Ultrasound Done But CONFUSED!!

[john98]

Hi,

I have some pain for 2 months now in my left testicle and sometimes spreads to my left ab area and upper thigh. The left testicle is sensitive to touch at times and the pain comes and goes. I have taken 500 mg cipro antibotics twice now and the pain still comes back. I'm sexually active with one partner only and sometimes when i ejaculate my left testicle feels uncomfortable afterwards. The only thing i can remember that my have to do with this condition is one day i ejaculated for the second time in the shower but the sensation was different when i climaxed and clear urine like fluid was ejaculated.  I went for an ultrasound  a week later when the pain started and the study showed the following:

[The ultrasound shows normal right and left testicles. There is flow to both testicular regions. A trace of fluid is seen around the left testicle but this is probably within normal limits. The epididymis is slightly different appearing on both sides with the left being slightly inhomogenous compared to the right. Whether this is significant is questionable.]

I am confused about this study and clearly something is wrong with my testicle because i am feeling discomfort and the pain becomes very annoying and is starting to effect my lifestyle in a negative way... please help with any information on what to do about this condition.
Thank You.

[Dr Smitha Mathews]

Hi,

If the ultrasound revealed that there is no inhomogenicity, it would indicate that the infection has been settling down and that the inflammation has subsided. A hydrocele usually appears due to trauma, irritation, etc.

Hydroceles that appear in conjunction with an inflammatory reaction resolve by themselves over a period of several weeks. As it is just a collection of fluid, there is really no urgent cause for surgical intervention to correct the hydrocele.

The type and color of the vaginal discharge indicates the type of infection that is causing the vaginitis. It would be better if she goes to the OB/GYN to be examined and treated with antibiotics based on what organisms are detected.

Pain in the testicle can be due to the local infection and inflammation or could be referred pain from the prostate if the infection had spread there.

Another possibility is that of an inguinal hernia, but that can be ruled out by your doctor on physical examination.
Avoid unprotected intercourse until both you and your partner are completely free of infection and there is no risk of passing it back and forth.

Sitting in a hot bath can help relieve the pain when the pain is intense or aggravated. Avoid sitting for prolonged durations and prostate irritants like caffeine and alcohol.

[john98]

Hi again,

Its been just over a month since i posted a question to you and i now have another. I recently had a second testicular ultrasound done because of my persistant left testicle pain. The results are as follows:

[There is normal symmetric blood flow on Doppler interrogation. The testicles are of homogeneous echotexture (note: the 1st ultrasound i had showed that the epididymis is slightly different appearing on both sides with the left being slightly inhomogenous compared to the right). The epididymides are unremarkable in appearance. There is a small left hydrocele.]

Out of a 10 scale, i have pain in left testicle constantly at 2.. sometimes it gets worse like 8 out 10..  How can i treat the hydrocele? is it a serious condition? Also is a hydrocele contagious? because i have had unprotected sex with my wife and she recently has been having discharge and pain with her vagina while having sex. She complains about the discharge and pain so is it possible that i passed my condition to her?

Thank You,

[Dr Smitha Mathews]

Hi,

Urinating before and soon after ejaculation prevents a urinary tract infection.

The prostate gland secretes the fluid in which the sperm produced in the testes survive. This combination of sperm and fluid is called semen.
If there is too frequent ejaculation, beyond the capacity of the prostate to produce semen, there is irritation and inflammation of the gland. If there is too infrequent ejaculation, there is build up of fluid in the gland which can cause irritaion and predispose to infection.

One testicle is always lower than the other as this is part of normal anatomical development.

Pain during ejaculation or urination, increased frequency of urination, pain in the penis or perineal region radiating to the penis are all signs of prostate infection.

You mentioned that you have pain in the testes, so it is possible that you have epididymitis or epididymo-orchitis.

The resolution of any inflammation of the testes and epididymis progresses along a longer course - about 4-8 weeks.

Regards

[john98]

Hi,

Thanks for the response. I wanted to know how ejaculating 3-4 times a week will help my condition? Also, a friend told me that urinating soon before or after ejaculation can cause infections and problems with the testicles.. is this true? He said you must wait some time to urinate after ejaculating.. or don't ejaculate if you urinated within the last hour..Should there be any precaution with urinating and ejaculation?

