AUTHOR AND EDITOR INFORMATION

Section 1 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

INTRODUCTION

Section 2 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Background

Epididymitis is defined as inflammation of the epididymis, the tightly coiled segment of the spermatic duct that connects the efferent duct from the posterior aspect of each testicle to its respective vas deferens. It is a significant cause of morbidity and is commonly observed by urologists, emergency medicine practitioners, and primary care physicians.

Epididymitis is the fifth most common urologic diagnosis in men aged 18-50 years. It is an important entity to differentiate from testicular torsion, which is a true urologic emergency.
 
Acute epididymitis is characterized by the onset of epididymal pain and swelling over a period of several days. Chronic epididymitis is characterized by epididymal pain and inflammation that lasts more than 6 weeks and may be accompanied by scrotal induration.

Although epididymitis is thought to be an infectious process, cultures commonly fail to demonstrate any identifiable infection. Infection that is severe and extends to the adjacent testicle is termed acute epididymo-orchitis. Orchitis is an acute inflammatory reaction that involves only the testes, exclusive of epididymitis, and is much less common. Hippocrates first described mumps orchitis during the fifth century BC.

Pathophysiology

The exact pathophysiology of acute epididymitis is unclear; however, it is believed to be caused by the retrograde passage of infected urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens. Obstruction of the prostate or urethra and congenital anomalies create a predisposition for sterile or urethrovasal reflux. Normally, the oblique angle of the ejaculatory ducts through the dense prostatic tissue prevents reflux. Fifty-six percent of men older than 60 years who have epididymitis exhibit concurrent bladder outlet obstruction (BOO) such as urethral stricture or benign prostatic hyperplasia (BPH). (For additional information on BPH, see Medscape's BPH Resource Center.)

Reflux may also be induced by Valsalva or strenuous exertion. Epididymitis is commonly found to develop during strenuous exertion in conjunction with a full bladder. 

Instrumentation and indwelling catheters are common risk factors for acute epididymitis. Epididymitis may also be accompanied by urethritis or prostatitis. Tuberculous epididymitis may be the presenting feature of genitourinary tuberculosis (TB), which develops via hematogenous spread. Other bloodstream infections may seed the scrotum, especially in children. In a study by Chiang et al, 2 of 7 infants had either Escherichia coli or Neisseria meningitides sepsis associated with epididymo-orchitis.¹ 
 
Orchitis is found in association with acute epididymitis in 20-40% of cases. Orchitis differs from epididymitis in that a viral pathogen (mumps) is an important factor. One third of postpubertal boys diagnosed with mumps develop orchitis.

Frequency

United States

• Epididymitis is the fifth most common urologic diagnosis in men ages 18-50 years. 
• An estimated 1 in 1000 men develop epididymitis annually, and acute epididymitis accounts for more than 600,000 medical visits per year in the United States. 
• The mumps, measles, and rubella (MMR) vaccine has markedly reduced the incidence of mumps orchitis. 
• Chronic epididymitis may account for up to 80% of patients presenting with scrotal pain in the outpatient setting.

Mortality/Morbidity

Complications of acute epididymitis and epididymo-orchitis include the following: 

• Scrotal abscess and pyocele
• Testicular infarction
• Chronic epididymitis and orchalgia
• Infertility secondary to inflammation or epididymal duct obstruction
• Testicular atrophy with resulting hypogonadotropic hypogonadism
• Cutaneous fistulization

Race

Epididymitis and orchitis have no predilection for any racial or ethnic group.

Sex

Epididymitis occurs only in males.

Age

• Acute epididymitis most commonly occurs in men aged 20-59 years (43% in men aged 20-39 y and 29% in men aged 40-59 y). Childhood (prepubertal) epididymitis is rare, and testicular torsion is more common in this age group.  
• Structural urologic abnormalities are common in children and in men older than 40 years with acute epididymitis. Adults usually have BOO or urethral stricture. Children may have urethral abnormalities such as a prostatic utricle, urethral duplication, posterior urethral valves, or urethrorectal fistula or other anomalies, such as an ectopic ureter, ectopic vas deferens, detrusor sphincter dyssynergia, or vesicoureteral reflux. Siegel et al found that 47% of prepubertal boys with epididymitis had associated urogenital abnormalities, including ectopic vas deferens or ureters, and urethral abnormalities.²  
• The average age of a patient with chronic epididymitis is 49 years. Patients often experience symptoms for 5 years before diagnosis.
• Mumps orchitis occurs in 20-40% of postpubertal boys with the mumps but is rare in prepubertal boys.

