation of the testicle.1 The most common etiology of acute orchitis, and epididymitis, is infection with the sexually transmitted pathogens C. trachomatis and N. gonorrhea in young men below the age of 35.2 Epididymorchitis is also the most common cause of the “acute scrotum” in this age-group.3 The most common organisms to cause orchitis and epididymitis in men over the age of 35 and in prepubertal boys are E. coli and P. mirabilis.4

Less common causes of infectious orchitis and epididymitis include brucellosis (B. meli­ tensis), tuberculosis (M. tuberculosis), cryptococcus (C. neoformans), and the mumps virus. In these cases of epididymorchitis, orchitis develops from the infection spreading contiguously from the epididymis in 20–40%.5 Mumps is the most common cause of orchitis not associated with epididymitis, with both testicles involved in 14–35% of cases.6 Mumps orchitis can result in oligospermia and male factor infertility. Childhood vaccination is the best way to prevent mumps orchitis and its sequellae.7 The incidence of mumps orchitis has diminished with advent of the vaccine, although there have been reports that the measles, mumps, and rubella (MMR) vaccine can induce orchitis in a small number of patients.8

Viral orchitis is typically disseminated by hematogenous route.1 Genitourinary tract tuberculosis can be a source of orchitis. Epididymorchitis has also been reported in men treated with intravesical instillations of bacillus Calmette-Guerin (BCG) therapy for the treatment of bladder cancer.9

In the pediatric population, anomalies of the male excurrent duct system can predispose children to epididymorchitis, which is a rare source of the acute scrotum in this population. Epididymorchitis in children is thought to be due to urinary tract infections associated with these anatomic anomalies.10

Clinical Signs and Symptoms

The typical symptoms of orchitis include scrotal pain, swelling, tenderness, and skin fixation over the testicle. Prehn’s sign has been described in orchitis and epididymitis, when there is relief of pain with elevation of the testicle over the symphysis pubis.11 Prehn’s sign is nonspecific and nondiagnostic and does not necessarily distinguish epididymorchitis from spermatic cord torsion.

Orchitis can cause an irreversible affect on spermatogenesis, impacting the quality and number of spermatozoa. Lymphocytic infiltration and seminiferous tubule damage is seen on testicular biopsies of subfertile men with a history of chronic orchitis.12

C.R. Chapple and W.D. Steers (eds.), Practical Urology: Essential Principles and Practice,	309
DOI: 10.1007/978-1-84882-034-0_23, © Springer-Verlag London Limited 2011