Epididymis

Epididymis

Epididymal pathology is rare in prepubertal males. In sexually active males, acute epididymitis (often due to Chlamydia ) with significant pain and swelling needs to be distinguished from acute testicular torsion. A Doppler USS may help di ff eren - tiate between the two conditions: in epididymitis it shows an - increased blood flow into the inflamed epididymis, whereas in torsion it shows decreased or complete lack of blood flow to the testis. If ther e is any doubt, scrotal exploration is undertaken. Epididymal cysts can form similar scrotal swellings to hydroceles but can be distinguished by the fact that the testis can often be felt separately . They contain clear or white fluid. Both hydroceles and epidid ymal cysts transilluminate on clin - ical examination. Genitourinary TB can result in bilateral nodular induration of the epididymis and nodularity of the vas deferens. It may also result in scrotal abscesses that, unlike pyogenic abscesses, ( Figure 81.1 ).

Figure 81.1 Cold abscess of the left scrotum. (Reproduced with permission from Kumar R. Reproductive tract tuberculosis and male infertility. Indian J Urol 2008; 24 : 392–5.)