CLINICAL

Section 3 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

History

• Acute epididymitis and orchitis  
• • Gradual onset of scrotal pain and swelling, often developing over several days (as opposed to hours such as in testicular torsion)
  • Usually located on one side
  • Dysuria, frequency, and/or urgency
  • Fever and chills (in only 25% of adult patients with acute epididymitis but in up to 71% of children with the condition)
  • Usually no nausea or vomiting (as opposed to testicular torsion)
  • Urethral discharge preceding the onset of acute epididymitis (in some cases)
• Chronic epididymitis  
• • The patient has a long-standing history of pain (>6 wk) that can be described as either waxing and waning or constant.
  • The scrotum is not usually swollen but may be indurated in long-standing cases.
• Mumps orchitis  
• • Fever, malaise, and myalgia are common.
  • Parotiditis typically precedes the onset of orchitis by 3-5 days.
  • Subclinical infections occur in 30-40% of patients.

Physical

• Acute epididymitis  
• • Tenderness and induration first occur in the epididymal tail, which may be the first site of reflux via the vas deferens. It then appears to spread to the body, head, and even the spermatic cord (funiculitis) or the ipsilateral testis (epididymo-orchitis).
  • Prehn sign: In this physical examination, the affected hemiscrotum is elevated. This action relieves the pain of epididymitis but exacerbates the pain of torsion. The elevation takes the weight of the testis off the epididymal suspension.
  • Physical examination findings may fail to distinguish acute epididymitis from testicular torsion. A normal cremasteric reflex indicates that testicular torsion is less likely.
  • Acute epididymitis is bilateral in 5-10% of affected patients.
  • Erythema and mild scrotal cellulitis may be present.
  • A reactive hydrocele is common in patients with advanced epididymo-orchitis, complicating scrotal examination.
  • Postpubertal individuals with acute epididymitis frequently have associated bacterial prostatitis and/or seminal vesiculitis.
  • TB can cause focal epididymitis, a draining sinus, or beading of the vas deferens with extensive involvement. Orchitis rarely occurs without epididymitis in TB.
  • In children, epididymitis may be related to an underlying congenital anomaly of the urogenital tract, such as urethral abnormalities, an ectopic ureter, an ectopic vas deferens, detrusor sphincter dyssynergia, or vesicoureteral reflux.
• Orchitis  
• • Testicular enlargement, induration, and a reactive hydrocele are common. 
  • The epididymis is not tender.

