Pathology in the male upper GU tract can be due to epididymitis, orchitis and prostatitis, i.e. inflammation of the epididymis, testis and prostate. In the female, salpingitis, oophoritis, endometritis and ‘pelvic inflammatory disease’ (PID) describe infection or inflammation of the fallopian tubes, ovaries, endometrium, and pelvis.

Male upper GU infections

Epididymitis

The epididymis, which lies on the posterior surface of the testicle, is responsible for transport, storage, and maturation of sperm. Epididymitis is the most common cause of intrascrotal inflammation, and is likely to be due to retrograde extension of organisms from the vas deferens. Hematogenous spread is very rare. It is primarily a disease of adults, most commonly in the age range of 19–40 years. The onset of pain and swelling is usually gradual, and there may be initial abdominal or flank pain because the inflammation typically begins in the vas deferens. Younger patients may have symptoms of urethritis, and there may be a urethral discharge. A recent history of instrumentation or urinary tract infection is more common in the older patient. The disease is usually unilateral; bilateral involvement is seen in only 10% of cases. Peritubular fibrosis can lead to occlusion of the ductules and obstructive azoospermia. Progression of the infection can lead to an epididymal abscess, epididymo-orchitis, or testicular abscess.

The causative agent can be identified in 80% of cases, varying with the age of the patient.