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Urology/Testicular aching / Next Steps


Hello Dr. Leslie,
I am a male 48 years of age who has been experiencing right testicular aching, chronically, (4th episode) over the past year. The top of the testicle is also tender to the touch, and uncomfortable when contacted during walking or sitting not just right. The current episode has been going on for 10 weeks now, where I made an appointment to see the urologist. While waiting for the appointment I have applied ice packs and taken over the counter anti-inflammatories to no avail. Upon examination, I was diagnosed with orchitis / epidydemitis and bactrium was prescribed as well as an ultrasound schedule. I noted to my urologist that I have always had small traces of blood in my urine (not detectable with the eye). The ultrasound identified a difference of size between testicles, the right being smaller and elevated higher than the left. The right testicle has an area of relative hypoechogenicity. No bloodflow was demonstrated within this area. The rest of the testicle is slightly heterogeneous relative to the left testicle.Given this, consideration was given to chronic infarct.  Blood flow was demonstrated within the rest of the testicle. The epididymides appears normal and no fluid, hydrocele,seen. Note that I was once kicked in the groin when I was a teenager thou I did not seek any medical attention at the time but do remember it as it was like yesterday.The bactrium did not provide any relief and Celebrex was prescribed. A cystoscopy was performed and everything was normal. The Celebrex also did not provide any relief. What should be my next step in finding relief?


There is a difference between the testicle and the testis.  An epididymal cyst or spermatocele can appear as you've described in the testicle which includes the testis and all the surrounding structures.  If the testis shows a hypoechoic area with no blood flow that is causing chronic pain and has been unresponsive to other treatments, then consideration should be given to surgical removal.  Discuss this with your urologist.


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Stephen W. Leslie, MD


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


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.

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

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.

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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