Inflammation of the testicle
Orchitis is an inflammatory process, with an acute or chronic course, which affects one or both testicles and sometimes part of the male genital apparatus. Despite what has been said, the simple isolated inflammation of the testicle is a rather rare phenomenon, being often related to other diseases, such as epididymitis: not by chance, more than by orchitis proper, we often speak of orchiepididimite.
The term orchite derives from the Greek ορχεις ( orcheis ) testicle, while the ending, -ite, indicates an inflammatory process: literally, therefore, orchitis means inflammation of the testicle .
Causes
However, most often, the orchitis occurs as a complication of mumps ( mumps ), a typical viral infection. Even congenital malformations of the urinary tract could cause testicular inflammation.
Less frequently, orchitis is caused by syphilis, brucellosis or typhoid; even severe forms of influenza, mononucleosis and hepatitis are possible, albeit rare, causes of testicular orchitis inflammation.
Orchitis has also been diagnosed in some paraplegic patients suffering from neurogenic dysfunction of micturition (eg neurological bladder): in similar situations, the main cause of testicular phlogosis lies in a non-precise catheterization.
However, the etiological research is not always simple and immediate: specifically, when the orchitis is caused by bacterial or viral infections, the infection generally occurs via the lymphatic or hematogenous pathway, through the epididymal channel [taken from clinical Andrology, of Wolf-Bernhard Schill, Frank H. Comhaire, Timothy B. Hargreave].
Risk factors
In addition to the causes just listed, there are some risk factors that - although not representing the main triggers - could predispose the subject to orchestral complications. These include:
- Age of the patient: when the subject exceeds 45 years, the chances of contracting orchitis increase
- Consuming unprotected sex with multiple partners increases the chances of transmitting sexual diseases, and with them the risk of developing a secondary orchitis
- Patients not subjected to mumps vaccination are more prone to orchitis
- Compared to adolescents, a male who contracts mumps after puberty is 30% more likely to develop acute orchitis.
- When a subject is subjected to various surgical operations on the genital apparatus, he is subjected to a greater risk of urinary infections, therefore the chances of orchitis increase.
Classification of orchitis
It is a mistake to generalize when it comes to orchitis; rather, it is necessary to carry out a precise classification of its various forms.
Depending on the type of infection, the viral orchitis is distinguished from the bacterial orchitis:
- Viral Orchitis:
As already discussed, the mumps virus, belonging to the Paramyxovirus group, is one of the major defendants of testicular inflammation.
- Bacterial Orchitis:
Generally, bacterial orchitis is always associated with epididymitis, hence with phlogosis of the epididymis. In fact, the epididymitis, generated in turn by an inflammation of the urinary tract or by venereal diseases, often also affects the testicle, causing precisely an epididymitis.
The orchite also stands out for its course: in fact, there are acute and chronic forms:
- Acute orchitis: they are rather rare, and most of the time they follow phenomena of epididymitis [from Ecografia, by G. Gavelli, A. Lentini]. However, acute orchitis can also derive from brucellosis, typhoid or mumps: they are all generalized infections that complicate the patient's clinical profile. When the adult subject is struck by mumps, we have seen that the chances of contracting orchitis also increase: this possibility must not be underestimated, considering that, in similar situations, the patient runs the risk of becoming sterile.
- Chronic Orchitis: more frequent, it is usually generated by testicular trauma or, more rarely, by syphilis and tuberculosis. The clinical explanation is not demonstrable; however, some authors believe that the chronic form of orchitis may result in reactions of the organism in response to foreign substances contained in the seminal fluid. A typical prodrome of chronic orchitis is the increase in testicular volume, a situation which in any case does not cause pain in most cases.
Furthermore, according to histology, the tubercular orchitis and granulomatous orchitis can be distinguished:
- Tuberculous orchitis: presence of caseous abscesses
- Granulomatous orchitis: it is characterized by the presence of mononuclear cell infiltrate. The granulomatous variant of orchitis consists of an aspecific phlogosis affecting the testicle, usually generated by an autoimmune reaction against the spermatozoa themselves.
Specific granulomatous orchitis is generally caused by syphilis, typhoid or tuberculosis.
Therefore, patients with orchitis should undergo careful diagnostic tests, since the orchitis, particularly the granulomatous one, can be mistaken for malignancy.
