I am a 23 yo M w/ no significant past medical history. For the past 7 months I have been experiencing bilateral testicular pain only upon palpation of my testicles on a certain area next to the epididymis bilaterally. At the same time I wake up in the middle of the night 3-4 times to urinate. I went to a urologist who said I have an inf inflamed testicular cyst on the right side and possibly a case of low grade epididymitis bilaterally. He also said most likely have overactive bladder. Started me on Levaquin 500mg PO QD x 7 days and Vesicare 10mg PO QD.The cyst went down but the pain around the epdidymis persisted w/ no change. After 4 weeks of Vesicare I still have no change in my nocturia. I had an ultrasound of my bladder, testicles, kidneys all normal. I then had a cystoscopy done which showed no abnormalities besides a tight sphincter. My urologist told me to continue the Vesicare which I have been doing. At my latest follow up I had a trace of a urinary infection which he said was most likely from the cystoscopy prescribed me Cipro 500 mg PO BID x 10 days. I am to return for another follow up in 2 weeks. However I still pain in my testicles, radiating to my inguinal area and lower abdomen. I also still wake up in the middle of the night 3-4 times to urinate. This is driving me crazy. I am a medical student about to start residency and I cant take it anymore. I have no pain w/ ejaculation. I have no erectile dysfunction. I have no pain with urination. I only use the bathroom 2-3 times during the day. My CBC w/ diff was normal. I had complete metabolic panel done it was normal. HBa1C 4.5. Thyroid tests all normal. Full STD panel including HIV negative. Complete hepatic panel negative
Sorry to learn that you are having health issues at a critical stage in your life. Hope it gets resolved at the earliest.
By the way, what was your ultrasound results on prevoid and post void urine volumes? You have mentioned a " tight sphincterr " finding on cystoscopy, if it is bladder neck muscle, shouldn't it cause larger post void volumes?, which itself can cause nocturia. By the way by definition, nocturia alone, as in your case, is not a sufficient condition for Over Active Bladder (OAB) as can be seen from the following link:
In OAB, increased urinary frequency (both Day and Night) along with low urine volume with urgency, with out UTI are considered the main criteria.
In your case, if testicular issues are decoupled from nocturia, you should consider possibilities of Obstructive Sleep Apnea ( there is an article related to this case in this Forum), non uniform voiding of total fluid intake between day and night, effect of any diuretic medicine, food item etc. taken after afternoon ( any recent change in diet for dinner), stress induced neurological factors that affects urinary urgency and/or ADH section pattern etc may be considered.
However it is more likely that nocturia in your case is triggered by a testicular infection.By the way what was the ultra sound findings of the Epididymis? Any swelling, lesion over there?, or is it below the sensitivity of the instrument? I still feel your symptoms could be due to a testicular infection by an unidentified or drug resistant micro organism, fungus or parasites like filarial worms. May be you could also get a semen analysis done. Many times, I feel persistent fungal infections are under diagnosed in Allopathy, as many patients complain about continuing UTI symptoms, in spite of blind treatment with antibiotics in the absence of microorganisms in urine. I therefore advise you to do more tests regarding this aspect in a better equipped hospital and get an early solution to your problems.
Hey thank you for responding to my questions. I will try to answer all of them as best as I can as I wish to ask more of your advice.
1.) What was your ultrasound results on prevoid and post void urine volumes?
I failed to mention that I had a urodynamic study done. This showed that my prevoid capacity is low around 500 ml. However when I voided I only had around 5ml of fluid left over.
2.) You have mentioned a " tight sphincterr " finding on cystoscopy, if it is bladder neck muscle, shouldn't it cause larger post void volumes? This is in reference to the bladder neck muscle however I will have to double check with the impression as i cant find the copy of the results. But I know that my post void capacity is near normal.
3.) By the way what was the ultra sound findings of the Epididymis?
Besides the finding of a small cyst there were no abnormal findings. The urologist advised me there was good blood flow to each testicle and no findings that led him to believe there was anything wrong with the epididymis. No swelling or lesions. And the cyst did go down and is now hardly noticeable.
I also failed to mention that I had a sleep study done which showed no obstructive sleep apnea. However my sleeping environment for the past year was very poor as there was much noise as i lived near a highway. I would have trouble falling asleep with the noise but eventually got over it. Since then all these issues started to occur. I first had trouble sleeping, then i started to have nocturia and now I have mild bilateral testicular pain along with intermittent lower abdominal pain (most likely radiating from the testicles).
Besides a semen analysis, do you think I should have any other tests?
I did move and am now sleeping a bit better with fewer awakenings. Bust still have awakenings usually 4 hours after falling asleep.
Thank you for the detailed feedback. Apparently you have done many tests with negative results. Therefore,it seems the nocturia in your case is mostly on account of the disturbed sleep you have had due to environmental noise ( especially if the night time urinations are without urgency and in small quantities). Since you have moved out, it should get cleared in due course.
In case, the nocturia is associated with urinary urgency and normal voiding volumes, indicating the day time shortage of voiding is compensated by night time urination, you could also do the following:
1. Reduce fluid and coffee intake after evening.
2. Do some exercises in morning and evenings with legs in raised position, so that if any fluid is accumulated in the extremities, the same is voided during day time itself. In case in recent times you used to stand up many hours during the day, these exercises will help both nocturia as well as testicular pain.
A semen analysis may still be done to make sure everything is alright in the epididymal path.
In case the symptoms aggravate or persists beyond three months, a second opinion may be got from another urologist.
I have had chronic pain in my testicles radiating into my lower groin for a while.
I have had bilateral hernia repairs so we thought it was nerve entrapment in scar tissue. I had the nerves severed still persists.
I had terraquant laser treatments in the lower groin/spermatic chord areas relieve the pain around the testicle and spermatic chord nerve blocks through the scrotum relieve or in most cases lessen the testicle pain for 6 weeks or so
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