Chronic epididymitis is often a consequence of incomplete treatment of acute epididymitis. In some cases, no prior acute inflammatory episode is observed, and it may coexist with chronic prostatitis. The epididymis typically becomes firm and nodular. Microscopic examination reveals fibrous hyperplasia of epididymal tissue, extensive scar formation, obstruction of epididymal tubules, and infiltration of lymphocytes and plasma cells.
The clinical presentation includes persistent mild discomfort or a dragging and distending pain in the scrotum, which improves with rest. The epididymis usually has localized thickening and enlargement, with well-demarcated boundaries separating it from the testes. The spermatic cord and vas deferens may also thicken, while the prostate may appear firmer on examination. Differentiation from epididymal tuberculosis is necessary. In cases of epididymal tuberculosis, the epididymis tends to be slightly harder, with involvement typically starting at the tail of the epididymis. A characteristic finding in epididymal tuberculosis is a beaded thickening of the vas deferens. The prostate in such cases is often small with nodules, while the ipsilateral seminal vesicle frequently demonstrates pathological changes. Microscopic examination of urine typically reveals white blood cells, and Mycobacterium tuberculosis may be detected. Ultrasound, plain X-ray imaging, and cystoscopy often provide evidence of concurrent renal tuberculosis. Bilateral epididymal infection can impair fertility.
Treatment involves administering targeted antimicrobial therapy according to the causative pathogen. Symptom management may include scrotal support, localized heat application, warm sitz baths, and physical therapy, all of which can help alleviate discomfort. Coexisting chronic prostatitis requires concurrent treatment. In cases of severe localized pain, recurrent episodes, or significant impacts on daily life and work, epididymectomy may be considered.