Epididymitis (mechanism of disease)

This is a flowchart on epididymitis, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Tuberculosis
Viral (mumps)
Orchitis
Renal tuberculosis
Risk factors / SDOH
Cell / tissue damage
Structural factors
Epididymitis
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Neurological pathology
Genetic / hereditary
Flow physiology
Pathophysiology
Etiology
Manifestations
Retrograde ascent of pathogens to the epididymis via the ejaculatory ducts and/or vas deferens, possibly exacerbated by:
Instrumental obstruction
Anatomic abnormalities
Excessive physical exertion
Indwelling catheters
Prostatic hypertrophy
Posterior urethral valves
Urinary tract infections: E. coli, Pseudomonas, Proteus mirabilis, Klebsiella pneumoniae
Older men
Children
Sexually transmitted infections: Chlamydia, gonorrhoeae, T pallidum, Trichomonas, Gardnerella
Sexually active young males (35)
Older men
Children
Repetitive activities (running, jumping)
Exercise or sex with full bladder
Drugs (amiodarone-induced)
Inflammation of the epididymis
Autoimmune (Behcet disease)
Scrotal pain
Scrotal swelling
Radiates to flank
Posterior testes tenderness
Unilateral in 90-95%
Reduced pain when the affected hemiscrotum is elevated (+ Prehn sign)
Overlying scrotal skin may be red, shiny, edematous
+/- low grade fever
+/- dysuria, frequency, urgency
Recurring bouts
Chronic epididymitis
Thickened epididymis
Minimal swelling
Defined as chronic when 6-week course of the disease, usually from recurrent and/or untreated acute epididymitis
Urinalysis; urine culture
NAAT; gram stain
+/- Duplex ultrasound: enlarged, hyperemic epididymis with increased blood flow

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