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Should I find another urologist opinion about my chronic testicular pain?
I am a 21 year old male nurse practitioner student without any other significant medical histories and currently take zero medication. I had a sports-related scrotal/bilateral testicular injury in high school (5 years ago) that got better acutely but has now progressed into a chronic condition. Long story is below, short story is that my urologist finds a normal testicular exam and professionally thinks that my testicular ultrasound is normal despite the radiologist impressions of bilateral varicoceles, bilateral hydroceles, a trace left epididymitis, and a right 2mm cyst. His plan was to start me on a low dose of amitriptyline (an antidepressant) nightly. I instantly refused the medication as I am sure there is more of a physiological element at play than nervous/neurotransmitter-related. Should I get a second opinion, perhaps from a more trusted or higher rated urologist?
Pain characteristics range from dull and achy to sharp if the swelling and associated activities are demanding. The location of the pain depends on which testicle is inflamed. For instance, sometimes an activity might jerk or bump my left testicle and therefore the pain may be radiate from that centralized location that is then relieved by medicine or light icing. Additionally, I noticed pain along the lower abdomen running vertical, wondering if that has anything to do with a potential varicocele. The pain is relieved by over the counter NSAIDs and Tylenol but those are not a long-term solution obviously. Upon self-testicular examination, I find a 'worms-like' texture on my left testicle that becomes more apparent as my activity level increases.
I finally bit the bullet, as nurses are stubborn, and visited a Urologist. The first appointment consisted of a urine analysis (normal) and a testicular examination (normal). I was almost in shock that the Urologist determined my testicular examination was normal since I can definitely feel the 'worm-like' sack at all times. He pressed down arguably hard during the exam and caused decent scrotal pain for the next few days. He also ordered a testosterone level (normal) and a testicular ultrasound (abnormal but normal to him which is the reason biggest reason for this post). As stated above, the results are bilateral varicocele, bilateral hydrocele, trace left epididymitis, and right 2mm cyst.
He explained to me that the varicoceles are normal and that 15% of males have them. He denied significant importance of the trace left epididymitis, and the right 2mm cyst. He also didn't talk about the bilateral hydroceles either. In short, in his professional opinion, my testicular exam is normal, my testosterone is normal, my ultrasound is normal (despite the pathological indications) and let's try and antidepressant.
Pain characteristics range from dull and achy to sharp if the swelling and associated activities are demanding. The location of the pain depends on which testicle is inflamed. For instance, sometimes an activity might jerk or bump my left testicle and therefore the pain may be radiate from that centralized location that is then relieved by medicine or light icing. Additionally, I noticed pain along the lower abdomen running vertical, wondering if that has anything to do with a potential varicocele. The pain is relieved by over the counter NSAIDs and Tylenol but those are not a long-term solution obviously. Upon self-testicular examination, I find a 'worms-like' texture on my left testicle that becomes more apparent as my activity level increases.
I finally bit the bullet, as nurses are stubborn, and visited a Urologist. The first appointment consisted of a urine analysis (normal) and a testicular examination (normal). I was almost in shock that the Urologist determined my testicular examination was normal since I can definitely feel the 'worm-like' sack at all times. He pressed down arguably hard during the exam and caused decent scrotal pain for the next few days. He also ordered a testosterone level (normal) and a testicular ultrasound (abnormal but normal to him which is the reason biggest reason for this post). As stated above, the results are bilateral varicocele, bilateral hydrocele, trace left epididymitis, and right 2mm cyst.
He explained to me that the varicoceles are normal and that 15% of males have them. He denied significant importance of the trace left epididymitis, and the right 2mm cyst. He also didn't talk about the bilateral hydroceles either. In short, in his professional opinion, my testicular exam is normal, my testosterone is normal, my ultrasound is normal (despite the pathological indications) and let's try and antidepressant.
As a paramedic, my training tells me that it's time to get another opinion... If you can, try to find a urologist that deals with sexual problems as well because it could come to that and you will be seeing one guy that is familiar with the whole history. A a patient I can tell you that I had 6 or 7 BOTCHED penile procedures that took 47 years to correct... RUN, don't walk, to another doctor right now. You already know from your training (assuming you are a good way into it) that I am right. Now you owe me... I am curious to know what number 2 says. :)
amirsohel yes BUT, he had already been treated for trauma and at this point I think that he needs to rule out further trauma or complications as a result of trauma before he blows him off.
I'm of the mindset that if you aren't comfortable with your doctor, for any reason, you should find another. You are supposed to have a good partnership and that can't happen if you don't feel he's dismissive of your concerns.
Varicoceles are very common, but that doesn't mean it's "normal" to have them. Strep throat is common, but it's not "normal" to have it. Your conditions are causing you pain, therefore it's not "normal".
I understand why he wanted to try the amitriptyline - it's very commonly used for chronic pain. It's also very sedating, and for many, it's hard to take. Personally, I feel like it's often used as a "here, take this, and get out of my office". Obviously, not all docs do that, but a lot do.
So get your second opinion. Worst case scenario, your first doctor's opinion is confirmed, and you can go from there and make decisions, so you don't have anything to lose.
Varicoceles are very common, but that doesn't mean it's "normal" to have them. Strep throat is common, but it's not "normal" to have it. Your conditions are causing you pain, therefore it's not "normal".
I understand why he wanted to try the amitriptyline - it's very commonly used for chronic pain. It's also very sedating, and for many, it's hard to take. Personally, I feel like it's often used as a "here, take this, and get out of my office". Obviously, not all docs do that, but a lot do.
So get your second opinion. Worst case scenario, your first doctor's opinion is confirmed, and you can go from there and make decisions, so you don't have anything to lose.
The problem with that is, just treating pain doesn't deal with what is causing the pain. I take 4 amitriptyline every night... it doesn't do **** for me and I also take 900mg Gabapentin and 600 mg Codeine Contin. These meds do not treat my herniated discs... it barely helps with the pain. See another doctor.
2 Comments
Oh if I at all sounded like I was endorsing amitriptyline, I was not. I was just saying that I understood why the doctor prescribed it, because so many doctors use it for chronic pain. I've been on it twice myself and it didn't do anything except sedate me and leave me unable to function until about 2 pm the following day.
No auntiejessi, I didn't get the impression that you were endorsing Amitriptyline, I just wanted to share my experience with the drug and point out that I am taking double what he is and it still doesn't work worth a ****.
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