Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities.

Of 47 children diagnosed as having epididymitis between 1975 and 1985, 8 of 17 prepubertal patients (47 per cent, or 17 per cent of the total group), including 3 of 4 infants (75 per cent), had an underlying urogenital anomaly. Thus, patients with epididymitis secondary to an underlying anomaly present at an earlier age. The common finding in patients with underlying anomalies was a pathological connection between the urinary tract and the genital duct system or bowel. Coliform urinary infections predominated in patients with underlying anomalies (4 of 6). Although a positive urine culture suggested an underlying anomaly (positive predictive value 0.60), a negative culture virtually ruled out an anomaly (negative predictive value 1.00). Of the 8 patients with underlying anomalies 6 underwent voiding cystourethrography and 6 underwent excretory urography, and the diagnosis was established in 6 (100 per cent) and 4 (67 per cent), respectively. Thus, voiding cystourethrography has the greatest diagnostic yield. Any prepubertal patient with epididymitis merits a complete urological evaluation, including a urine culture, voiding cystourethrography and excretory urography to rule out an underlying urogenital anomaly, which often is amenable to an operation. Surgery often involves severance of the pathological urogenital or urinary-fecal connection and it was successful in 7 of our 8 patients.