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Overview

Epididymitis is the inflammation of the epididymis, the elongated cordlike structure along the edge of the testis that provides for storage, transit and maturation of sperm. Orchitis is an inflammation of the testicle.


Causes
Infectious organisms (Brucella canis, distemper)
Disseminated systemic mycosis (blastomycosis, coccidiomycosis)
Rickettsial disease (Ehrlichiosis, Rocky Mountain spotted fever)
Infection associated with the prostate or bladder
Contamination by urine from severe abdominal trauma
Direct trauma to the scrotum
Bite wounds
Lymphocytic orchitis (immune-mediated disease)
Epididymitis and orchitis are more common in dogs than cats. There is no breed predilection for most. Lymphocytic orchitis has been seen primarily in beagles.

What to Watch For
Swollen testicle
Pain
Excessive licking of scrotum
Listlessness
Anorexia
Reluctance to walk
Open wound or abscess
Diagnosis
Complete blood count (CBC)
Biochemical profile
Urinalysis
Serology (blood test) for Brucella canis
Abdominal X-rays
Ultrasound (abdomen, testicles and epididymis)
Semen evaluation and culture
Prostatic lavage or aspirate for cytology and culture
Culture open wounds in the area
Treatment
Removal of the underlying cause if identified
Appropriate antibiotic therapy (based on culture and sensitivity)
Cold compresses
Hospitalize for supportive care if needed
Castration when stable if not a valuable breeding animal
Home Care

Follow the instructions given to you by your veterinarian. Continue therapy for the entire recommended time. Consider having your pet neutered and treat any and all underlying disorders.


Information In-depth

Because the testis and epididymis are in close apposition, any inflammatory or infectious process involving one usually involves the other, although on occasion, isolated orchitis or epididymitis may be seen. The onset of disease may be acute (sudden onset over a short period of time) or chronic (slower onset over weeks or months).

Orchitis and epididymitis have many possible causes, and typically, bacteria are involved. Individuals may have no clinical signs, or they may be quite ill and painful. Several other disease processes need to be considered and often present with similar clinical signs.
Inguinoscrotal hernia is the herniation, or abnormal protrusion, of abdominal contents through the inguinal canal into the scrotum. These individuals usually have scrotal enlargement.
Scrotal dermatitis is an inflammation of the skin covering the scrotum. These dogs often lick excessively at the scrotal area, which can be quite inflamed and painful.
Testicular neoplasia, or cancer, often manifests itself by testicular enlargement, sometimes asymmetry, and occasional infertility. The most common testicular tumor types include Sertoli cell tumors, seminomas and interstitial cell tumors.
Testicular torsion is a twisting of the spermatic cord, blockage of venous blood from the testis with subsequent engorgement, and necrosis (death) of associated tissue. These individuals are often exquisitely painful, may be incapable of walking, and present for severely inflamed, swollen testes.
Testicular or epididymal abscesses often appear identical to orchitis and epididymitis. They are often differentiated by biopsy of the testicle itself.
Prostatitis is an inflammation of the prostate. Individuals with prostatitis often have a variety of clinical signs. These need to be considered and/or differentiated from epididymitis and orchitis, especially when there is swelling or change in these structures.
Cystitis is an inflammation of the urinary bladder. Occasionally, this is associated with epididymitis and orchitis and may have similar signs.

Veterinary Care In-depth

Diagnosis In-depth

Certain diagnostic tests must be performed to diagnose epididymitis and orchitis and exclude other disease processes that may cause similar symptoms. A complete history, description of clinical signs, and thorough physical examination are all an important part of obtaining a diagnosis. In addition, the following tests are recommended to confirm a diagnosis:
A complete blood count (CBC) may be within normal limits, although in some patients it may reveal an elevated white blood cell count.
A biochemical profile is usually within normal limits and helps rule out other disorders.
A urinalysis helps assess hydration and kidney status and may show signs of inflammation or infection.
Chest and abdominal X-rays are an important part of any baseline work-up. Although they may be within normal limits, they may reveal evidence of enlarged prostate, and in addition, it is important to rule out other diseases and causes of the patients? clinical signs as well.
Abdominal ultrasound may be recommended in certain cases. It is very helpful in evaluating all of the abdominal organs, including the prostate. It is equally important to rule out other disorders or diseases that may initially be difficult to differentiate from epididymitis and orchitis. Abdominal ultrasound is a noninvasive test that often needs the expertise of a specialist and/or referral hospital.
Ultrasound of the testes and epididymis can be great benefit in these cases, as there are some characteristic changes, and it helps rule out other disorders.
Semen evaluation for cytology and culture/sensitivity may be helpful in these cases.
Obtaining a bacterial culture and sensitivity from any open wounds in the area is strongly recommended, as these wounds often share the same bacteria as are involved in the epididymitis and orchitis.
Serologic testing is the one single most useful and reliable method to diagnose Brucellosis. It necessitates a blood test, which reveals a value measuring the strength of a reaction between certain substances in the body. High values are usually diagnostic for Brucellosis.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions. These tests are not always necessary in every case, but they may be of benefit in certain individuals, and are selected on a case by case basis. These include:
Serology for tick-born diseases to include Rocky Mountain spotted fever, and Ehrlichia are often recommended, as these disorders have been associated with epididymitis and orchitis.
Fungal cultures and/or titers in cases suspicious of fungal involvement should be obtained.
Prostatic massage/lavage for cytology and culture should be performed may be recommended.
Prostatic aspirate or biopsy and culture may be recommended in cases where the previous diagnostics were inconclusive.
Therapy In-depth

Therapy should be initiated once appropriate bacterial cultures have been obtained.

The recommended therapeutic approach depends on the wishes of the owner. If fertility is of no concern, neutering should be the ultimate goal. If maintaining reproductive potential of an individual dog is important, this may not be an option, except for cases with uncontrollable infections. Stable patients can be treated as outpatients as long as they are monitored closely for response to therapy. With appropriate therapy, most patients do quite well, although breeding capability is often compromised. It is important that all recommendations by your veterinarian are followed very closely, and any questions or concerns that arise during the treatment protocol are addressed immediately.
Intravenous fluid and electrolyte therapy may be indicated in dehydrated or debilitated patients.
Appropriate antibiotic therapy should be chosen based on culture and sensitivity of the organism. Depending on the particular organism, certain antibiotics are more effective than others. The length of treatment should not be compromised, as it is important to thoroughly eradicate the infection.
In immune-mediated epididymitis and orchitis, drugs that suppress the immune system (such as corticosteroids) may be recommended. It is important to have a definitive diagnosis before using these type drugs, as their inappropriate use in cases of bacterial infection could be life threatening.
If fertility is to be maintained and neutering is not an option:
Cold compresses or water can be placed on the scrotum to help minimize thermal damage to the delicate internal structures involved in reproduction.
Anti-inflammatory agents such as corticosteroids and aspirin may be used to control inflammation.
Unilateral orchiectomy, or removal of the testicle, may be considered in a valuable stud dog in an attempt to salvage the normal testicle.
Neutering once the patient is stable is strongly recommended.

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Follow-up

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve. Administer all prescribed medication as directed. Alert your veterinarian if you are experiencing problems treating your pet.

The prognosis for maintaining fertility in dogs following epididymitis and orchitis is guarded to poor. Spermatoceles, which are cystic distensions of the epididymis, are not an uncommon sequele. Breeding dogs should be examined and evaluated on a regular basis as recommended by your veterinarian to assess their status regarding fertility and sperm production.

Most patients, other than with regard to fertility, generally have a full recovery and do well.