They may occur secondary to a retrograde extravasation. Urinalysis often is normal, and urine and prostatic fluid cultures are negative. The symptoms are similar to those of bacterial epididymitis. Treatment Treatment consists of bed rest, scrotal elevation, scrotal ice packs, analgesics, and oral antimicrobial therapy for 7 to 10 days. If sepsis is suspected, a parenteral aminoglycoside or 3rd-generation cephalosporin may be useful until the infecting organism and its sensitivities are known.
Cultures are important for establishing adequacy of treatment.
Unless abscess, pyocele, or testicular infarction occurs, surgical drainage usually is not required. Occasionally, chronic epididymitis requires an epididymectomy for relief of symptoms, but in some patients discomfort persists. Patients who must continuously wear an indwelling urethral catheter are prone to develop recurrent epididymitis and epididymo-orchitis. Prophylactic bilateral vasectomy should be considered in recurrent cases in patients with structural abnormalities. Placement of a suprapubic cystostomy or institution of a self-catheterization regimen may be useful.