Epididymitis: a 21-year retrospective review of presentations to an outpatient urology clinic.

PURPOSE: We describe patient characteristics and age distribution of epididymitis in an outpatient pediatric urology referral practice during a 21-year period.

MATERIALS AND METHODS: We retrospectively reviewed all pediatric patients diagnosed with epididymitis or epididymo-orchitis (ICD9 604.9) either clinically or with the aid of scrotal ultrasound at Primary Children's Medical Center from 1992 through 2012. Charts were reviewed to record demographic and clinical features, as well as radiological and laboratory data. Multiple acute episodes occurring in individual patients were recorded.

RESULTS: A total of 252 patients were identified. Mean ± SD age at first presentation was 10.92 ± 4.08 years. The majority of cases occurred during the pubertal period (11 to 14 years) and few patients younger than 2 years were diagnosed with epididymitis (4%). A total of 69 boys (27.4%) experienced a second episode of epididymitis. Scrotal ultrasound results were consistent with epididymitis in 87.3% of cases (144 of 165). Urine culture results were available in 38 patients and were positive in 7 (21%). Positive urine culture was associated with an anatomical abnormality on followup voiding cystourethrogram (RR 5.7, 95% CI 1.37-23.4). Physical activity was noted as a likely precipitating factor in 23 patients and a recent urinary tract infection was identified in 20.

CONCLUSIONS: The majority of cases of epididymitis occur around the time of puberty in early adolescence, with relatively few cases occurring during infancy. Recurrent episodes of epididymitis are more common than previously reported and may affect as many as a fourth of all boys with acute epididymitis.