painful testacle

[don]

About a month ago I began to notice a tenderness in my right testacle mostly when I sat or squated down causing my pants to pull up tight against them.Upon examining them I found a slightly swollen area on the bottom of the right one which was tender when pushed.I went to my GP and he gave me Doxycycline 100mg twice daily for 10 days for what he said might be epiditimus.This did no good so I went back and he recommended me to a urologist,which I haven't seen yet.The swollen area seems to be the same but I sometimes have a dull ache in the area just above the right testacle.I had a vasectomy 22 years ago and a piece of the vas was removed so I think this eliminates a prostate infection going through to the epiditus also I thought the epiditus was on the top & sides of the testacle not the bottom.I will be going to the urologist in a few weeks but in the meantime this bothers me more mentally than physically thinking about possible testacle cancer.Any thoughts on this?

[HFHS M.D.-BL]

Dear Don,


Epididymitis (an inflammation of the epididymis and often the testicle) is not always accompanied by a urinary tract infection, but it can sometimes require months of antibiotics and anti-inflammatory drugs to control the pain.  It is difficult to give advice without actually examining you myself, but many men who suffer from epididymitis complain of very similar symptoms.  Due to the many different pathologies that can cause scrotal pain and a mass, your physician has referred you to a urologist for an expert opinion.


Unfortunately, due to their similar presentation such as scrotal swelling and sensation of fullness, testicular cancer is often first diagnosed as epididymitis.  Your history of having undergone a vasectomy in the past also means that a sperm granuloma could be causing your symptoms.  Sperm granulomas form when sperm leak from the testicular end of the vas.  Sperm granulomas are rarely symptomatic, but in a few individuals may result in a painful lump.  Depending on what your urologist finds on his history and physical exam, he may suggest a scrotal ultrasound to help better delineate the nature of your problem.   Close follow-up is critical, and any mass that is still present after a prolonged course of antibiotics should raise suspicion.  Very sensitive serum markers such as human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) are used to help detect testicular cancer.  Despite all of our recent technical advances,  the treatment of an often baffling disease like epididymitis still requires a great deal of clinical judgment.


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.-BL

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