Ochitis

2. DR SHAHID ALI
PGR Urology-Unit-2
Mayo hospital Lahore

4. OUTLINE
1.BRIEF INTRODUCTION
2.DEFINATION
3.ETIOLOGY/RISK FACTORS
4.DIFFERENTIALS
5.PATHOPHYSIOLOGY
6.CLINICAL MANIFESTATIONS
7.DIAGNOSTIC EVALUATION
8.MEDICAL MANAGEMENT
9.SURGICAL MANAGEMENT
10.COMPLICATION
11.PROGNOSIS
12.DETERRENCE AND PATIENT EDUCATION

5. INTRODUCTION:
 Testis are two oval male reproductive organ
situated in the scrotum. They are responsible
for the production of male sex hormones and
sperm.
 Blood supply is from two paired arteries
arising from abdominal aorta.
 Venous drainage is through pampinoiform
plexus.

6.  Lymphatic drainage is through Para-aortic
lymph nodes, while superficial inguinal lymph
nodes drain the scrotum.
 Nerve supply by testicular plexus, which
contains nerves originating from renal and
aortic plexus.

7. DEFINATION OF ORCHITIS
 Orchitis is defined as the inflammation of the
testicles unilaterally or bilaterally.
 Isolated orchitis is rare, usually accompanied
with epididymitis called epididmyo orchitis.

8. ETIOLOGY /RISK FACTORS
 Pyogenic bacteria
 Gonococci
 Tubercle bacilli
 Viruses
RISK FACTORS
Pre existing history of epididymitis
Unprotected sexual contact.
Multiple sexual partners
Long term use of Foley catheter,
Bladder outlet obstruction
Lack of immunization with MMR

9.  Differentials
1:Most common is testicular torsion
2:Abscess formation
3:Pyocele
4: Epididymitis

10. PATHOPHYSIOLOGY
Due to the etiological factors
Inflammatory fluid seeks the testicle into the
serous membrane (lining the testicles)
unilateral or bilateral swelling/inflammation

12. HISTORY AND PHYSICAL EXAMINATION
The patient usually presents with acute onset of
testicular pain, which may initially involve one
testis, and then may spread to include the whole
scrotum.
The patient may also complain of fever
accompanied by malaise, fatigue rigors and chills.
On examination there is testicular enlargement,
tenderness and induration.
Scrotal edema and erythema may also be present.
Mumps orchitis may present with bilateral parotid
enlargement and usually present 4 to 8 days after
onset of parotitis.

13.  DIAGNOSTIC EVALUATION
 Orchitis diagnosis is usually from history and
physical findings.
 Laboratory tests are generally not helpful, but
urethral swabs and urine samples may be obtained
for routine examination and cultures to rule out
urinary tract infection and diagnose sexually
transmitted infections as a source.
 IMAGING
 Color Doppler ultrasonography of scrotum is the
first choice of investigation.
 Serum immunofluorescence antibody testing is
useful to confirm the diagnosis of mumps orchitis.

15. MANAGEMENT
SUPPORTIVE TREATMENTS
It includes bed rest,antipyretics,analgesics,srotal support,
and hot or cold packs for analgesia are advisable.
DEFINATIVE MEDICAL TREATMENTS
Antibiotics are not necessary for viral causes of the disease.
Antibiotics should start empirically based on the likely
pathogens according to age and sexual history.
If there is suspected enteric bacteria then fluoroquinolones
(ciprofloxacin,ofloxacin,levofloxacin)for 10 to 14 days are
the preferred drugs.trimethoprim-sulfamethoxazole is also
an option for these pathogens.
If there is suspicion of sexually transmitted pathgen,then
treatment should consist of ceftriaxone 250mg single shot
intramuscularly and doxycycline 100mg BD for 10 to 14
days.
Azithromycin is also an option in place of doxycycline.

16. SURGICAL MANAGEMENT
 Aspiration
 If hydrocele is present the fluid may be
aspirated to reduce pressure on the testis.
 Surgical tapping
 It is done when edema is persistent and it
decreases a chance of getting testicular
atrophy when done within first 2 days.
 Surgical excision
 The tunica albuginea must be excised to
improve resolving phase.

17.  COMPLICATIONS
 Testicular atrophy (up to 60% of cases
demonstrate some degree of atrophic changes)
 Impaired fertility
 Sterility
 Epididymitis
 Reactive hydrocele
 Rarely testicular infarction
 Cutaneous scrotal fistula

18. PROGNOSIS
 The decrease in body temperature in the first
three days of anti bacterial treatment is
considered as good prognostic marker.
 Overall, the majority of viral and antibiotic
treated cases will resolve without any
complications.

19. DETERRENCE AND PATIENT EDUCATION
 Prevention resolves primarily in avoiding the
risk factors
 Vaccination against mumps
 Safe sex practices to prevent gonorrheal and
chlamydial infections
 Avoid indwelling urinary catheters
 Surgically correct urinary tract obstructions for
eligible patients.