INTRODUCTION

Infectious and inflammatory processes involving the contents of the scrotum are uncommon. They are usually easy for patients to identify because they cause symptoms of pain and swelling. However, most clinicians other than urologists are unfamiliar with the range of problems that can affect the testis and epididymis and rarely see boys or men with orchitis or epididymitis.

ANATOMY/DEFINITION

The epididymis is a tightly coiled tubular structure on the posterior aspect of the testes that connects the efferent ducts of each testis to the vas deferens. The three regions of the epididymis–the head, body, and tail–serve as sequential sites for sperm transport, maturation, and storage.

Epididymitis involves inflammation or infection of the epididymis, usually accompanied by pain and swelling. It is the most common cause of intrascrotal inflammation. Acute epididymitis is characterized by symptoms lasting for less than 6 weeks, whereas chronic epididymitis involves symptoms persisting for 3 months or longer. Orchitis, or inflammation of the testes, is less common than epididymitis. However, the two structures can be involved together making it difficult to distinguish the clinical entities involving them, thus the term epididymo-orchitis is used to capture these combined inflammatory processes. In patients with acute epididymo-orchitis, inflammatory responses in adjacent structures, such as the seminal vesicles, can occur and can lead to abscess formation.