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Urology (Expert Forum)
Re: Testicular cancer
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Re: Testicular cancer
by hfhs M.D.-AK, Jan 01, 1995 12:00AM
Posted By HFHS M.D.-AK on January 15, 1999 at 12:41:38:
In Reply to: Testicular cancer posted by Gary on January 12, 1999 at 18:22:21:
One yr. ago I had a right radical orchiectomy to treat a mass. The mass was a benign mature teratoma, follow up in one yr. Five months after the surgery i woke up with pain in my left testicle and on the affected side groin and abdomen. I noticed a clear urethral discharge. I was at school so I went to a different urologist. He assured me that it was not cancer but it was urethritis which he treated me for. The antibiotics cleared up the discharge but not the pain. The doctor called me and told me there was no infection in my urine or culture. Several months went by and the dull pain was still there. I went back to the same doctor and told him that the pain seemed to radiate into my left leg. He told me to get it out of my head and that nothing was wrong. So I just dealt with the pain. Several months went by and the pain became unbearable. I went home to the urodoc who did the surgery and he ordered a chest and abdominal ct. The day of the ct my testicle became swollen and hard. When I went to get the results of my ct's which were normal I showed him the testicle. He said that it felt like fluid but would order an u s. The u s showed an epididymal cyst, microlithiasis. and a small hydrocele. He said there was no reason for the pain. After that my testicle would grow and shrink every day. I went to another urodoc who ordered another u s which showed the same thing and a testicular scan which showed no torsion or varicocele. I have noticed an accumulation of veins in my scrotum which gather when I stand. There has been no sign of infection the whole time. Could the cyst be the problem? The cyst hurts upon palpatation. What could cause the testicle to grow and shrink back down. It seems to get bigger when I stand and shrink when I sit.
Thanks,
Gary
______-
Dear Gary,
A spermatocele is a cystic structure or outpouching of the epididymus. The cyst itself is usually firm and tender. It is usually filled with sperm and epididymal fluid and considered a benign lesion. It is possible for it to lead to a decrease in fertility however this is uncommon. The most important part of diagnosis is the make sure there is no cancerous lesion, which your doctors have done.
It is still possible that you have a varicocele, dilated veins, which are normally present in about 10-15% of the male population. This diagnosis can easily be missed on ultrasound, unless the radiologist is looking for it. The radiologist would have to ask you to stand and valsalva(bare down). This is not part of a routine ultrasound and is often skipped.
. You also commented on a hydrocele. This is simply a fluid collection in the sac (Tunica Vaginalis)surrounding the testicle. It consists of fluid that is not reabsorbed by the body. Most hydroceles grow to a certain size and then stabilize. They are acutely caused by local injury, radiotherapy, acute nonspecific or Tuberculous epididymitis, or orchitis. It could even occur secondary to a neoplasm.
An option in your case is to take anti inflammatory medications (Motrin, Advil, Alieve) and follow conservatively. If the spermatocele or hydrocele continues to grow and the pain increases, surgery is probably your best option. One of my sayings that I would tell my patients in this situation is as follows; I will never tell you, you need to have this operation, you will have to tell me you want this operation. I dont like to operate for pain when the removal of a structure may not be the source of the patients pain. In your case this would go for the spermatocele(cyst), the potential varicocele, or the hydrocele.
I dont know why you were told that your testicle would fluctuate in size.
This information 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:Spermatocele
In Reply to: Testicular cancer posted by Gary on January 12, 1999 at 18:22:21:
One yr. ago I had a right radical orchiectomy to treat a mass. The mass was a benign mature teratoma, follow up in one yr. Five months after the surgery i woke up with pain in my left testicle and on the affected side groin and abdomen. I noticed a clear urethral discharge. I was at school so I went to a different urologist. He assured me that it was not cancer but it was urethritis which he treated me for. The antibiotics cleared up the discharge but not the pain. The doctor called me and told me there was no infection in my urine or culture. Several months went by and the dull pain was still there. I went back to the same doctor and told him that the pain seemed to radiate into my left leg. He told me to get it out of my head and that nothing was wrong. So I just dealt with the pain. Several months went by and the pain became unbearable. I went home to the urodoc who did the surgery and he ordered a chest and abdominal ct. The day of the ct my testicle became swollen and hard. When I went to get the results of my ct's which were normal I showed him the testicle. He said that it felt like fluid but would order an u s. The u s showed an epididymal cyst, microlithiasis. and a small hydrocele. He said there was no reason for the pain. After that my testicle would grow and shrink every day. I went to another urodoc who ordered another u s which showed the same thing and a testicular scan which showed no torsion or varicocele. I have noticed an accumulation of veins in my scrotum which gather when I stand. There has been no sign of infection the whole time. Could the cyst be the problem? The cyst hurts upon palpatation. What could cause the testicle to grow and shrink back down. It seems to get bigger when I stand and shrink when I sit.
Thanks,
Gary
______-
Dear Gary,
A spermatocele is a cystic structure or outpouching of the epididymus. The cyst itself is usually firm and tender. It is usually filled with sperm and epididymal fluid and considered a benign lesion. It is possible for it to lead to a decrease in fertility however this is uncommon. The most important part of diagnosis is the make sure there is no cancerous lesion, which your doctors have done.
It is still possible that you have a varicocele, dilated veins, which are normally present in about 10-15% of the male population. This diagnosis can easily be missed on ultrasound, unless the radiologist is looking for it. The radiologist would have to ask you to stand and valsalva(bare down). This is not part of a routine ultrasound and is often skipped.
. You also commented on a hydrocele. This is simply a fluid collection in the sac (Tunica Vaginalis)surrounding the testicle. It consists of fluid that is not reabsorbed by the body. Most hydroceles grow to a certain size and then stabilize. They are acutely caused by local injury, radiotherapy, acute nonspecific or Tuberculous epididymitis, or orchitis. It could even occur secondary to a neoplasm.
An option in your case is to take anti inflammatory medications (Motrin, Advil, Alieve) and follow conservatively. If the spermatocele or hydrocele continues to grow and the pain increases, surgery is probably your best option. One of my sayings that I would tell my patients in this situation is as follows; I will never tell you, you need to have this operation, you will have to tell me you want this operation. I dont like to operate for pain when the removal of a structure may not be the source of the patients pain. In your case this would go for the spermatocele(cyst), the potential varicocele, or the hydrocele.
I dont know why you were told that your testicle would fluctuate in size.
This information 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:Spermatocele
