Question Title: My Urologyst suggest an Operation

(Sorry for my bad English)

I'm a 28 year old Peruvian with an average health.
I don't drink and I've never been smoked.

In May, I had two sexual relations after a long time
without sex (1 year).
After 5 days from the second sexual act I felt some pain in my Left testicle
and it turned 2 or 3 times bigger tha the right one.
After 4 days, the pain ended, but the left testicle remained bigger.
Then, after 2 weeks, I felt pain again, so I went to the urologyst.

He examined my testes manually and he suggested an operation:
To cut a piece of my testicles and send that piece to a pathologyst.
He also ordered me to do Bood and Urine analysis and a Testes Ecography.
Now (8th June) I have no pain again but my left testicle remained bigger.

Is this operation necessary?
Are there other options?

Thank you so much for your answer.

Alex Sarmiento J.

Dear Alex,
It is very difficult to make a judgment in your case due to the fact that an examination is so important.. If you were my patient I would want to propose a list of possible reasons that could be causing your pain and check each possibility carefully. The most important objective is to make sure you don’t have cancer. It sounds like your doctor is trying to do this by sending a biopsy.
In your case the list (differential diagnosis) would consist of:
1)Infection (epididymitis);Inflammation
2)Spermatocele
3)varicocele
4)hydrocele
5)tesicular cancer
6)Torsion
7)Inguinal hernia
I my opinion most of these possible diagnoses need to be evaluated.
Infection- have you been given antibiotics, anti inflammatory medication?
Spermatocele- an outpouching of the epididymus filled with sperm. These do not need to be very big to cause a significant amount of pain. Probably not an acute situation such as yours.
Varicocele-dilated veins in the scrotum around the testicle,
Hydrocele- fluid collection around testicle.
Testicular cancer-would have to be seen on ultrasound
Torsion- Testical would have died by now and there would not be any flow in the vessels on ultrasound.
Inguinal Hernia- This would be evident on a good physical exam.
If you are concerned, make sure your doctor has worked-up your problem correctly that they have addressed the above issues. You may need to have an ultrasound done if possible before an operation is done. Again, I have not examined you so you should go with what your doctor recommends You may also want to take an over the counter anti-inflammatory medication to help with the pain and inflammation.
This information is provided is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Testis

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