Epididymitis

[tockpa]

I have suffered from severe inflamation (inflammation) behind the left testicle for almost 20 years. A history of the condition is below. Last February had surgery to remove epididymis...still getting pain in October 2004. Now consultant (who is excellent) recommends removal of testicle. Do you agree? Are there any options left....getting tired of this?  

Paul

· Condition first appeared in 1986 (dull ache behind left testicle)
· First diagnosis was Epididymitis. Subsequent diagnoses have included chronic prostatitis
· GP’s prescribed various drugs & antibiotics over a 17 year period:
o Trimethprin
o Septrin
o Cephalexin
o Doxycycline
o Amitriptyline
o Diclofenac Sodium
o Ciprofloxacin
o Ofloxacin
o Ciprobay
o Bactrim
o Fagyl
o Taravid
o Tamsulosin
o Herbal Remedies (Beta Sitosterol, Quercetin etc.)

· Had surgery in 1989 at St Pauls in Covent Garden. No major problems found apart from scar tissue on epididymis.
· Have undergone various tests over the years, including MRI, ultra sound etc. (all indicating no major problems).
· Urine tests have almost always shown a trace of blood.
· Pain and discomfort persisted on and off for 17 years apart from a gap of 2 years (1999-2000)
· Symptom always on the left hand side behind the testicle. Symptom always worse after ejaculation.
· Had flexible cystoscopy. Nothing conclusive found  
· Had a comparatively pain free summer in 2003, (probably due to deliberately low level of sexual activity), although symptoms returned in late September/ October. (worse than ever)
· Other recent symptoms have included:
· Reduced flow
· Need to urinate frequently during the night
· Had surgery in February, 2004 to remove the left epididymis.
· Still suffering pain some 2-3 months later. Severe on occasions.  Local GP prescribed Ciproflaxin to treat apparent infection and painkillers.
· Consultatant agreed further monitoring whilst taking amythriptylene and a visit to the Pain Clinic.
· Consultation with Pain Clinic. Suggested doubling the dose of amythriptylene to 2 or even 3 tablets per day.
· Pain always returned after ejaculation. Pain was worse in the mornings when the scrotum was tight. Hot baths eased the pain.
· August saw another major attack (pain level 9-10). Visited GP who prescribed Ciproflaxin to treat an apparent infection (trace of blood in urine) and painkillers. This improved the condition after about one week. Had a number of completely pain free days.

October - still severe pain after ejaculation.

[Kevin Pho, MD]

I believe there has been a thorough evaluation, including treatment with a wide variety of antibiotics, as well as comprehensive imaging tests with MRI and ultrasound.  

At this time, if the cause is truly because of the testicle, removing it may be considered - I cannot think of a diagnostic or treatment option that has not been discussed above.  

Before going through with this, you may want to be evaluated by a second opinion - since the surgery is irreversible.  I would also consider a neurology referral to ensure there isn't a nerve cause of the pain.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

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