Comparative Study on the Clinical Characteristics of Tuberculous Epididymitis and Nonspecific Chronic Epididymitis

Ko, Sang Tae; Shin, Ki Yong

Abstract

Differential diagnosis between tuberculous epididymitis and nonspecific chronic epididymitis is one of the most difficult problem in the field of urology. The definitive diagnosis of tuberculous epididymitis is often made by pathological examination of the epididymectomy or orchiectomy specimen. However, the preferred approach to treatment of tuberculous epididymitis is primarily antituberculous chemotherapy and we believe that as a primary measure, surgical procedure is avoidable with careful clinical work-up. A clinical comparative investigation was undertaken on 20 cases of tuberculous epididymitis and 13 cases of nonspecific chronic epididymitis, diagnosed by histopathologic examination during recent 6 year period. Tuberculous epididymitis occurred most frequently in men aged 21-30 years (80%), whereas nonspecific chronic epididymitis occurred frequently in men aged above 31 years (69.2%). Tuberculous epididymitis and nonspecific chronic epididymitis Were present clinically as painless scrotal mass in 70%, 53.8%, painful scrotal mass in 30%, 46.2%, and voiding symptoms in 15%, 7.7% respectively. Scrotal swelling were present in 30% of tuberculous epididymitis, but only in 7.7% of nonspecific epididymitis. Irregularity of mass were noted in 65% of tuberculous epididymitis, and in 23.1% of nonspecific epididymitis. Scrotal fistula were present only in 5% of tuberculous epididymitis. Of the patients with tuberculous epididymitis, 20% had a history of tuberculosis, and 46.1% of the patients with nonspecific chronic epididymitis had a history of acute epididymitis. In tuberculous epididymitis, clinical findings of concurrent infection with tuberculosis were found in kidney, prostate, vas, lung, and testis in order of frequency. Past history of tuberculosis or acute epididymitis and clinical findings of concurrent tuberculous lesions were helpful for clinical diagnosis, in 70% of the patients with tuberculous epididymitis and 46.2 % of the patients with nonspecific chronic epididymitis.