Banyra and Shulyak reported a staging system for acute epididymo-orchitis. This can help guide management. The authors are fro 2nd Lviv Municipal Polyclinic and Danylo Halytsky Lviv National Medical Univerisity in Lviv, Ukraine.
Patient selection: acute epididymo-orchitis
Parameters:
(1) palpation of epididymis
(2) palpation of testis
(3) local softening (malacia) on palpation
(4) hydrocele on scrotal ultrasound
(5) abscesses on scrotal ultrasound
(6) size of largest abscess in cm
Findings
Stage
palpable epididymitis with relatively normal testis; no other finding
I
palpable epididymitis with relatively normal testis; hydrocele; may have few abscesses <= 0.5 cm
II
both epididymis and testis inflamed; hydrocele; may have abscesses <= 0.5 cm
IIIA
one or more abscesses > 0.5 cm in diameter; hydrocele; palpable softening may be present
IIIB
where:
• A Stage 0 could be added if there is no palpable inflammation of the epididymis or testis and all other findings are absent.
Stage
Management
I
conservative
II
conservative initially; if no improvement after 2-3 days consider surgery
IIIA
conservative initially; if no improvement after 2-3 days consider surgery
IIIB
surgery
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