急性附睾炎

　　1、发病原因

　　尽管阴囊外伤或无菌尿从尿道经输精管反流偶可引起附睾炎症，但是绝大多数病人主要是由病原体感染所致。国外有研究认为，35岁以前的附睾睾丸炎多在性交后感染沙眼衣原体和(或)淋球菌等病原体导致，而35岁以上的附睾睾丸炎则多由非性传播的革兰阴性肠道杆菌引起的尿道感染所致。但是同性恋的男性也可在肛交后发生肠道杆菌导致的附睾睾丸炎。一般认为病原体进入尿路导致尿道炎、膀胱炎或前列腺炎，由此穿过淋巴系统或经输精管直接侵入附睾及睾丸。另外，扁桃体炎、牙齿感染或全身感染时致病菌进入血流也可导致附睾炎的发生。如果近期行器械操作如尿道扩张术，或曾留置尿管，则革兰阴性肠道杆菌感染是更常见的原因。幼儿附睾炎反复发作提示尿路可能存在解剖异常，从而使尿液进入精囊所致。随着检测手段的不断进步，约80％的附睾炎可以找到病因，但仍有20％的附睾炎病例病因不明，有人认为过敏及免疫因素在其中发挥一定作用。

　　2、发病机制

　　附睾炎早期是一种蜂窝织炎，一般在输精管开始再延伸至附睾尾部。在急性期，附睾肿胀高低不平。感染一般从附睾尾延至附睾头。此时如切开附睾可见小脓肿，鞘膜分泌液可呈脓状。精索变厚，睾丸的肿胀是继发于被动充血，极少数病例睾丸同时发生炎症。早期组织学见水肿及中性白细胞、浆细胞及淋巴细胞浸润，以后即出现脓肿。感染在后期可完全消失而无损害，但附睾管周围的纤维化可使管腔阻塞。如为双侧附睾炎，可发生男性不育症。

　　If treated in time, the damage can be completely resolved without damage, but the function of the epididymis may still be affected to a certain extent. If treated in a timely manner or treated improperly, inflammation can develop into an abscess, causing serious damage to the epididymal tissue. In addition, epididymitis can lead to fibrosis, causing the narrowing or occlusion of the epididymal duct. Bilateral epididymal damage often leads to male infertility or low male fertility. In the case of involvement of the testicle, it can also cause testicular spermatogenic dysfunction. Epididymal abscess can extend and destroy the testicle (epididymo-orchitis). Acute epididymitis can evolve into chronic epididymitis.

　　The onset is sudden, with high fever, elevated white blood cells, swelling and pain in the scrotum on the affected side, a sinking sensation, and pulling pain in the lower abdomen and inguinal area, which worsens when standing or walking. The epididymis on the affected side is enlarged, with marked tenderness. When the inflammatory range is large, both the epididymis and testicle are swollen, and the boundary between them is unclear when touched, which is called epididymo-orchitis. The spermatic cord on the affected side is thickened and also tender. Generally, the acute symptoms can gradually subside after a week.

　　For patients with urinary tract infection and prostatitis, thorough and effective anti-infection treatment must be carried out to avoid the displacement and infection of the epididymis and testicular tissue by pathogens. If necessary, to prevent recurrence, unilateral vasectomy can be performed. At the same time, attention should be paid to the hygiene of the reproductive organs, young men should avoid excessive masturbation and frequent sexual life. Due to urethral dilation and congestion after sexual excitement, it is easy to induce epididymitis due to retrograde infection.

　　1. Blood count:Increased blood leukocytes, left shift of the nucleus, urine culture may have pathogenic bacteria growth.

　　2. B-ultrasound examination:It can be seen that the epididymis is diffusely and uniformly enlarged, or locally enlarged, with uneven internal echo, thickened light points, which can show the swelling and inflammation range of the epididymis and testicle.

　　Diet should be light and nutritious, with attention to dietary balance. Avoid spicy and刺激性 foods. In order to prevent the recurrence of the disease, such as seafood, chicken, dog meat, and so on. At the same time, do not ban spicy foods. Eat more fresh vegetables and fruits. Fresh vegetables and fruits contain a large number of nutrients needed by the human body. Eat more foods that enhance immunity: postoperative patients have poor physical condition and low immunity, so they should eat more foods that can enhance immunity, such as yam, turtle, mushroom, kiwi, fig, apple, sardine, honey, milk, pork liver, etc., to improve the body's ability to resist diseases.

　　I. Treatment

　　I. Medical Treatment

　　Since the cause of epididymitis is bacterial rather than urinary reflux, medication should be used. The pathogenic bacteria of acute epididymitis are often caused by intestinal bacteria or Pseudomonas aeruginosa, and are more common in middle-aged and elderly men. The choice of antibacterial drugs should be determined according to bacterial culture and antibacterial drug sensitivity test. If sensitive to trimethoprim (Combifloxin), it should be taken orally twice a day for a total of 4 weeks, which is more useful especially for those with bacterial prostatitis. If local redness and swelling are obvious, an increase in blood leukocytes, and an elevated body temperature, intravenous administration of antibiotics should be given until the body temperature returns to normal, and then oral antibiotics should be taken. Urinary and reproductive tract examinations should be performed on these patients. Other general supportive therapies: bed rest should be maintained during the acute stage of epididymitis. The scrotum should be supported by an artificial support to relieve pain. If the epididymal pain is severe, 20ml of 1% lidocaine can be administered locally by injection into the spermatic cord from the upper end of the testicle to relieve discomfort. Oral painkillers and antipyretics can also be used. In the early stage, an ice pack can be placed on the epididymis to prevent swelling. In the later stage, hot compresses can be used to accelerate the disappearance of inflammation and relieve the patient's discomfort. Indomethacin (inflammatory pain) can also be used to relieve symptoms. Avoid sexual activity and physical activity during the acute stage, as both can worsen the symptoms of infection. During the acute stage, the Yige Golden Powder can be mixed with sesame oil (or vinegar, which is more irritating to the skin) and applied to the scrotum, covered with gauze, which has a good effect on inflammation and pain relief. If hot compresses are also applied at the same time, the effect is even better.

　　II. Surgical Treatment

　　The vast majority of acute epididymitis disappear spontaneously after medication, but 3% to 9% of cases develop abscesses one month after the acute stage. A group of 610 patients with acute epididymitis had 19 cases of orchiectomy due to purulent epididymo-orchitis. A small number of acute epididymitis (1%) may develop into testicular infarction and require orchiectomy. Some people advocate surgical exploration for uncontrollable acute epididymo-orchitis. If the testicle is not involved, only the epididymectomy should be performed.

　　II. Prognosis

　　Acute epididymitis should be diagnosed in time and treated appropriately. Generally, it can recover without complications. It takes about 2 weeks, 4 weeks, or even longer for the epididymis to return to normal size and texture. Bilateral acute epididymitis can lead to decreased fertility or infertility in patients, although it is rare in clinical practice.