Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J. Jamnagerwalla and H.H. Kim
Table 10.3. Classification of chronic epididymitis.
1. Inflammatory chronic epididymitis: pain and discomfort associated with
abnormal swelling and induration
a. Infective
b. Post-infective (following acute bacterial epididymitis)
c. Granulomatous (tuberculosis)
d. Drug induced (amiodarone)
e. Associated with syndromes (Behçet’s disease)
f. Idiopathic
2. Obstructive chronic epididymitis (i.e., congenital obstruction vs. post-vasectomy
scarring)
3. Chronic epididymalgia: pain or discomfort in a normal feeling epididymis with
no identifiable etiology
From Nickel et al. [ 40 ], reprinted with permission of MedReviews ® , LLC. Reviews
in Urology is a copyrighted publication of MedReviews ® , LLC. All rights reserved
of chronic epididymitis is difficult because there is no identifiable cause
in the majority of cases.
Granulomatous Epididymitis Tuberculosis should be suspected in
men presenting with chronic granulomatous epididymitis , especially if
they have a known history or recent exposure. Those with tuberculosis
epididymitis should have further evaluation for systemic disease along
with treatment with 6 months of triple drug therapy of isoniazid, rifampin,
and pyrazinamide [ 30 ]. Sarcoidosis is a less common cause of granulomatous
epididymitis, with an estimated 0.2–5 % of cases having
genitourinary involvement [ 30 , 61 ].
Drug-Induced Epididymitis The most common drug implicated in the
development of epididymitis is the anti-arrhythmic amiodarone. While
the exact mechanism is unknown, tissue levels of amiodarone and its
metabolites have been shown to be 25–400 times higher in the epididymis
than serum, which may lead to fibrosis and lymphocyte infiltration [ 62 ].
The incidence of amiodarone- induced epididymitis in men taking highdose
amiodarone is 3–11 %, with discontinuation of the drug generally
leading to resolution of symptoms [ 63 ].
Idiopathic Chronic Epididymitis In the absence of an identifiable
cause of epididymal pain, the diagnosis of idiopathic chronic epididymitis
is often made. Idiopathic inflammatory epididymitis involves
focal epididymal tenderness with swelling and induration, whereas
chronic epididymalgia involves referred epididymal pain as part of