Fertility problems
In prepubertal patients with epididymitis, antibiotic therapy only for young infants and those with pyuria or positive urine culture findings
Testicular atrophy
Analgesics, including nerve blocks
Ice packs
Testicular infarction: Cord swelling can limit testicular artery blood flow
Scrotal abscess and pyocele
Epididymotomy: Infrequently performed in patients with acute suppurative epididymitis
Recurrence, chronic epididymitis, and orchialgia
Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (seen especially in tuberculosis)
When treating epididymitis secondary to Chlamydia trachomatis or Neisseria gonorrhoeae, treatment of all sexual partners
Scrotal support and elevation
Anti-inflammatory agents
In chronic epididymitis, a 4- to 6-week trial of antibiotics effective against bacterial pathogens (especially chlamydiae)
Skeletonization of the spermatic cord via subinguinal varicocelectomy: Performed in rare cases of refractory pain due to chronic epididymitis and orchialgia
Reduction in physical activity
Orchiectomy: Indicated only for patients with unrelenting epididymal pain
Avoidance of urethral instrumentation
Sitz baths
Epididymectomy: Typically reserved for refractory cases
