Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma.

Many patients with unilateral or bilateral testicular, epididymal, or scrotal pain as their sole presenting symptom receive a diagnosis of "chronic epididymitis." This common clinical entity is diagnosed and treated by practicing urologists but essentially ignored by academic urologists. This article defines chronic epididymitis, reviews current knowledge regarding its etiology, and describes appropriate physical examination and clinical testing for patients with the condition. The recently developed Chronic Epididymitis Symptom Index is presented, which can be used for baseline evaluation and follow-up of patients with chronic epididymitis, both in clinical practice and in research treatment trials. Treatment options, from watchful waiting to medical therapy to epididymectomy, are reviewed.