I'm a 60 year old with a long history of abacterial prostatitis. I've had cystoscopy in the past and was advised by the urologist to expect repeated flare-ups. I have also studied quite closely your macros about the subject. I am very familiar with the symptoms, which come and go - often based on stress levels. This time, however, about three weeks after I did some sustained heavy lifting, I experienced strong discomfort in my right testicle. Is it unusual that I would have testicle pain now, after so many years of prostatitis - and not having that symptom before? I was palpitated on two occasions by a very experienced family doctor, who felt no hernia and diagnosed me with epidymo-orchitis. I did a month of doxycycline (to no avail) and a month of Cipro. I am now about 90 -95% better, but still have some lingering testicle discomfort along with the typical prostatitis symptoms. On occasion (once or twice a day) I also feel a little lower ab pain - although mild and apparently in the muscle layer. So, is it likely that the abacterial prostatitis was triggered by the lifting, and that's why there is testicle involvement? It bothers me more when I am tired or after a hot tub visit when my testicles hang low. I use ice packs at that time to firm things up, and it helps. Thanks for the info. I value your expertise, and would appreciate what you think I might expect.
Sam, as you might imagine, for this type of problem it is not possible for me to make an exact diagnosis over the internet because of the inability to do a physical examination. However, I shall try to help you.
First, one has to determine if the testicles are anatomically normal or not. If they are NORMAL, there are several causes for discomfort. Let me give you some background information to make this easier for you to understand. The testicles in the fetus are formed high up just below the kidneys and under the diaphragm in a space called the retroperitoneum. Just before birth, they begin to descend toward the scrotum. In order to reach this site, they must actually force a whole in the lower abdominal muscles. The spermatic cord supports the testicle(s) and contains the vas deferens, arteries, veins and nerves necessary for their function. Remnants of the abdominal muscles actually wrap around the cord as a permanent envelopment called the cremaster muscles. When one contracts the abdominal muscles, they simultaneously contract the cremaster muscles. The cremasters can be injured by strenuous physical activity. The pain is often transmitted to the testicles, exacerbated by activity and lessened by resting. Rest, heat, elevation, anti-inflammatory drugs and avoiding the activity leading to excessive strain are the treatment. In your case, I suspect this is the cause of your discomfort. Hernias and referred pain to the testicle from other problems such as kidney stones, colitis and prostatitis have to be considered. Of these, inflammation of the prostate gland (prostatitis) is by far the most common. Even if you have never experienced testicular aching when your prostatitis has flared in the past, this remains a possibility. However, again the most likely etiology of your particilar discomfort in this case is cremaster muscle strain.
If the testicle is anatomically ABNORMAL, the most common cause is epididymitis. The epididymis is the tubular structure located behind the testicle that drains sperm from the testis to the vas deferens and eventually out the ejaculatory ducts. Inflammation or infection of the prostate gland (prostatitis) often will spread down the vas and into the epididymis causing inflammation in this area (epididymitis). This is the most common cause of epididymitis although it may also occur without prostatitis. Typical signs of epididymitis are swelling of the scrotal skin with loss of the normal skin folds (rugae), redness of the skin, enlargement of the epididymis and testicle, and local tenderness and pain that is eased by elevation of the testicle. Epididymitis is treated with antibiotics, warm baths, scrotal supporter and mild pain relievers. Probably the best antibiotics to use are from the fluoroquinolone group, such as Cipro and Levaquin. Usually the pain is gone in a few days but the swelling may persist for several weeks. Treatment should be instituted by a urologist after a proper and prompt evaluation. The urologist should follow the patient until the inflammation has totally resolved and the testicle has returned to normal. The reason for this is that occasionally, a tumor of the testicle may present clinically as epididymitis. In this case, the inflammation and swelling initially obscure the true diagnosis. A lack of response to treatment may be due to bacterial resistant to the antibiotic being used, the formation of a testicular abscess (which may be detected on ultrasound), or a misdiagnosis of torsion of the testicle.
Because of all the possibilities, evaluation by a urologist, as you have done, is strongly recommended. Good luck.