Archive for the ‘torsion of testis’ Category

When You Have A Tack In Your Sack-Chronic Testicular Pain

June 15, 2012
When It Hurts Down There

Chronic Testicular Pain

Chronic testicular pain is a common malady causing havoc in men with this problem. The pain can be so debilitating that men lose productivity in the work place, have sexual problems and even depression that requires treatment. Men often have anxiety about cancer. Chronic testicular pain is also called orchialgia, orchidynia, chronic pelvic pain syndrome, or chronic scrotal pain syndrome. These are all terms used to describe intermittent or constant testicular pain.

Chronic testicular pain occurs at any age but the majority of the patients are in their mid to late thirties. The pain can involve one or both testicles. The pain can remain localized in the scrotum or radiate to the groin, perineum, back or legs. On clinical examination the testis may be tender but in the majority of men is otherwise unremarkable.

Causes of orchialgia include infection, tumor, testicular torsion, varicocele, hydrocele, spermatocele, trauma and previous surgical procedures such as a vasectomy.

Any organ that shares the same nerve pathway with the scrotal contents can present with pain in this region. Pain arising in the kidney, hip, prostate gland or back pain caused by a herniated disc can present as testicular pain. Injury to nerves following a hernia repair can cause chronic testicular pain. Chronic testicular pain has been recognized as a feature of diabetic. Some men attribute the start of their chronic testicular pain to some form of blunt injury to the testicles. Unfortunately in a large proportion of patients the cause of their pain remains unknown.

Post vasectomy chronic pain syndrome
It is not common but there is a possibility that following a vasectomy an obstruction or congestion of the vas or in the epididymis may be the cause of the pain.
If the man has an injection of local anesthetic, such as xylocaine, prior to cutting the vas, this may reduce both immediate and long term post vasectomy pain.

The formation of spermatic granuloma following a vasectomy has been well documented but its protective or causative role as been controversial.

Testing
Scrotal ultrasonography is usually part of the evaluation of patients with scrotal pain. However, in the absence of significant clinical findings during physical examination and in the presence of negative urinalysis, the only real benefit of scrotal ultrasound is reassurance to the patient worried about cancer

Treatment
Surgery is to be avoided if possible. Even if infection has not been identified a small number of patients may respond to a combination of antibiotics and non-steroidal anti-inflammatory drugs. Tricyclic antidepressants, such as imipramine, sometimes relieve the pain. Those with intractable symptoms may benefit from a multidisciplinary team approach involving a urologist and a pain clinic specialist including a psychologist. Transcutaneous electrical stimulation or TENS analgesia often have favorable results. This works on the principle that transcutaneous electrical stimulation causes release of endorphins in the nerves of the spinal cord that supply the scrotum.

A spermatic cord block with a local anesthetic such as xylocaine can be done in the doctor’s office. The procedure, if successful, can be repeated in regular intervals.

For patients who fail to respond to conservative management and wish to avoid the surgical options that are available in treating chronic orchialgia, a trial with an alpha blocker might be an option.

For patients in whom all medical treatments have failed and testicular pain continues to impair their quality of life, surgical intervention may be indicated as a last resort. A number of surgical strategies have been described.

Microsurgical denervation of the spermatic cord may provide relief of chronic testicular pain. Another technique is to divide the ilioinguinal nerve and its branches.

Removal of the epididmymis or epididymectomy should be performed only if the patient had been counselled regarding the likelihood of poor results.

Vasectomy reversal
Putting the vas back together or a vas reversal has helped a number of men with chronic testicular pain.

Unfortunately a small number of patients who fail to respond to medical or more invasive treatment will ultimately undergo removal of the entire testicle for pain relief. This procedure must be the last resort.

Bottom Line:
Chronic testicular pain remains a challenge to doctor as well as the patient.
Help is usually available with medication, nerve stimulation with TENS, and only surgery as a last resort.

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When It Really Hurts Down There-Epididymitis

June 3, 2012

When men experience a painful testicle, it can be frightening and a source of not only pain but anxiety as most men associate the testicles with pleasure and reproduction. This article will discuss a common cause of pain in the scrotum and what treatment options are available.
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Epididymitis is most common in men between the ages of 14 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed.
Epididymitis symptoms include: Testicle pain and tenderness, usually on one side, painful urination, painful intercourse or ejaculation, chills and fever, a lump on the testicle, discharge from the penis especially if the cause is from a STD, and discoloration of the semen.

Location of the epididymis

Location of Epididymis On Top and Behind the Testicle

Causes
Epididymitis has a number of causes, including: STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection. Epididymitis may be caused by urine going backward into the epididymis. This is called chemical epididymitis and may occur with heavy lifting or straining.

Diagnosis
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include: STD testing. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging is a noninvasive test, which uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain.
A nuclear scan of the testicles is also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Treatment
Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. If you have significant pain, you will probably receive an anti-inflammatory medication. Your sexual partner will also need treatment.
When you’ve finished your medication, it’s a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn’t, your doctor may try another antibiotic. If the infection still doesn’t clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STD.

To ease your symptoms, try these suggestions: Bed rest-depending on the severity of your discomfort, you may want to stay in bed one or two days. Mild relief will occur if you place a folded towel under your scrotum. Wear an athletic supporter or jockey underwear. A supporter provides better support than boxers do for the scrotum. Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes. Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Bottom Line: Epididymitis is a common cause of scrotal pain. Epididymitis is usually a result of an infection and can be successfully treated with antibiotics. See your doctor whenever you have scrotal pain or you find a lump or bump in your scrotum.