Testicular inflammation – orchitis and epididymo-orchitis
By far the commonest form of orchitis is that found in association with inflammation or infection of the adjacent epididymitis. This condition, epididymo-orchitis, is generally considered to arise from retrograde spread of bacteria from the posterior urethra into ejaculatory ducts, down the vas deferens and finally into the anatomical ‘cul-de-sac’ of the epididymis. Epididymo-orchitis is a painful and, in the short term, debilitating condition. There is an incidence of a late complication of secondary fibrosis and obstruction of the ejaculatory system. Rarely, a scrotal abscess may arise. The majority of infections causing epididymo-orchitis are due to common urinary tract pathogens, particularly E-coli. Though once common, the classic presentation of a tuberculous epididymo-orchitis is now rarely seen.