The surgical management of acute bacterial epididymitis with emphasis on epididymotomy

During the course of acute bacterial epididymitis of nonvenereal origin, severe epididymal inflammation and edema can produce compression of adjacent branches of the spermatic vessels, which can compromise the testicular vascular system. Scrotal fixation over the involved testicle heralds this event and indicates actual or impending epididymal suppuration. At this crucial moment either surgical decompression of the epididymis or epididymectomy is indicated to prevent ischemia of the testis and subsequent development of gangrenous epididymo-orchitis with testicular slough. Between 1956 and 1980, 14 epididymotomies were done, which resulted in salvage of 12 testicles (86 per cent). During the same period 10 patients with acute epididymitis had progression of the disease to gangrenous epididymo-orchitis, which necessitated orchiectomy. Epididymotomy can prevent progression of acute epididymitis to gangrenous epididymo-orchitis in many instances and is believed to have a role in the management of this troublesome affliction.