Causes

• The etiology of acute epididymo-orchitis varies depending the age of the patient and may involve a bacterial, nonbacterial infectious, noninfectious, or idiopathic process.  
• • Nonspecific bacterial infections: Infections with urinary coliforms (eg, E coli, Pseudomonas species, Proteus species, Klebsiella species) are the most common cause in children and in men older than 35 years. Ureaplasma urealyticum, Corynebacterium species, Mycoplasma species, and Mima polymorpha have also been isolated. Systemic Haemophilus influenzae and N meningitides infections are rare. In homosexual men, infections with coliform bacteria are also a common etiology.
  • Sexually transmitted diseases (STDs): Chlamydia is the most common cause in sexually active men younger than 35 years (accounting for up to 50% of cases, although laboratory evidence of chlamydia may be absent in up to 90% of cases). Infections with Neisseria gonorrhoeae, Treponema pallidum, Trichomonas species, and Gardnerella vaginalis also occur in this population.
  • Tuberculous epididymitis: This can occur in endemic areas and is still the most common form of urogenital TB. It is believed to spread hematogenously and often involves the kidneys. Epididymo-orchitis may develop following bacille Calmette-Guérin (BCG) treatment for superficial bladder cancer (at a rate of 0.4%).
  • Viral epididymitis: This is thought to be the predominant etiology of pediatric epididymitis. It is defined by the absence of pyuria. Although mumps is the most common viral cause of epididymitis, coxsackievirus A, varicella, and echoviral infections have also been identified.
  • Other rare infections (eg, brucellosis, coccidioidomycosis, blastomycosis, cytomegalovirus [CMV], candidiasis, CMV in HIV) have been implicated but usually occur in immunocompromised hosts.
  • Roughly 1 in 1000 men who undergo vasectomy describe a postvasectomy pain syndrome of chronic, dull, aching pain in the epididymis and testicle. The pain is most likely secondary to chronic epididymal congestion of sperm and fluid that continues to be produced after the vasectomy. The epididymis can become distended from back pressure of this fluid, particularly following the close-ended vasectomy technique. When sperm extravasates from the end of the vas deferens, such as can occur in the open-ended vasectomy technique, a sperm granuloma may develop with a resulting inflammatory reaction.  
  • Obstruction: Men older than 40 years may have BOO (eg, BPH) or a urogenital malformation that predisposes them to urethrovasal reflux and the development of epididymitis; children may have various congenital abnormalities or functional voiding problems that increase the risk of reflux into the ejaculatory ducts.
  • Vasculitic syndromes: Acute epididymitis-orchitis has been described in 12-19% of individuals with Behçet syndrome. It is also associated with Henoch-Schönlein purpura in the pediatric population, most likely as part of a systemic inflammatory process. Up to 38% of patients with Henoch-Schönlein have scrotal involvement (range, 2-38%).  
  • Amiodarone epididymitis is secondary to high drug concentrations, usually in the head of the epididymis, and can occur in up to 3-11% of patients taking the drug. This is a dose-dependent phenomenon and typically occurs at dosages greater than 200 mg daily. Epididymal levels of the drug are up to 300 times those of the serum, resulting in anti-amiodarone HCl antibodies that subsequently attack the epididymis, resulting in the symptoms of epididymitis. Histological analysis reveals focal fibrosis and lymphocytic infiltration of epididymal tissues.  
  • Sarcoidosis affects the genitourinary system in up to 5% of cases, typically presenting with epididymal nodules.
  • Trauma to the scrotum can be a precipitating event.
  • Some cases are idiopathic.
• Etiology of chronic epididymitis  
• • Inadequate treatment of acute epididymitis
  • Recurrent epididymitis
  • Associated with a granulomatous reaction (most commonly Mycobacterium tuberculosis)  
  • Associated with a chronic disease process such as Behçet syndrome 
• Etiology of acute orchitis  
• • Viral: Mumps orchitis was once the most common etiology; however, since the introduction of the mumps vaccine in 1985, this has been virtually eliminated. Roughly one third of postpubertal boys with mumps have concomitant orchitis. Coxsackievirus type A, varicella, and echoviral, adenoviral, enteroviral, influenzal, and parainfluenzal infections are rare. 
  • Bacterial and pyogenic infections: Infections with E coli, Klebsiella species, Pseudomonas species, Staphylococcus species, and Streptococcus species are unusual. 
  • Granulomatous: T pallidum, M tuberculosis, Mycobacterium leprae, Actinomyces, and fungal diseases are rare.
  • Trauma 
  • Idiopathic

DIFFERENTIALS

Section 4 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Other Problems to be Considered

Scrotal hernia
Idiopathic scrotal edema
Reactive hydrocele
Pyocele
Henoch-Schönlein purpura
Behçet disease
Polyarteritis nodosa
Vasculitis

WORKUP

Section 5 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Lab Studies

• Acute epididymitis and nonviral orchitis  
• • The WBC count may be elevated with a left shift (10,000-30,000 cells/μL).
  • A midstream urine culture and Gram stain are useful in guiding therapy. Urinalysis findings are positive for pyuria in only 25% of patients and are sterile in 40-90% of patients.
  • Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is in the at-risk age group or if the patient is older than 40 years and not monogamous. Gonorrheal infections often demonstrate gram-negative diplococci on smear, while chlamydial infections can be established in two thirds of cases when only WBCs are seen on smear. Chlamydia polymerase chain reaction (PCR) is highly specific and sensitive for chlamydial infection.
  • Perform blood cultures if the patient is systemically ill.
  • It is recommended that pediatric patients be evaluated for underlying congenital anomalies via abdominopelvic ultrasonography, voiding cystourethrography, and, in some cases, cystoscopy, especially when the urine culture result is positive. Debate is ongoing as to whether further work-up is necessary only in those with recurrent episodes or also after a first episode of epididymitis or epididymo-orchitis.  
• Mumps orchitis  
• • Use immunofluorescent antibody testing to confirm the diagnosis upon clinical doubt.
  • Urinalysis and culture findings are negative.
• Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis.

Imaging Studies

Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. Do not allow studies to delay intervention or exploration if testicular torsion is suspected because testicular viability drops significantly with delay. In addition, the clinical evaluation is paramount and imaging studies should be used if the examination findings are indeterminate. Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis.

