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Urology/cremaster related injury

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QUESTION: Dr, Leslie, I am a 60 yr old man. About 3 months ago I did an enormous amount of lifting over a period of about three weeks. I also experienced a great deal of stress in that time. I've suffered from prostatits on and off for many years. My symptoms began about three weeks after all the lifting. My right testicle became very uncomfortable, almost like it was being squeezed. It also is sensitive particularly in the back of the teste, but generally all over. My physician palpitated on two occasions, finding only the sensitivity. I did a month of doxycycline and a month of cipro. Symptoms are now about 80% better, but still aggravating and anxiety producing. Situation is better when cremasters are holding high, which I accomplish with ice at night because that's when they tend to drag and become more uncomfortable. Can you please tell me how long a cremaster injury could last? Also, if this is chemical, abacterial, etc. What miight the treatment be and how long couid the symptoms last. What can I expect at a urologist visit? Thanks very much.

ANSWER: Lewis:

I am far from certain that you have a cremasteric injury.  A hernia, reflux or chemical prostatitis, or epididymitis are far more likely.  Assuming that it is not a hernia, continuing antibiotics along with ibuprofen regularly may help.  If things are not improving, you may want to check with a urologist.  You can expect another examination but with a higher level of expertise.  In many cases where the cause is not obvious, we often recommend ultrasound examinations of the testicle.

---------- FOLLOW-UP ----------

QUESTION: Dr. Leslie, thank you for the information. My symptoms have continued to improve, but at a slow pace...as they have all along for about 3 months now. I have no more aching, just sensitivity - particularly when tired or after being in a hot tub. When uncomfortable, I use ice to firm things up and that helps. It also feels better when I am laying down, as compared to walking around or crouching when the cloth of my pants rubs against it. I have a few additional questions, please. First, although I have a long history of abacterial prostatitis, this is the first time there has been testicle involvement. Is that a possibility because of the lifting I did? I was checked for hernia by my physician with negative results, and also I was under the impression that a hernia would not improve spontaneously, yet I have improved 90%. So, if this is in fact a reflex or chemical prostatitis, what would the treatment be - and how long might I expect these symptoms to last? Finally, how much time should I allow before following up with a urologist? Please keep in mind that I suffer from medical-based anxiety and would like to avoid further investigation unless you feel the situation is absolutely imperative.

Answer
Lewis:

I am still far from convinced that it is not a hernia.  A visit with a general surgeon would be definitive.  For example, you benefit from lying down which is typical for a hernia.

Hernias can certainly improve spontaneously.

Treatment for prostatitis includes antibiotics, anti-inflammatories, dietary modifications and similar means.  Symptoms can last for weeks to months and sometimes even longer.

You need to overcome your medical based anxiety so you can take advantage of good medical advice.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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