(254) Orchitis and Epididymitis in Emergency Department: A Retrospective Study on Diagnosis and Treatment

Introduction Epididymitis is a prevalent condition affecting adult males, with an incidence ranging from 25 to 65 cases per 10,000 men annually. It presents in acute, chronic, or recurrent forms, with acute epididymitis and orchitis being characterized by pain, swelling, and increased temperature of the scrotum. The condition is often caused by the migration of pathogens from the urethra or bladder, with Enterobacterales, C. trachomatis, and N.gonorrhoeae being the most commonly identified pathogens. Appropriate diagnostics can identify the causative pathogens in up to 90% of patients.Scrotal ultrasound is recommended by the European Association of Urology (EAU) guidelines as the preferred diagnostic tool for acute epididymitis and orchitis, offering greater accuracy than urinalysis alone and aiding in the exclusion of other conditions such as testicular torsion, which is a critical differential diagnosis in young males. This study aims to evaluate the current diagnostic and therapeutic approaches for managing orchitis and epididymitis in an emergency hospital setting. Objective The primary objective of this study was to assess the management strategies for orchitis and epididymitis in an emergency hospital room, focusing on diagnostic and therapeutic practices. Specifically, the study aimed to evaluate the use of diagnostic tools such as scrotal ultrasound, blood tests, and urinalysis, as well as the prescription patterns of antibiotics in both the emergency room and upon discharge.The study aimed to evaluate the management of orchitis and epididymitis in the emergency setting, focusing on diagnostic methods (ultrasound, blood tests, urinalysis) and antibiotic prescribing patterns during care and at discharge. Methods This retrospective study analyzed records of 202 patients with orchitis or epididymitis (Jan 2022–Dec 2023), assessing diagnostic methods and antibiotic use in the emergency room and at discharge. Data were analyzed using SPSS. Results Out of 202 patients with a mean age of 41 years, 154 (76%) underwent scrotal ultrasound, 132 (65%) had blood tests, 118 (58%) had urinalysis, and only 75 (37%) underwent urine culture. Notably, none of the patients were tested for sexually transmitted infections (STIs). Regarding treatment, 106 patients (52%) received a single dose of antibiotics in the emergency room and were subsequently discharged with oral antibiotics or required hospitalization. The most frequently administered antibiotic in the emergency setting was Ceftriaxone, used in 90 out of 106 patients (84%), followed by Ciprofloxacin, Cefuroxime and Amoxicillin with Clavulanic Acid used in 4 patients each (5%) and Piperacillin/Tazobactam used in 2 patients (1%).For home treatment, among the 162 patients with accessible prescription data, 88 (54%) received fluoroquinolones, 26 (16%) were prescribed Doxycycline, 20 (12%) received Amoxicillin with Clavulanic Acid, 14 (9%) were given Cefuroxime, 8 (5%) were treated with Azithromycin, and 6 (4%) received Trimethoprim/Sulfamethoxazole. 28 (14%) required hospitalization. Conclusions The study showed that management of orchitis and epididymitis in the emergency setting mainly relied on scrotal ultrasound, in accordance with EAU guidelines, while urine culture and STI testing were underused. Ceftriaxone was the main antibiotic used in the emergency room, and fluoroquinolones in outpatient care. The lack of STI testing indicates poor adherence to diagnostic protocols, potentially affecting antibiotic choice and outcomes. The study highlights the need for better compliance with guidelines, standardized antibiotic use, and improved diagnostic accuracy to optimize patient care and prevent recurrence. Disclosure No