Epididymitis in older boys: dysfunctional voiding as an etiology

Although male infants and young boys with epididymitis have a high incidence of anatomical pathology, dysfunctional voiding is not a well established cause of epididymitis. In our series 36 boys with epididymitis underwent noninvasive urodynamic studies to determine whether a physiological defect could be assigned as an etiology. The 2 mechanisms proposed are similar to that in children with vesicoureteral reflux associated with dyssynergia or bladder instability and to a cause of recurrent urinary tract infection in children (the infrequent voider syndrome). Urinalysis and urine culture are recommended in all children with epididymitis and urethral swabs are obtained from those who are sexually active. We recommend renal/bladder ultrasound and voiding cystourethrography in all infants and young children with epididymitis. In the older child we advocate detailed questioning regarding voiding symptoms and the performance of noninvasive urodynamic studies.