Treatment of tuberculous epididymitis by intratunical rifampicin injection

The results of treating 4 patients with tuberculous epididymitis by rifampicin injection into the tunica vaginalis sac were compared with the results in another 4 patients treated with the common oral antituberculous drugs. Oral treatment consisted of daily administration of rifampicin (600 mg), isoniazid (300 mg), and ethambutol (25 mg/kg body weight). Rifampicin (600 mg) was injected intratunically every 4 to 6 days. Treatment continued for 6 months in both groups, with 3 months follow-up thereafter. Periodic clinical assessment as well as semen and hydrocele fluid examination were performed. In the intratunical injection group, epididymal swellings disappeared in 3 to 6 months; semen and hydrocele fluid became sterile in 4 months. The oral group showed partial diminution of the epididymal mass in one patient only; one patient developed scrotal fistula. Semen remained positive for tubercle bacilli, and hydrocele fluid became negative in one patient only. The satisfactory results with the intratunical rifampicin administration seem to be due to the drug reaching the epididymis in high concentrations. The tunica vaginalis is a part of the peritoneum and, like it, is believed to have a high absorptive power. Furthermore, the intratunical injection treatment uses a single drug, in contrast to the oral therapy, which, by its multidrug administration, enhances the incidence of side effects.