what is the treatment for relapsing epidydimitis and painful edema?
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Child 5 yesrs old [boy]3 times relapsing epidydimitis not response the therapy with antibiotics appear again painfull edema please i ask help for my child! No testicles problem ..Ultrasound resalts show calcifications without abscess and big head of left epidydim.The doctors open syrgery and not found cystis or tumors.Istological test its clean no cancer.
Posted Mon, 13 Jan 2014 in Child Health
Answered by Dr. Chakravarthy Mazumdar 4 hours later
Brief Answer: Complex but I tried to give my opinion. Detailed Answer: Hi, I understand how apprehensive the parents would be with a 5 yr old kid diagnosed with recurrent epididymitis while on ALL therapy. Though such complex cases were not presented in my clinic I tried to bring out the following information for you. I find some important information missing in your child's case. Although I found that testis is normal and the complications of recurrence were ruled out as well. Was a drug induced epididymitis though off by your doctor? The drugs used for Acute Lymphoblastic Leukemia treatment. The drugs used can cause chemical irritation of the epididymitis. If yes then the doctor may have to start from the beginining like a normal kid with no ALL. Were congenital abnormalities like Vesicoureteral reflux ruled out by Pediatric Urologist? Was an Ultrasound abdomen with emphasis on kidney and PUJ done? Voiding cystourethrography or Intravenous Urography can be done to rule out congenital abnormalities of the urinary tract. Was the urine cultured? Does it have sterile or with organisms? Sometimes chemical irritation because of urine reflux into the seminal tract could be the reason. The second most important reason could be voiding dysfunction. In such a case bladder retraining and medications for detrusor and sphincter relaxation stopped the recurrence. Unknown reasons and urine voiding dysfunction acccount for 39% of cases of recurrent epididymitis in children. If the urine culture had organisms antibiotic treatment against coliform bacteria and pseudomonas, Staph and proteus for three weeks is important while trying to investigate other reasons. The Pediatrician should try to investigate sarcoidosis, Kawasaki disease, seminal vesicle calculus and Henoch Scholein Purpura. Common treatment methods: Bed rest is the only and the most important way to ensure adequate lymphatic drainage from the infected epididymis. Ample Ibuprufen and Ice packs should be given for pain relief. Parents needs to be educated on the issue. If there are congenital abnormalities surgery is required and most often the kids do better after the surgery. The studies also suggest that neurovascular sparing vas clipping can be used effectively in children with structural anomalies and urethrovasal reflux who have developed intractable epididymitis. The next step would be carry my opinion to a Pediatric Urologist and Pediatrician. The earlier would intervene with investigation and surgery if required. The latter would rule out secondary causes for recurrence while following up regularly with the kid and counseling the parents. I tried my best to give the suitable information.