Acute epididymitis in children: a 4-year retrospective study.

OBJECTIVE: To evaluate the incidence of acute epididymitis (AE) compared to testicular torsion (TT) as a form of acute scrotum in children, to describe clinical aspects and to assess the value of laboratory tests and radiological investigations in AE.

METHODS: Retrospective review of the medical records of 49 patients presenting with clinical aspects of AE over a 4-year period; evaluation of clinical features, laboratory tests (blood, urine), radiological examinations (duplex and real-time ultrasound, renal sonography, voiding cysturethrography [VCUG]) and urodynamics.

RESULTS: 49 patients with an overall mean age of 9.8 years (range 0.2-15.3 years) presented with AE. In the same period, 31 subjects required surgery for TT. Local pain on palpation of the epididymis and spontaneous pain in the testis and/or epididymis were the most common clinical signs. In 2 patients, urine cultures revealed significant bacteriuria. Duplex and real-time ultrasound showed no false negative result. 41% of the patients revealed concomitant urological diseases, but only in 1 patient was treatment influenced by the uropathy. 16/21 older boys (76%) demonstrated normal uroflow patterns.

CONCLUSION: AE seems to be more common than acute TT. Urinalysis and urine culture should be performed for all children with AE. High resolution ultrasound with an experienced investigator is able to exclude TT reliably so that routine surgical exploration is seldom necessary.