Changes in the Testis Parenchyma Caused by Acute Nonspecific Epididymitis

Abstract

22 patients, hospitalized for observation and treatment of acute nonspecific epididymitis, participated in a study designed to examine the extent of infective involvement of the testicular parenchyma in conjunction with acute nonspecific inflammation in the epididymis. An attempt was made in a followup to classify possible injury to spermatogenesis occurring after nonspecific epididymitis. Age at onset of acute nonspecific epididymitis varied between 21-82 years. The epididymitis was unilateral in 20 patients and bilateral in 2 patients. 12 patients had symptoms of posterior urethritis. 18 patients were followed for 2-3 years after the acute onset. 3 of the older patients had died of intercurrent diseases at the time of the followup. Aspiration biopsy from the testis was performed with a 23-gauge needle; punctures were carried out during short-term narcosis 4-15 days (average 7 days) after the onset of the epididymitis. A section biopsy of testicular parenchyma was taken for histopathologic examination in 4 patients. Bacteriologic cultivation of the urine was performed in all 22 patients, and a portion of the aspirated material at testis puncture was sent for bacteriologic examination in 11 patients. The followup examination included palpation of the testes, at which time turgidity and consistency on both sides were judged. Atrophy of the testis is defined as a difference in consistency, as well as in size, between the affected and the healthy sides. Testicular atrophy was considered to be present if the combined axis measurements for the 2 sides differed by 10 mm or more and if the consistency of the testes differed. 16 of the patients showed an inflammatory cell reaction in the testis; a reduction of spermatogenesis was observed in the same number of cases. There was a significant correlation between the degree of the inflammatory cell reactions and the reduction of spermatogenesis. The 9 patients who showed a pronounced inflammatory cell reaction all had marked reduction of spermatogenesis. Of the 18 followup patients, 12 showed atrophy. Both of the bilateral caseds were among these. 6 patients were judged to have clinically normal testes. There was significant correlation between the presence of atrophy 2-3 years after the episode of acute epididymitis and the degree of inflammatory cell reaction during the acute infection phase. Of the 8 patients who showed pronounced inflammatory cell reactions, atrophy of the testis was found later in 7; 4 of the patients who did not show any inflammatory cell reactions had normal testis size and turgidity.