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Urological Emergencies in Clinical Practice - part 4

Xoắn tinh hoàn là chẩn đoán phân biệt chính. Một lịch sử trước các triệu chứng gợi ý viêm niệu đạo hoặc nhiễm trùng tiết niệu (nóng rát khi đi qua nước tiểu, tần số, cấp bách, và đau suprapubic) cho thấy viêm mào tinh hoàn là nguyên nhân của đau bìu, | 52 H. HASHIM AND J. REYNARD A rare noninfective cause of epididymitis is the antiarrhyth-mic drug amiodarone which accumulates in high concentrations within the epididymis causing inflammation Gasparich 1984 . It can be unilateral or bilateral and resolves on discontinuation of the drug. Differential Diagnosis Torsion of the testicle is the main differential diagnosis. A preceding history of symptoms suggestive of urethritis or urinary infection burning when passing urine frequency urgency and suprapubic pain suggests that epididymitis is the cause of the scrotal pain but these symptoms may not always be present in epididymitis. In epididymitis pain tenderness and swelling may be confined to the epididymis whereas in torsion the pain and swelling are localised to the testis. However there may be overlap in these physical signs. Where doubt exists where you are unsure whether you are dealing with a torsion or epididymitis exploration is the safest option. Though radionuclide scanning can differentiate between a torsion and epididymitis this is not available in many hospitals. Colour Doppler ultrasonography which provides a visual image of blood flow can differentiate between a torsion and epididymitis but its sensitivity for diagnosing torsion is only 80 i.e. it misses the diagnosis of torsion in as many as 20 of cases these 20 of cases have torsion but normal findings on Doppler ultrasonography of the testis . Its sensitivity for diagnosing epididymitis is about 70 . Again if in doubt explore. Treatment of Epididymitis Culture the urine any urethral discharge and blood if systemically unwell . Treatment consists of bed rest analgesia and antibiotics. Where C. trachomatis is a possible infecting organism prescribe a 10- to 14-day course of tetracycline 500 mg four times a day or doxycycline 100 mg twice daily. If gonorrhoea is confirmed on a Gram stain of the urethral discharge if present and on culture prescribe ciprofloxacin though check the sensitivity on culture