Re: Pain in Scrotum

Posted By HFHS M.D.-MS on June 24, 1998 at 18:46:15:

In Reply to: Pain in Scrotum posted by Alan  on June 24, 1998 at 08:49:08:






For a number of years I have had a general ache in my scrotum, but it didn't bother me enough to do anything about it.  I put it down to a vascetomy I had about four years ago.  I knew it couldn't be STD-related as both myself and my wife are monogomous.
I have always been bothered with urine retension but after passing blood in my urine a couple of years back, my doctor sent me for a series of tests which showed that, although I was retaining urine, it didn't necessitate treatment.
About six months ago I experienced pain when I ejaculated or passed urine and again my urine sample showed blood and excessive white blood cells, but no bacteria.  My doctor said it was probably prostatitis and didn't feel treatment was necessary.
Last week I had extreme pain on the left side of my scrotum and felt a slight lump above the left testicle.  My doctor told me it was epydidimitis, probably connected with the prostatitis, and perscribed antibiotics.  However, I'm concerned that all of these symptoms are become more of a problem to me and surely there is something that can be done.  
I'm worried in case I infecting my wife and is there anything I can do myself to relieve the problem.
Thanks for posting. You have several genitourinary compaints which seem unrelated so I will address them separately.
1.  Blood or white cells in the urine is not normal.  White cells  without bacteria in the urine called pyuria can be caused by tuberculosis or bladder tumors. Urine test for blood and white cells are different.  If it is a dip stick, the test depends on a chemical reaction between the iron from the blood, or an enzyme in the white cell  in the urine with the chemicals on the stick.  These test are not very reliable and should be checked with a microscopic evaluation.  Three or greater red blood cells per high powered field is the cut off for a urological work-up.  The typical work-up for microscopic hematuria  and UTI is a  cystoscopic exam (telescopic look into the bladder), plus or minus a urine for cytology and an IVP ( intravenous pyelogram- dye/ contrast x-ray to look at the kidneys and ureters.     If your work-up  is negative which about 30% are you will need to have these repeated every three to five years if you continue to have microscopic blood in the urine.  Some of the causes of blood in the urine is infection, stones or tumors.  These diseases can be dangerous to your health if not found or treated.  These same test can be used to see why you got a UTI called epididymitis.  
2. Retention of urine can predispose you to an infection of the bladder which then spreads to the epididymis. The bacteria have a chance to overgrow in the bladder because it is not emptied out  completely.  Some men have blockage of the bladder with the prostate as it grows as we age.   The bladder contraction gets weaker in some also as we age.  Both of these can contribute to retained urine in the bladder.  Surgery can be offered to open the prostate and self cathing can be performed for the weak bladder.  
    3. Chronic pain in the scrotal area  is not  rare. Several structures in this area can cause pain.  A few percent of patients will have chronic  pain after a vasectomy.  This can be due to irritation of the nerve, or rupture of the epididymis from back pressure. The epididymis is the tube closest to the testicle which  carries  sperm. An epididymal rupture has an acute onset and usually resolves over a week.  Varicocele can also cause chronic pain, but usually when they are large.  This is a varicose vein of the scrotum.   It is diagnosed with a scrotal exam and can be seen on ultrasound if questionable.   Surgery can offer relief from pain but may not.   You could  have a cyst in the epididymis which is benign and rarely needs surgery for pain control.  This would be seen on the ultrasound.   An inguinal hernia would be the other possibility which may also explain your groin discomfort.   A hernia usually presents as a bulge in the groin.  It is recommended that this condition be corrected surgically before it gets larger or causes more problems.
4. Epididymitis can be sexually transmitted, (like gonnorrhea or chlamydia) but with monogomus partners is usually the same organisms found in the gastrointestinal tract and hence not infectous to your partner. Acute pain and swelling of the epididymis usually means epididymitis, and is treated with antibiotics.  The pain should go away within the week, but the swelling will be around for a month or so. Close follow-up is with your urologist is recommended.
Hope this has shed some light on your genitourinary health. 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.
Sincerely;
HFHS-M.D. MS
* Keyword: chronic scrotal pain, epididymitis, urinary retention, hematuria

[ROHIT202]

A related discussion, why do i have a sharp pain in my scrotum since i have a stone in my left kidney and in my bladder was started.