Furthermore, is there any way i can tell if the prostate has inflammation? both testicles of mine look normal in size except i recently noticed that the right testicle hangs lower than the left (left side has the pain though)

Thank You for all your help!

[Dr Smitha Mathews]

Hi,

Thanks for the additional details.

If you have completed a full course of the ciprofloxacin (500 mg twice daily for 5 days) both times and symptoms subsided during treatment, it is possible that the organism is sensitive to antibiotics, but was not completely eradicated by the treatment.

So it may have required a longer course of antibiotic therapy or been only partially sensitive to the antibiotic.

Sometimes, a reflux of semen during ejaculation can flow back and cause an inflammation or infection of the prostate.

Frequent urination and urge when you have already voided is a sign of an infection along the urinary tract.

Urinalysis negative for organisms is not conclusive in infections of the prostate. So you would need to have a repeat urinalysis done.
You should also have a prostate exam done to rule out any inflammation of the prostate. Additionally, you may also be required to have a prostate massage test if the prostate is enlarged. This is done to identify the presence of any infective organisms.

An infection of the epididymis could also be persisting and the radiation of pain to the upper thigh and lower abdomen could be due to this.

In the interim,

Keep intake of fluid levels high.
Consume foods rich in vitamin C (citrus and cranberry juices).
Sit in a hot bath (even though relief is transient, blood flow increases and aids healing).
Avoid caffeine, alcohol, and spicy food.
Ejaculate about 3-4 times a week.

Do keep us posted on your progress.
Regards

[john98]

Hi,

Thanks for your help.

Another test i have done was a CT scan of abdomen and pelvis. The results were as follows: [CT was carried out from the domes of the diaphragm down to the pelvis without contrast material.  Clinical history indicates left sided pain. The spleen is normal. There is no evidence of hydronephrosis. The ureters are normal. No calculi are visualized. The bowel gas pattern is unremarkable. There is a amount of stool throughout the colon.]

I have had a urinalysis and the results were negative, PH was 6.0 and specific gravity was 1.018. The culture report was reported: No growth.

In May 2008 i began taking 500 cipro and an anti inflammitory called Napro.. not sure what exactly it was called. I took those 2 medicines and felt better but once off them the pain and discomfort came back. I started Cipro 500 mg again in June 2008 and yet again the pain started 2-3 days after done the medication.

I went to a walk in clinic as well and she felt around my penis (abdominal area) and made me cough to check if i had hernia. She didn't mention that i had a hernia so i think that area is fine..

I have been getting pain around the left testicle and sometimes is sensitive to touch (tender). The pain almost feels like it is travelling and sometimes the head of the penis and shaft are uncomfortable after urinating. The pain and discomfort are intermittent mainly around the left testicle. I have tried sitting in the bath with hot water and it did soothe my discomfort but after awhile the feeling comes back. After ejaculating there is discomfort as well. Other earlier symptoms i had were:

Getting the feeling the you have to urinate but can't
Frequent urination
Pain left testicle, sometimes right side and shaft
Pain spread to upper left thigh and left abdominal area
After urination very sensitive and discomfort of the left testicle

Should i take any other antibotics.. maybe stronger and longer period of time? What exactly should i do to get rid of the inflammation of the epidydimis and what may have caused it? Anything else i should avoid? Any information will be helpful.

Thank You for everything.. You have been such a great source of information already

God Bless You.

[Dr Smitha Mathews]

Hi,

It is possible that the symptoms you have described could be due to an inflammation of the epidydimis (epidydimitis).

An inhomogeneous echogenicity can be observed in the examination of an acutely inflamed epidydimis.

Could you please detail the tests you underwent before being put on ciprofloxacin and the results of the same?

Have you had a urinalysis?

The fluid collection could be normal or could be due to a hydrocele, but this is not a serious condition.

Try sitting in a hot bath for 10-15 minutes every day and evaluate the relief availed.
An inflammtion of the epidydimis can settle by itself if it is abacterial or will respond to antibiotics if it is caused by an infection.

Meanwhile, practice safe sex (condoms).
Drink plenty of fluids (in excess of 2000 ml)
Wear supportive underwear.
Avoid strenuousphysical exertion.

And have a hernia ruled out.

Do keep us posted on your doubts and progress.
Regards