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Q. USG showed epididymitis and reactive hydrocele. Is Alfoo the right medication?

Answered by
Dr. Shahil Khant
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 18, 2020

Hello doctor,

I am a 30-year-old male. I had pain below the belly, which, on the next day, passed to the left scrotum, and was swollen. I visited a urologist, got USG done on the scrotum, blood test, urine test, urine culture, sugar. Left epididymitis with reactive hydrocele was noted. Nothing was found in my blood and urine test reports.

Uroflow was done, and it was 356 ml / 19.6 ml per second max / 8.5 ml per second average. I was given four weeks of Doxybond medicine twice a day, and Alfoo for four weeks. Scrotum support is also used, and there is no pain after the second day after I started taking medicines. After four weeks of USG KUB, the PVR scrotum was done again with uroflow. Nothing in USG KUB PVR (450cc pre/9cc post void), but USG scrotum show no infection, but chronic left epididymitis was said in the report because I still had swollen left cord. No pain or hydrocele was noted.

Uroflow 750 ml/ 22 ml per second 8 ml per second. Doctor said this chronic epididymitis will persist for some time or may not go ever, but no side effects will be there in the future.

Now Doxycycline is stopped, but Alfoo is still continued for two months because uroflow is not good as per the doctor. Now I am taking Alfoo for four days and has stopped Doxybond and will get uroflow done two months again.

Is the treatment right or not? What is the ideal uroflow for the age of 30 years? What could be the cause of epididymitis? Could it be due to masturbation or sex? I only have only one sex partner (wife). Should I get any CT or MRI done to find the cause of epididymitis and prevent it in the future? Could epididymitis come again? Please advise.



Welcome to

I have read your query and seen all reports (attachment removed to protect patient identity).

Treatment done is right and nothing to worry about. After an acute epididymitis episode, there are high chances that it can turn into chronic epididymitis as in your case. It may take time to resolve, but nothing to worry about now. You may feel small swelling or discomfort on and off. Your uroflow is near to perfect, nothing to worry. Not only numbers but the flow pattern is also required to be seen. So we cannot defy normal based on numbers. Your numbers are fine, but only pattern is slightly disturbed but nothing to worry about. Continue Alfoo as advised.

There can be many causes of epididymitis, but in most cases, it is idiopathic (cause not known). In your case, it could be idiopathic or sexual. Masturbation does not cause epididymitis. It can be sexual. There are no tests to differentiate if it is idiopathic or sexual. No requirement for CT or MRI at all.

Yes, it can come in the future, but chances are very less if it is idiopathic. As in your case, it is likely to be idiopathic as all other USG (ultrasound), and reports are normal.

Thank you doctor,

I feel my left scrotum is a little bit heavy than my right scrotum before I pass urine. Once I pass urine, both scrotum feels similar. Could it be urine filling in the scrotum due to hydrocele or any injury leading to leakage in the urethra. Though hydrocele is not mentioned in the first and final USG reports.



Welcome back to

You may feel heaviness in the scrotum for some time. If there is no urine filling or leak of urine, only heaviness, it is just because of infection. It is just you are correlating with the passing of urine.

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