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Spermatic cord/testicular pain

        In October of '96 I was diagnosed with physical examination as having epididymitis and received Floxin x 10 days, Dioxycyline an additional X 10 days, and Septra for another x 10 days. No results came from the medication and blood and urine test after the physical examination came up negative for any infections. It is now October of '98 and two Urologists later the only thing I get is a physical examintion in which it is always recognized that the spermatic cord on the right side is inflamed and there is always a spermatocele present ranging in size from 4-12mm and the epididymis is always inflamed and tender. I am dealing with military doctors and find their lack of concern or action to be disturbing. This condition is very uncomfortable to ocassionally very painful. The basic long term treatment I have received is take 800mg Motrin and a limited activity recommendation. After 1-1/2 years of job and personal/ family conflict I am wondering if there is something I might be able to ask the doctor to ring his bell and does this sound familiar to any other cases. Other symptoms are rectal pain with a normal prostate, ocassional lower back pain when the cord pain is hightened, and straight line type pain radiating from the testicle at about a 10-15 degree angle upward for 8-10 inches through the abdomen. If I run or ride a motorcycle or bicycle for 5 minutes or more it will stimulate me to 3-4 days of real pain rather than dull pain or an ache. No known trauma (i.e. lifting, groin kick) ocurred prior to these symptoms. I am a 34 year old male. About the only thing that brings relief is icing the area but doing that to excess for one condition would obviously lead to other problems in the testicular area so is only used as a last resort for treatment.Also had a CT of the pelvis done in which the right cord was determined as inflamed and the spermatocele was present on the right side. I have also been told I should just deal with the pain and find this to be a less than satifactory remedy (the doctor needs to try and tell my wife, son, and the US Army this remedy and find out how other people view an unresolved extended ailment).
Dear James,
Testicular or epididymal pain on one side could be due to a variety of problems, many which are not identified and go away on their own.  You have mentioned epididymitis and spermatocele which can cause the pain you describe, but sometimes less obvious problems such as a kidney stone in the lower ureter can cause lower back pain, groin pain, and a pain sensation that radiates down to the testicle.  This however is rare, and frequently associated with other problems such as blood in the urine, flank pain, etc. which you do not appear to have.  Sometimes a muscle spasm or pull may be the cause of such pain, but this usually resolves with Motrin or any other anti-inflammatory medication.  A hernia can also mimic symptoms similar to what you describe, however one would assume that you have been checked for this especially since your work-up appears to have been extensive.
I think the problem most likely relates to either the spermatocele which has been demonstrated on your physical examination and CT scan, or to the inflamed spermatic cord which has also been palpated as abnormal on physical examination and appearing inflamed on the CT scan.  At least, objective tests indicate something might be going on.  In general, any type of scrotal operation for pain such as epididymectomy (removal of the whole epididymis for unresolving pain), spermatocelectomy (removal of spermatocele), etc. may or may not resolve the pain.  In fact, we usually quote a rate of 40-50% chance of resolution to patients seeking an operation for relief of pain.  However, I recommend that you follow-up with a urologist you trust who would perform a thorough physical examination to rule out any other occult process that may be going on.  Wish you the best.
This information is provided for general medical education 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).
*Keyword: Testicular pain, Epididymitis

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