Testicular Pain

I'm a 32 year old male in otherwise good health, but I've been having problems with some intermittent testicular pain (left side only).  The pain is quite severe at times, painful enough that I've gone to the hospital for treatment.  I'll outline my history below.

In May 2004, I ended up in hospital with acute onset severe testicular pain.  Prostate exam produced normal results. I had a testicular US which was normal, except for slight decrease in testicular perfusion and two epididymal cysts on the left testicle (one about 4 mm the other about 1/2 that size (just a guestimation).  The urologist at the hospital thought it might be torsion, but wasn't 100% sure.  The pain had subsided by the time all the tests were done (about 4 hours of time had past).  I was discharged and suggested that I go to a urologist for a follow up.

In late May I followed up with a second urologist was treated with Cipro and Vioxx.  About a month after the initial attack I had another one and again was admitted to hospital.  I was again given a testicular US and it came back normal.  Following up again with the second urologist we decide to do a bi-lateral orchiopexy.  After healing from the surgery, the pain returned again in several attacks over the next couple of months.  I was referred to a third urologist.

With the third urologist he prescribed an abdominal US and an abdominal CT scan.  Both came back normal.  He is unsure what to make of the results and suggested that it could be a sensitivity left over from the surgery (I don't quite buy it since the pain is the same as before the surgery).

I have noticed a couple of other signs/symptoms when attacks occur. I've started having severe pain in my kidney area (on the left side) about an hour after an attack starts.  Sometimes the pain is a bit lower closer to the top of my buttock.  During the attack the left testicle is elevated and/or it being continuously drawn up and released.  It's sort of like the cremasteric reflex is slowly spasming.  The pain is quite sharp.

I also seem to have smaller episodes of pain with similiar symptoms except the pain is less and there's no back pain.  I've found that taking 600mg of Advil every 4 hours helps control the pain in these case.  The time between major episodes has been anywhere from 1 week to a couple of months.  I'm not sure if the pain would get more severe in the smaller episodes if I wasn't to take the Advil.  The smaller episodes a fairly frequent,usually a couple times a week.

I'm not sure what to do now since the third urologist has thrown in the towel and essentially told me to deal with it.  I don't like the fact that I'm taking so much Advil and that I'm still having painful episodes.  I'm interest to any insight you could provide.

Thank you,

James

[Kevin Pho, MD]

You have clearly had a comprehensive evaluation including referrals to three urologists, surgery, and multiple CT scans and ultrasounds.  Many of the more common causes would have been seen with these tests.

I would assume that things like infections and prostatitis have been appropriately evaluated for.  A transrectal ultrasound of the prostate can be considered to evaluate for any abscesses.

If everything is negative, you may want to inquire about things outside of urology.  This can include a neurology referral to evaluate for any nerve disorders or damage.  Electrodiagnostic testing can be done as part of the evaluation.

If negative, then a referral to a pain management specialist can be considered to help alleviate the symptoms.  

These options can be discussed with your personal physician.

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.
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