Management of Epididymitis

EPIDIDYMITIS

Epididymitis is an infection of the epididymis that usually results from an infected prostate or urinary tract. It may also develop as a complication of gonorrhea. In men younger than 35 years of age, the major cause is Chlamydia trachomatis infection.

CLINICAL MANIFESTATIONS
·    Unilateral pain and soreness in the inguinal canal along the course of the vas deferens.
·    Pain and swelling in the scrotum and groin.
·    Extremely painful and swollen epididymis; temperature elevated.
·    Pyuria and bacteriuria with resulting chills and fever.

MEDICAL MANAGEMENT
·    If seen within 24 hours after onset of pain, spermatic cord may be infiltrated with a local anesthetic agent for relief.
·    If chlamydial in origin, patient and patient’s sexual partners must be treated with antibiotics.
·    Observe for abscess formation.
·    If no improvement within 2 weeks, consider underlying testicular tumor.
·    Epididymectomy (excision of the epididymis from the testes) is done for recurrent, incapacitating episodes or chronic, painful conditions.

NURSING MANAGEMENT

·    Place patient on bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction on spermatic cord and improve venous drainage and relieve pain.
·    Give antimicrobial medications as prescribed.
·    Provide intermittent cold compresses to scrotum to help ease pain; later, local heat or sitz baths may hasten resolution of inflammatory process.
·    Give analgesic agents as prescribed for pain relief.
·    Instruct patient to avoid straining, lifting, and sexual stimulation until infection is under control.
·    Instruct patient to continue with analgesic and antibiotic medications as prescribed and to use ice packs as necessary for discomfort.
·    Explain that it may take 4 weeks or longer for the epididymis to return to normal.


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