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Urology/Nerve entrapment


Hello, my name is Jonathan, I'm 22 years old. Sorry for the quality of my english I'm French. I have a huge health problem... My life is a real nightmare I can't live like that anymore...
Three years ago I had my left testicle that was going up then blocked more and more often during sex barely after erection and it was  hurtful. I needed to put it down manually every time several times.. I talked with an urologist he told me he could remove the cremaster muscle. I did the surgery on the 13th December 2010. Since that all the system is going wrong and the testicle still goes up which is very painful. My global problems are premature ejaculation (in few seconds, I can't have anymore social relation...), hypospermia, no more power/distance, no more refractory period ( can do it 5 times in a row and come fast as the same, before couldn't even come after the second time in a row)), inflammation in the urethra, left side of the shaft hypersensitive painful and flacid during erection,( basically the blood flow goes well in the right side but not in the left side) intern muscle of the left buttock amorphous,painful scar sometimes burning scar, difficulties to control when I want to urinate, painful testicle, pain, burn, electricity shock, paralysia, etc..  The  symptoms are going worse and extending with the time passing. At the beginning it was only on the left zone of the pelvic zone including the penis. Now it takes all the pelvic zone, left buttock, and stomach. If I push anywhere on the stomach I want to throw up. I can't drink anymore alcohol, sodas or eat different kind food without feeling nauseaus even trhowing up. I feel pain coming from the inguinal canal going up to the stomach. I have difficulties to contract the muscle of the perinea, when I do it makes worse the other symptoms.. All the system of the body starts to go wrong. Now I start to have problems to breath when I lay down...Of Course I never had any of these symptoms before the surgery. I've seen about 40 experts in different countries they don't know what to do. The specialists told me there is probably  a kind of " defense reaction" that appaeared, kind of algodystrophia degenrative, a dysfunctionality of the system.I took every kind of exam possible there is nothing except on the  MR thats shows " inflammed pelvic zone" but no specific details. I also tried every kind of treatement no improvement, except with the injection of corticosteroids it was better during one hour, then after it was much worse during one week...  The more the days are passing and the more it's getting violent and the number of symptoms increases...
Finally I Just took A Neurography exam and had the results ,  Branchs of illioingual and genitmoral nerves have been blocked by the surgeon,maybe other nerves too. Unfortunately, it's too complicated to determine where exactly. I heard about endomicroscopy that could help to see exacty. What kind of surgery would be the best for nerve entrapment? I heard cutting the tissue around was not really effective. I heard sometimes surgeons put a very small balloon around the nerve. Do you also the world leader specialists of  this kind of surgery.

Thank you very much for your help.


Jonathan, as you might imagine, your problem is much too complicated to answer in this type of forum.  Therefore, it is not possible for me to make an exact diagnosis or give recommendations over the internet because of the inability to take a more complete history and do a physical examination.  However, I shall try to help you with some of your difficulty.

The testicular problem you started with sounds typical of intermittent torsion of the testicles. For this, we generally recommend a simple procedure called orchidopexy which is a simple tacking down of the testicle to the inner scrotal wall with a fees sutures to limit it's movement and ability to twist.   The testicles are suspended by a rope-like structure called the spermatic cord.  This cord is composed of a number of parts including the vas deferens,  arteries, veins, nerves, lymphatics (tissue vessels) and connective tissue.  Surrounding the testicles is a membrane called the tunica vaginalis. The testicles are further anchored to the inner scrotum by a band of tissue called the gubernaculum. The testicles in the fetus are actually formed just below the kidneys in a space called the retroperitoneum.  Just before birth, they begin their descent into the scrotum.  In the lower abdominal area, they force a hole in the abdominal muscles and drag some muscles fibers along the cord.  This is called the cremaster muscle which allows one to pull the testes upward by contracting the abdominal muscles.

There is great variation in these attachments and some testicles are more prone to change position than others.  As long as there is no associated pain or swelling, there is no cause for concern.  However, abnormalities of any of these structures may predispose to a condition called torsion where the spermatic cord can twist on itself causing the testicle inside the tunica vaginalis to twist also.  This results in diminishing the testicle's blood supply to varying degrees.  Usually the testicle on the affected side is drawn up toward the groin due to foreshortening of the cord.  The torsion may be partial or complete. Partial torsion testicle (as I believe you had) causes variable pain and swelling and often spontaneously corrects itself by detorsion.    If complete, the pain and swelling are quite impressive.  If prompt correction is not performed within a few hours (either manually or surgically), the testicle can be destroyed due to lack of blood supply.  If there is suspicion of either type of torsion, one should be seen by a urologist ASAP (today).   The diagnosis is made by clinical evaluation and confirmed by doing a radioactive scan of the testicles.  If an attempt at manual detorsion fails, prompt surgical detorsion and bilateral orchidopexy is performed.  This is a minor outpatient operation that involves small incisions in each side of the scrotum, untwisting the spermatic cord and tacking the testicles to the inner wall of the scrotum with sutures to prevent a future torsion.  The orchidopexy is done bilaterally as the propensity for torsion on the asymptomatic side is increased in such individuals.   Sometimes the torsion is intermittent and self-correcting.  The urologist may detect abnormal mobility of the testicles on examination but not always.  If there is a question of the diagnosis, often the safest practice is to perform a prophylactic bilateral orchidopexy.  

As far as damage to the nerves in the groin are concerned, the simplest thing to try would be a nerve block with a combination of a "caine" and steroid (such as lidocaine and prednisone).  The "caine" temporarily relieves the pain and the steroid helps to reduce inflammation in the nerve and thus, lessens the discomfort.  Sometimes, several injection are required.  I have no personal expertise beyond this in treating this problem.  Furthermore, I do not know of any specialists in this type of problem.  A neurologist or neurosurgeon would most likely have the expertise you want if the above does not work.  Good luck.


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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