• Color Doppler ultrasonography  
• • This test is the most widely available; however, it is examiner-dependent. The effectiveness of the examination can be limited by pain and patient size (eg, infants). It should also be reserved for patients with indeterminate examination, history, or laboratory workup findings.
  • Increased blood flow occurs with epididymitis; no flow occurs with torsion. Testicular tumors can also appear hyperemic.
  • The examination may reveal epididymal enlargement or a reactive hydrocele of mixed echogenicity (inhomogeneous echogenicity).
  • Use ultrasonography to help detect a scrotal abscess, as well as complications of epididymitis and bacterial or pyogenic orchitis.
  • Chronic epididymitis is characterized by an enlarged testis and epididymitis, as well as thickened tunica vaginalis with a heterogeneous echo pattern and the presence of course calcifications. The testicle may be atrophic and hypoechoic or heterogeneous from testicular infarction secondary to compromise of the testicular blood flow due to intratesticular edema.
  • The sensitivity for torsion is 82-100%, and the specificity is 100%.
• Radionuclide scans  
• • Use technetium Tc 99m scanning with imaging every 2 seconds for 2 minutes after injection of the tracer.
  • Acute epididymitis is characterized by increased tracer uptake, while torsion is characterized by defective uptake in the scrotum.
  • Late torsion may result in inflammation that resembles epididymitis.
  • The study’s usefulness is limited by availability, cost, and difficulty with interpretation
  • Sensitivity for torsion is 90-100%, and specificity is 89-97%.
  • Hydrocele and abscess cause false-positive results. Spontaneous detorsion and intermittent torsion may cause false-negative results.
• Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in >50% of these patients). In infants with bacteruria and epididymitis, in whom anatomical abnormalities are more common than in older children, a vesicoureterogram (VCUG) and abdominal ultrasonography are recommended. Retrograde urethrography is also indicated to evaluate for urethral stricture disease as symptoms dictate.
• Radiologic studies for mumps orchitis are not indicated, although a reactive hydrocele is common.
• Patients with tuberculous epididymitis require a full workup for systemic TB. This may include chest radiography, renal function tests, or CT or excretory urography.

Procedures

• Cystourethroscopy: Along with radiological evaluation, cystourethroscopy may be indicated to evaluate for structural abnormalities in children, as radiographic and clinical suspicion dictates.

TREATMENT

Section 6 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Medical Care

• In addition to antibiotics (except in viral epididymitis), the mainstays of supportive therapy for acute epididymitis and orchitis are as follows:  
• • Reduction in physical activity  
  • Scrotal support and elevation
  • Ice packs
  • Anti-inflammatory agents
  • Analgesics, including nerve blocks
  • Avoidance of urethral instrumentation
  • Sitz baths 
• In chronic epididymitis, a 4- to 6-week trial of antibiotics for bacterial pathogens, especially against chlamydial infections, is appropriate.

Surgical Care

• Scrotal exploration  
• • Perform a scrotal exploration if torsion or tumor cannot be ruled out and for the complications of acute epididymitis and orchitis (eg, abscess, pyocele, testicular infarction).  
  • Diagnosis of intrascrotal disorders is often confirmed during orchiectomy.
• Epididymectomy
• • This procedure was once reported to offer a limited chance (at best 50%) of relieving pain caused by chronic epididymitis. However, a recent study by Siu et al found that 70% of patients who underwent epididymectomy in the face of chronic epididymal pain (in the setting of postvasectomy pain, obstruction due to radical retropubic prostatectomy or hernia repair, epididymal cysts, chronic epididymitis) reported pain resolution.³ In this same study, 91% of patients reported satisfaction with their decision for surgery.
  • Despite these findings, surgery is still suggested to be reserved for only refractory cases.
  • The possibility of fertility sequelae should also be discussed with the patient.
  • Pain relief is often transient and is followed by pain recurrence or transfer of symptoms to the contralateral testicle.
• Epididymotomy: Conduct this procedure infrequently in patients with acute suppurative epididymitis.
• Viral mumps has no surgical indications.
• In rare cases, refractory pain due to chronic epididymitis and orchalgia has been managed with skeletonization of the spermatic cord via subinguinal varicocelectomy.
• Orchiectomy is indicated only for unrelenting epididymal pain, although up to 50% of patients still report phantom postoperative pain.

Consultations

• Obtain immediate consultation with a urologist upon suspicion of testicular torsion or failed medical treatment.

MEDICATION

Section 7 of 12  

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• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Nonspecific bacterial epididymitis and orchitis (often assumed in patients >35 y) require empiric treatment that covers coliform bacteria (eg, levofloxacin or ofloxacin) for 10 days. Systemic illness warrants hospitalization and coverage with intravenous ampicillin and gentamicin. Additionally, use blood and urine cultures to guide therapy.

Consider sexually transmitted epididymitis in men aged 15-35 years who are sexually active; however, STDs must also be considered in children and older adults based on history and context. Empiric therapy consists of treatment for N gonorrhoeae and Chlamydia trachomatis infections with a one-time dose of intramuscular ceftriaxone followed by oral doxycycline for 10 days. A single dose of azithromycin is an alternative to doxycycline, which may improve compliance.

