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Urology/unusual testicular lie

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QUESTION: There are a number of symptoms which do not seem to be consistent with any particular diagnosis.
I know you mentioned that its normal for both testicles to hang differently but I keep thinking that the right one is hanging at an unusual angle. I cant remember exactly how it was before this all happened but it just doesnt look right.Its sort of horizontal now instead of vertical and doesnt hang as low.

Torsion is generally a very painful condition which you are in no doubt about whether you have it. In my case the pain is not severe its not even mild. I would say its just annoying. Plus the ultrasound i had recently never indicated any sign of this. It was normal. and you say the spermatic cord can not be shortened, so then either it just looks abnormal because ive been checking it constantly due to the pain or there is some other explanation. What could it be?

i have also discovered that the pain is actually coming from the right head of the epididimis. I am therefore self diagnosing it as a chronic epididimitis.

would you agree with this?

This would be consistent with the ultrasound coming back normal. It would also explain why its persisting for so long. But isnt epididmitis supposed to be a very painful condition? This doesnt correlate with the level of pain i have,

It would also mean that nothing can be done. Can you confirm its a medical condition which urologists do not know much about or know how to fix?

ANSWER: Jim:

Nope.  You didn't have a history of a prior infection so a chronic epididymitis is less likely than a small spermatocele.  Consult a urologist to help you figure it out.

I wouldn't go so far as to say that chronic epididymitis is something urologists don't know much about, but treatment is problematic and symptomatic as there is no specific cure.  In some cases, removal of the epididymis surgical is required but we don't even have a diagnosis on you yet so don't get too far ahead!

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QUESTION: I know i didnt have an infection but i have read that sterile urine can be refluxed and cause an 'infection' and lead to chronic epididimitis. That is what i am suspecting. What do you think about that?

Also its not only the right side which is affected. The left feels mostly normal but that side has also given me pain at times too. Therefore bilateral pain means we can rule out some of the possibilities. For example how common is bilateral torsion at the same time? it seems pretty rare. Similarly I would expect it to be rare to have a hernia on both sides at the same time.

i have looked into your suggestion of spermatocele and i think that could also be a possibility because i have noticed that there is a bit of a bulge on the right side at the top of the scrotum. can you suggest any simple self tests i can do at home to try to ascertain this?
do spermatoceles ever go away? or just get bigger?

thanks

ANSWER: Jim:

Reflux into the epididymis causing epididymitis would be exceedingly unlikely.  The connection is through the vas which is quite muscular and would not normally allow any refluxing fluid to reach the epididymis.

Simultaneous bilateral torsion is theoretically possible but even less likely than the reflux idea.  You would have better luck winning the lottery.

Simultaneous hernias are far more likely than bilateral torsions.

There is no test you can do at home to determine if there is a spermatocele.  Spermatoceles do not go away without surgery.  They tend to enlarge over time but at varying speeds.

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

QUESTION: Some doctors may say ejaculation frequency is a personal choice but from a medical standpoint is there such a thing as too little or too much? Medically what is the ideal frequency for a man in his late 20's?

I have considered the idea that infrequent or irregular ejaculation can cause the prostate and the whole reproductive system to get clogged up and bacteria can multiply. Also the various parts of the system begin to cease to function properly if ejaculation/sperm production doesn't occur at regular and frequent intervals. Is there any validity to this notion?

How does pain get referred upwards into the abdomen? sometimes I have felt pain from the testicle radiating up in to the lower abdomen.

Answer
Jim:

There is no official, universally accepted number, but 2-3 times per week is commonly found.

More frequent ejaculation may help but is not considered a risk factor for prostatitis.

There is no evidence that parts of the system cease functioning if ejaculation doesn occur at regular intervals.  There is anecdotal evidence that infrequent ejaculation can cause some discomfort.

Pain referred into the abdomen from the testicles would be expected as that is where the nerves run as the testicle began life near the kidneys and then descended.

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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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