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Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
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Subject: Re: Testicular Pain My husband started having recurring Epididymitis about 2 years ago. He also had a vasectomy in December of 1997. Two of the cases of epididymitis were before and two, including the most severe, were after. All four times he was given antibiotics, which eventually worked. He was seeing a Urologist for those problems. In June of last year, after the fourth time he had Epididymitis, another Urologist recomended a cystoscopy (Apologize for the spelling). The diagnosis after that procedure was chronic recurring Epididymitis. Then about the middle of October last year, the pain started again. Skipping the $100 per visit urologist this time, he went to a local clinic, where they prescribed 100mg of Floxin. A month later there was no change, except that the pain was worse. There is no swelling, discoloration, or lump. Sex and urination don't change the way it hurts. He says tying his shoes hurts worse than sex. After a month of Floxin, he returned to his urologist who speculated he might have a Sperm Granuloma leftover from the Vas (remember its been almost a year since the vas). He put him on anti-inflammatory, took him off the Floxin, and sent him home with instructions of hot baths and heating pads at night. Two more weeks and there was still no change. End of November he had a sonogram. The sonogram showed nothing, but the doctor did mention a tiny cyst, which he didn't even mention at first and seemed to think was non-threatening and clearly not a concern. We decided to try anti-biotics one more time, this time Doxycycline (100mg twice daily) for six weeks. The first day of this medication he came home from work with a bounce in his step and announced he felt better than he had in two months. He's now been on the medication for 4 1/2 weeks and thought he was feeling better. We thought he had kicked it finally. Then yesterday he came home saying the pain was back. He's been back to the Urologist this week, who is clearly out of options. His only suggestion was that my husband go see a Chronic Pain specialist. Basically he's saying its just something he will have to live with. We are both having a hard time accepting this. The pain is affecting his life, his mood, his spirit. He can't play with his kids, work on his house, and even has trouble sitting behind his desk all day. Doesn't there have to be something causing this? I'm worried about the non-threatening cyst and wondering if we should consult a third urologist, or perhaps some other specialist. My husband is 39 years old, in good health, except for all this, and until two years ago never had any illness except an occasional flu or cold. Please help. Lori = Dear Lori Thanks for your questions. Sorry about your husbands debilitating condition. Epididymitis is believed to result from a bacterial infection in the urine which desends the vas deferens and infects the epididymis. Men who have had vasectomy are not felt to be at risk unless infection has been incompletely treated prior to vasectomy. This is an unlikely in your case because bacterial epididymitis usually has an abnormal physical exam and ultrasound. ( a palpable inflamatory mass around the testicle). Chronic epididymal pain can be treated by surgical removal of the epididymis but most physicans are reluctant to perform surgery for pain alone. If your urologist were to consider surgical removal you would need to understand that your pain may not resolve post operatively. Another possibility may exist, Referred pain. In Referred pain, the brain percieves pain in one location when in fact it is generated in another. A passing kidney stone in the ureter, hernia, varicocele or prostatitis come to mind when testicle pain is the chief complaint. Good luck. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians notes and lab test results that you may be able to obtain. These will help us greatly. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. |
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