Fluoroquinolones are no longer recommended to treat gonococcal infection because of the high rate of resistant organisms. Chlamydial infections may be treated with levofloxacin or ofloxacin, especially if the patient is allergic to penicillin; however, ciprofloxacin and older fluoroquinolones are discouraged because of their incomplete coverage. Nongonococcal infections are treated with doxycycline or, alternatively, azithromycin or tetracycline. Both sexual partners must be treated. In a British study, up to 80% of female partners of young men diagnosed with acute epididymitis tested positive for chlamydia.

Antitubercular triple therapy consists of rifampin, isoniazid, and pyrazinamide for 6 months. Ethambutol is added in highly drug-resistant areas. In patients with BCG-related epididymitis, isoniazid and rifampin can be used alone because these strains are resistant to pyrazinamide. Brucella epididymitis is treated with 6 weeks of doxycycline.

Chronic epididymitis may respond to tricyclics and anticonvulsants (gabapentin); however, these are not supported by randomized placebo-controlled trials.

Amiodarone epididymitis usually responds to dosage reduction or discontinuation. Mumps orchitis and traumatic and idiopathic epididymitis require no specific therapy other than supportive measures. The efficacy of alpha interferon and gonadotropin-releasing hormone (GRH) therapy in the treatment of mumps orchitis is currently unproven.

Drug Category: Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Drug Category: Antituberculous drugs

These agents are used to treat tuberculous epididymo-orchitis.

FOLLOW-UP

Section 8 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Complications

• Acute epididymitis and bacterial orchitis  
• • Scrotal abscess and pyocele
  • Testicular infarction: Cord swelling can limit testicular artery blood flow.
  • Recurrence, chronic epididymitis, and orchalgia: True local pain can be distinguished from referred pain by spermatic cord injection with 1% lidocaine. Refractory pain that is not improved by analgesics has also been managed by denervation of the spermatic cord.
  • Fertility problems: Sterility is uncommon after acute epididymitis, although the documented true incidence is unknown. Disturbances in the sperm quality secondary to leukocytospermia and inflammation are usually transient. More important is the far less common azoospermia, which is caused by the epididymal duct obstruction observed in untreated and improperly treated men with epididymitis. The incidence of this condition is unknown.
  • Testicular atrophy
  • Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (seen especially in TB)
• Mumps orchitis  
• • Hypogonadotropic hypogonadism can occur as a result of testicular atrophy, which is observed in 30-50% of patients
  • Sterility occurs in 7-13% of affected patients. Orchitis affects the testicular interstitium more than the Leydig and Sertoli cells, but sperm counts, mobility, and morphology can be affected. 
  • Orchalgia may develop. 
  • Mumps orchitis is not associated with the development of testicular tumors.

Patient Education

• For excellent patient education resources, visit eMedicine's Men's Health Center, Bacterial and Viral Infections Center, and Sexually Transmitted Diseases Center. Also, see eMedicine's patient education articles Testicle Infection (Epididymitis), Inflammation of the Testicle (Orchitis), Mumps, and Sexually Transmitted Diseases.

MISCELLANEOUS

Section 9 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Medical/Legal Pitfalls

• Misdiagnosis of testicular torsion is a potential pitfall.
• Failure to recognize and treat both partners for STDs is a potential pitfall. Patients found positive for C trachomatis or N gonorrhoeae infection should be referred for further testing of other STDs, including HIV. 

ACKNOWLEDGMENTS

Section 10 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Michael Franks, MD, to the development and writing of this article.

MULTIMEDIA

Section 11 of 12  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

Media file 1:  Color Doppler sonogram of the left epididymis in a patient with acute epididymitis. The image demonstrates increased blood flow in the epididymis resulting from the active inflammation.
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Media type:  Photo

Media file 2:  Scrotal sonogram demonstrating the presence of a hydrocele and an enlarged epididymis in a patient with epididymitis. The echogenic white area is the normal testicle surrounded by the hydrocele.
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Media type:  Photo

Media file 3:  Scrotal sonogram showing the testes adjacent to the inflamed epididymis with a reactive hydrocele.
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Media type:  Photo

REFERENCES

Section 12 of 12

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• Acknowledgments
• Multimedia
• References

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16. Gatti JM, Patrick Murphy J. Current management of the acute scrotum. Semin Pediatr Surg. Feb 2007;16(1):58-63. [Medline].
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Article Last Updated: Jun 12, 2008