Management of paediatric epidiymoorchitis - is there a need for antibiotics and follow-up imaging?

Background: Epididymo-orchitis, in children and adolescents, presents with acute testicular pain. Diagnosis is usually made during emergency scrotal exploration for acute testicular pain. We conducted this study to assess the need of antibiotics and for follow-up renal imaging in this cohort. Methods A single institutional retrospective study was conducted in a tertiary paediatric surgical center from 2016–2020. All children and adolescents under 16 years of age who had a scrotal exploration for acute testicular pain and diagnosed with epididymoorchitis were included in this study. Electronic patient records and discharge summaries were used to gather information regarding admission, operation reports, antibiotic prescription, investigations and follow-up of these patients. Results A total of 353 boys had scrotal exploration in this period. Of these, 53 had an intraoperative diagnosis of epididymo-orchitis. Median age was 12 years (range 1 year to 15 years). Proportion of epididymo-orchitis among scrotal explorations each year remained fairly constant (15%). Only 1 boy with recurrent episodes of epididymo-orchitis had a positive urine culture which grew Escherichia Coli. Overall, 35% of children and adolescents were prescribed antibiotics. All patients had follow-up imaging requested to look for urological anomalies of which only a third attended the follow up appointment. Only 1 was diagnosed with urological anomaly which was attributable as a cause of recurrent epididymo-orchitis. Conclusion This study confirms a low incidence of bacterial aetiology and lack of evidence base for routine use of antibiotics and imaging after a single episode of paediatric epididymo-orchitis. Associated urological anomaly is rare after a single episode of epididymo-orchitis and most can be safely managed without the need for antibiotics or follow up renal imaging.