Epididymitis and Orchitis
Dr. Bari Spielman
A complete blood count (CBC) may be within normal limits, although in some patients it may reveal an elevated white blood cell count.
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 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 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.