Differential diagnosis between tuberculous epididymitis and nonspecific chronic epididymitis is one of the most difficult problem in the field of urology. The definitive diagnosis of tuberculous epididymitis is often made by pathological examination of the epididymectomy or orchiectomy specimen. However, the preferred approach to treatment of tuberculous epididymitis is primarily antituberculous chemotherapy and we believe that as a primary measure, surgical procedure is avoidable with careful clinical work-up. A clinical comparative investigation was undertaken on 20 cases of tuberculous epididymitis and 13 cases of nonspecific chronic epididymitis, diagnosed by histopathologic examination during recent 6 year period. Tuberculous epididymitis occurred most frequently in men aged 21-30 years (80%), whereas nonspecific chronic epididymitis occurred frequently in men aged above 31 years (69.2%). Tuberculous epididymitis and nonspecific chronic epididymitis Were present clinically as painless scrotal mass in 70%, 53.8%, painful scrotal mass in 30%, 46.2%, and voiding symptoms in 15%, 7.7% respectively. Scrotal swelling were present in 30% of tuberculous epididymitis, but only in 7.7% of nonspecific epididymitis. Irregularity of mass were noted in 65% of tuberculous epididymitis, and in 23.1% of nonspecific epididymitis. Scrotal fistula were present only in 5% of tuberculous epididymitis. Of the patients with tuberculous epididymitis, 20% had a history of tuberculosis, and 46.1% of the patients with nonspecific chronic epididymitis had a history of acute epididymitis. In tuberculous epididymitis, clinical findings of concurrent infection with tuberculosis were found in kidney, prostate, vas, lung, and testis in order of frequency. Past history of tuberculosis or acute epididymitis and clinical findings of concurrent tuberculous lesions were helpful for clinical diagnosis, in 70% of the patients with tuberculous epididymitis and 46.2 % of the patients with nonspecific chronic epididymitis.
Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Epididymitis* ; Fistula ; Humans ; Kidney ; Lung ; Male ; Orchiectomy ; Prostate ; Testis ; Tuberculosis ; Urology

PURPOSE: The incidence of genitourinary tuberculosis(tbc) has consistently declined as results of effective chemotherapy and health care. But it still has significant associated morbidity. The pathogenesis of prostatic and epididymal tbc remains obscure. To assess the progress of tuberculous infection in sex accessory organs including prostate, epididymis and testis, prospective clinical study was performed. MATERIALS AND METHODS: Of the 58 male patients with genitourinary tbc during a 8-year period(1989-1996), 23 patients (39.7%) had tuberculosis in sex accessory organs. Thirty patients who demonstrated tuberculosis in at least one organ amomg prostate, epididymis, testis and bladder were evaluated. The conclusive diagnosis was made on the basis of isolation of Mycobacterium tuberculosis, histopathology. A patients with organ confined tbc was considered to be caused by metastatic spread of infection. RESULTS: In 12(40%) of 30 patients tubercle bacilli were detected in urine. 14(87.5%) of the 16 patients with tuberculous epididymitis and 10(76.9%) of the 13 patients with tuberculous prostatitis were considered to have an infection extended through the metastatic spread. Three(25%) patients had tuberculous cystitis directly extended from the tuberculous prostatitis. All three tuberculous orchitis were secondary to the tuberculous epididymitis. CONCLUSIONS: The results suggest that the route of infection of tuberculosis in the prostate and the epididymis are mainly through the hematogenous spread and direct extension of infection is likely deveploped by descending spread.
Cystitis ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epididymis ; Epididymitis ; Humans ; Incidence ; Male ; Mycobacterium tuberculosis ; Orchitis ; Prospective Studies ; Prostate ; Prostatitis ; Testis ; Tuberculosis* ; Urinary Bladder

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Diagnosis, Differential ; Epididymitis/*diagnosis/drug therapy ; Humans ; Male ; Pain/*diagnosis ; *Pain Management ; Pain, Postoperative ; Physical Examination ; *Scrotum ; Spermatic Cord Torsion/*diagnosis/surgery ; Testis/physiopathology ; Varicocele/*diagnosis/physiopathology/therapy ; Vasectomy