Epididymitis bei Kindern: fact or fiction

Zusammenfassung

Die Epididymitis zählt im Kindesalter zu den die häufigsten Ursache des akuten Skrotums. Im Unterschied zum Erwachsenenalter liegt ihr in dieser Altersstufe eher selten eine nachweisbare aszendierende bakterielle Infektion zugrunde. Meist bleibt die Ätiologie ungeklärt. Während beim Vorliegen einer Leukozyturie und einer signifikanten Bakteriurie eine resistenzgerechte antibakterielle Therapie möglich ist, stehen in den übrigen Fällen eindeutige Kriterien, die eine Entscheidung für eine akute antibakterielle Therapie erlauben, nicht zur Verfügung. Dass trotzdem in der alltäglichen Praxis eine antibakterielle Therapie bei Epididymitis eingeleitet wird, basiert daher auf der Annahme der Möglichkeit („Fiktion“) der Infektion und nicht auf Fakten.

Dieses Dilemma lässt sich wahrscheinlich erst dann auflösen, wenn geeignete diagnostischen Marker für unterschiedliche Auslösemechanismen der Epididymitis gefunden werden.

Abstract

Epididymitis is one of the most frequent causes of acute scrotum during childhood. Unlike in adults, ascending bacterial infections are rarely the underlying cause of the condition in children. Antibacterial treatment in accordance with a prior antibiogram is possible in the presence of leukocyturia and significant bacteriuria. For the remaining cases, there are no definite criteria allowing for a decision on acute antibacterial treatment. The fact that antibacterial treatment is still initiated in cases of epididymitis in the clinical routine setting is based on the assumption of a possible infection rather than being based on facts. This dilemma will probably not be entirely resolved until adequate diagnostic markers for the different trigger mechanisms of epididymitis have been found.

Schlüsselworter

Epididymitis - Epididymoorchitis - akutes Skrotum

Key words

epididymitis - epididymo-orchitis - acute scrotum

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