03.05 Nursing Care and Pathophysiology for Epididymitis

Hey guys, so today’s lesson is on epididymitis. Once we are finished today you will have a better understanding of what it is and different causes, assessment findings as well as treatment options, and nursing considerations when caring for a patient with this condition.
Okay guys, so epididymitis is the inflammation of the epididymis caused by infectious or noninfectious source, characterized by scrotal/groin pain and swelling, pus and bacteria in the urine, and fever and chills. So the inflammation of the epididymis can be either acute or chronic, so basically a new problem or something that has been going on for a while. Epididymitis can be caused by an infection with a UTI, STD, prostatitis, and long term foley use. It can also spread from other sources like the prostate, bladder, and urethra. So really, any structure in the genitourinary tract in a male that is infected has the potential to cause epididymitis. It can also be caused by another source like with trauma, but bacterial infection is the most common cause. Let’s look at this picture so we can get a better idea of where the epididymis is compared to the other structures. So it’s located here. Let’s make it a little bit bigger because there’s inflammation and swelling which is going to push on other structures which causes pain.

A patient with epididymitis can have a few different symptoms. So before we go any further, I want you to remember that a main cause of this is infection. So when you’re thinking about the assessment findings, think infection. What is one finding that we see with infection? Pain and inflammation, right? So this is the same way. With epididymitis, patient’s can have scrotal and groin pain as well as swelling. So if the epididymis is inflamed, it’s going to push on other structures causing pain. Another assessment finding associated with infection is pus and bacteria - this is no different. Patient’s can have pus and bacteria in their urine. Fever and chills are also commonly seen with infection and they are also seen with epididymitis. Some patient’s can also develop an abscess depending on the progression of infection, and when it is diagnosed.

Diagnostic testing with epididymitis is pretty straightforward. So usually an ultrasound is ordered to just make sure nothing else is going on like an abscess or tumor, as our treatment could change with these diagnoses. A urine culture is also ordered to find what organism is causing the epididymitis to be able to treat it more efficiently. This picture is what epididymitis looks like with ultrasonography. So this top picture is the left epididymis which has a big increase in blood flow compared to the bottom picture, which is the right epididymis that has normal blood flow.

So it’s really important that epididymitis is identified and treated, because if untreated it can lead to abscess formation from the infection, or testicle infarction from the inflammation. If epididymitis is due to infection, then antibiotics are usually started first. Surgery can be used in cases that are a little more complicated, like if there is an abscess present. if this is the case then they have to get out the abscess, right? Abscess = infection. So a orchiectomy is performed in this case, which is the removal of one or both testes. If a patient has recurrent or chronic scrotal pain an epididymectomy or the removal of the epididymis can be done to remove the cause of the patient’s pain and inflammation. After surgery scrotal support is really important to help prevent pulling on the spermatic cord which includes all the nerves and vessels that run to and from the testicle. Patients should be on bedrest and elevate their scrotum to prevent pulling, help with drainage, and pain control. Just like with anything in the body guys, elevation helps with swelling and pain control. If the patient is ambulating, scrotal support should be worn to prevent pulling on the spermatic cord as well. Antibiotics are given until the patient’s symptoms resolve, like pain, swelling, pus in urine, etc. NSAIDs can be really useful to help with inflammation and pain control. Ice can be applied to help with inflammation, and sitz baths can help with comfort and to soothe the irritated area. So think of the post-op interventions as things to increase comfort, decrease swelling, and decrease pain.

One of the patient education topics is in regards to post-surgical interventions, like scrotal support, temperature therapy, and administering medications as applicable. So one of the nursing considerations is regarding prevention of future episodes of epididymitis. Patients should utilize condoms to prevent the spread of STD’s if that was the infectious source. If the condition is due to a STD, the patient’s partners should be treated as well. There are a few activities that patients should avoid and really they are pretty straightforward. Patients should avoid lifting, straining to urinate, and sexual activity until the infection is under control and there is no risk to the spermatic cord or the infection re-entering the epididymis.

One of the nursing concepts is an alteration in comfort as the patient usually has groin/scrotal pain and inflammation. The other nursing concept is regarding infection control as bacterial infection is the most common cause of epididymitis.
So the key points I want you to remember include the assessment findings of pain, swelling, pus and bacteria in the urine, fever and chills, and abscess formation. I want you to remember treatment options - antibiotics are given if surgery is not going to be performed, and there are two surgeries that can be completed as well. Post op-interventions include scrotal support both in and out of bed, medication administration of NSAIDs and antibiotics, and ice application and sitz baths. Our patient education will focus on prevention, activities to avoid, and post-op interventions.
Ok guys, that is it for our lesson on epididymitis. Make sure to check out all the resources attached to this lesson. Now, go out there and be your best self today, and as always, Happy Nursing!