ETIOLOGY AND CLINICAL-FEATURES OF ACUTE EPIDIDIMOORCHITIS

Seventy-nine patients presenting with acute epididymo-orchitis (AEO) w ere prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, serological, biochemical, imaging, an d endoscopic studies were undertaken to look for urinary tract infecti on (UTI), brucellosis, gonorrhea, diabetes mellitus (DM), bladder outf low obstruction (BOG), and other urinary tract pathology (UP). Thirty- nine patients also underwent, on their urethral scrapings, the direct immunofluorescence test with monoclonal antibodies (DIF) for Chlamydia trachomatis. The mean age was 44+/-20.4 years (median = 40 years) and 43% of the patients were married. Only one patient had urethritis, wh ich was nongonococcal. Thirty-five percent presented with pyrexia and only one had brucellosis. Fifty-three percent had significant pyuria b ut only 22 patients (28%) had bacteriuria and E. coil was the etiologi cal agent in 19/22 patients (86%). Eleven out of 39 patients (28%) wer e positive for Chlamydia trachomatis. BOG, UP and DM were encountered in 25%, 12.5% and 10%, respectively, but no obvious cause was detected in 26 (33%) patients. Recurrent AEO, abscess formation and bacteremia occurred in 21.5%, 4%, and 1%, respectively. Recurrent AEO was signif icantly more common in married patients than in single patients (P<0.0 5) and BOO was significantly more common in patients above the age of 50 years. It is concluded that an underlying cause of AEO could be ide ntified in only two-thirds of the patients. In the remaining one-third , the etiology continues to be obscure and investigations for viral an d fastidious infections may be of help in future studies. Endoscopy an d urodynamic studies for BOO can be restricted to the elderly patient to cut down the cost of management of this; fairly common emergency.