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Urology/question on testicle continued

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QUESTION: if the testicle has hardened due to scarring as you mentioned earlier, would this show up on the ultrasound?

also if i am suffering from some sort of infection would it show up?

what about non bacterial epididimitis would this show up?

what other tests can i request? I feel like im at a dead end.

and what medication can i safely try to see if it makes a difference?

Lastly, is it true that without medication, a testicular infection will never go away? doesnt the body have the ability to get rid of it?

thanks

ANSWER: Jim:

Scarring may not show up on ultrasound depending on the nature, thickness and density of the scar tissue.  Infections usually show up as asymmetrical vascularity.  Epididymitis typically shows up but may not if the infection healed up long ago leaving just the scar tissue.

There are really no tests to request; the best are a physical examination by a good urologist and an ultrasound.

There is no obvious medication to "try" since we don't have a real diagnosis yet.

It is NOT true that without medication a testicular infection will never go away.  The body has lots of ways of dealing with infections, mostly inflammation which increases pain and swelling.

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

QUESTION: I actually feel some unpleasant feelings down the inner thigh too on both sides. It goes 2 to 3 inches down from the joint.

if its referred pain, is it referred pain to the thigh from the testicle? or referred pain from the thigh to the testicle?
is there any way to know which way round it is?

also what can you tell me about the involvement of the thighs? are there nerves which are shared between inner thigh and scrotum?

If it is a nerve condition, is it permanent?

thanks

ANSWER: Jim:

Pain fibers from the testicle do not run into the thigh as there are no shared nerves.

It is impossible to determine from the available information if the condition if permanent or not.

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

QUESTION: If it is a hernia which is causing the pain is it the case that lying down will relieve the pain? and if it doesnt, can I discount the possibility of a hernia?

you say there are no shared nerves. What about the ilioinguinal nerve and Genitofemoral nerve? do they not serve both the genital area and thighs?

if it is a nerve entrapment or something similar why doesnt massaging the lower back give me any relief? how would it be reversed without surgery?

Answer
Jim:

If a hernia is causing the pain, then lying down may or may not relieve it. If it doesn't, you cannot discount the possibility of a hernia.

The genitofemoral nerve supplies sensation to the anterior scrotal skin, not the testicle.  Likewise, the ilioinguinal nerve also supplies some sensation to the anterior scrotum but not the testicle.  Posterior scrotal sensation is from the pudendal nerve.

The actual sensory nerves to the testicle comes from the same area as the kidney which is where the testicle originated prior to birth which is why testicular pain travels upwards and not to the thighs.

I don't understand why you would think that massaging the back would help a testicular problem.

If there were nerve entrapement or a similar problem, it would be difficult to treat without surgery.  An anesthetic block of the spermatic cord can be tried, but is unlikely to be a permanent solution.

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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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