Experimental Escherichia coli epididymitis in rabbits

We describe an experimental model of bacterial epididymitis in New Zealand white rabbits. Inoculation of 10(7) colony-forming units of Escherichia coli in a retrograde fashion into the vas deferens reliably produced clinical, bacteriologic, and pathologic epididymitis. Inflammation was maximum at two weeks and subsided by one month without treatment. E. coli could be reisolated from the epididymides for up to two weeks post inoculation. We detected loss of spermatogenesis in both the ipsilateral and contralateral testes and the appearance of antisperm antibodies subsequent to the infection in some animals. There were 2 cases (11%) of histologic bilateral epididymitis after unilateral inoculation; one of these had bilateral clinical epididymitis with E. coli recovered from both epididymides at two weeks.     

Schistosomal epididymitis

Epididymitis is a frequent inflammatory process. It is related to sexually transmitted diseases, urinary tract infections by E. coli, or scrotal trauma. We describe the case of a Caucasian 32-year old man, who presented scrotal pain for 3 months, with difficult management with medication. Testis was normal; however, the left epididymis was extremely painful and hardened. Following the unsuccessful use of analgesic and anti-inflammatory medication, a left epididymectomy was performed, with resolution of the pain. The pathological examination showed the presence of chronic inflammatory process associated with eggs of the parasite Schistosoma mansoni in the resected epididymis. Patient evolved without pain in the post-operative period and was medicated with a single dose of oxamniquine after etiologic confirmation.     

Amiodarone-associated epididymitis: drug-related epididymitis in the absence of infection

An atypical epididymitis syndrome developed in 6 of 56 men (11 per cent) treated with amiodarone, an effective new anti-arrhythmic agent. Of the 6 patients 5 (87 per cent) had bilateral epididymal enlargement and pain. The mean dosage in the patients with epididymitis was 700 mg. per day compared to 377 mg. per day in all patients (p less than 0.01). No infectious etiology was implicated in any patient. Temporary discontinuation or decrease in dosage is recommended for patients who suffer noninfectious epididymitis while on amiodarone therapy.     

Amiodarone-induced sterile epididymitis

Sterile epididymitis in 2 patients who were on amiodarone for cardiac arrhythmias is presented. Decrease in drug dosage rendered the patients pain-free and testicular swelling resolved in a fortnight.     

Surgical therapy of epididymitis

Five hundred and seventy-five patients with acute epididymitis were hospitalized between 1979 and 1987, and 149 of them (25.9%) underwent surgery to the epididymis or the testis. For removal of the morphological alterations responsible for the inflammation, secondary operations were required in 157 cases (27.3%). We divided the patients into four age groups (under 15 years, 15-30 years, 31-60 years and more than 60 years), because the operative treatment indicated depends partly on the patient's age. For every age group the value of different follow-up examinations was checked. Prepubertal children have to be considered separately.     

Diagnosis and management of epididymitis

Epididymitis is a common and morbid condition seen across a wide age range. There are multiple etiologies that may lead to inflammation of the epididymis, including infection, trauma, autoimmune disease, and vasculitis. Although there have been multiple advances in imaging of the scrotum and detection of urinary pathogens, a large portion of cases remain idiopathic. Management of epididymitis is often difficult, but relies on clinical expertise and the use of established clinical guidelines.     

Experimental Escherichia coli epididymitis in rats: a model to assess the outcome of antibiotic treatment

OBJECTIVE: To assess the effect of initial antimicrobial therapy with a new highly potent quinolone (sparfloxacin) on the outcome of infection, especially acute and chronic inflammation, in a rat model of unilateral Escherichia coli epididymitis. MATERIALS AND METHODS: The study included 60 Sprague-Dawley rats, each of which received 0.1 mL of an E. coli (0:6 strain) suspension (106 colony forming units/mL) injected into the right ductus deferens. At 24 h after infection an oral antimicrobial treatment with sparfloxacin was initiated in half of the animals. The rats were killed 14 days, 3 and 6 months after infection, and both epididymes and the prostate gland cultured to re-isolate E. coli. To evaluate the grade of inflammation in both epididymes, histological variables, including acute and chronic inflammation and scar formation, were evaluated and a total inflammatory score, representing the sum of all variables, computed. RESULTS: Whereas antimicrobial therapy eradicated the pathogen, in untreated animals the pathogen was detectable for up to 6 months after infection in the infected epididymis and/or the prostate gland, while the contralateral epididymis was sterile. The inflammatory reaction in the infected epididymis was significantly less in treated animals (P < 0.001). Subclinical nonbacterial inflammation was present in the contralateral epididymis. CONCLUSIONS: Although adequate antimicrobial treatment eradicated the pathogen and reduced the grade of epididymal damage, inflammation was not avoided. Subclinical inflammation of the contralateral epididymis may contribute to impaired fertility. These results indicate that an inflammatory reaction initiated by bacteria might persist as a nonbacterial process despite early therapy, or by bacteria undetectable by conventional culture techniques, and may compromise male fertility.