How do urologist confirm a patient has epididymitis instead of something worse? do they do urine or semen test?

Examination: Eipdidymitis can usually be made by examination of the testicle and epididymis. Confirmation by testicular ultrasound is obtained sometimes to insure the diagnosis and to evaluate the testicle better when the swelling may affect the ability to examine the testicle.

Physical exam: Epididymitis is usually diagnosed based on your history and the physical examination, revealing tenderness and maybe swelling of the epididymis. Sometimes an ultrasound will be performed, but it is often unnecessary. Urine and semen tests commonly negative when epididymitis is present.