Urology/pain

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Question
QUESTION: The question is, how do I know whether the pain in my testicle is not an indication of an inflammation or some other damage which is ongoing? how can I be sure whether the only thing I have is pain or whether there is more going on?

and could the pain get worse? Presumably your answer to that will also be yes. Why is the outcome always so perversely not in my favor?

ANSWER: Jim:

It is unlikely that continuing inflammation will be ongoing for month after month.  The best we can do is use the best available tools such as physical examination, MRI or CT scans, ultrasound, etc. as well as clinical trials such as a spermatic cord block.  At the end of the day, if no specific etiology can be found, the best we can offer is pain management, live with it, or consider surgery.  If all the available tests have been done and are negative, at least you can be reasonably sure there isn't "more going on".

Could the pain get worse?  Of course.  Why are the answers not in your favor?  I assume that was rhetorical.

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QUESTION: I remember you saying to me some time in the past that inflammation leads to scarring and hardening and so on.  or that there could be a cycle of healing and scarring, So even if it isnt continuous could it be cyclic in my case?
But there are various structures within and around the testicle. So any of these could be damaged. Can ultrasound always pick these up?

Why would there be some cases where men do suffer scarring and damage as well as pain and other cases where there is no scarring or damage but only pain?

and how does having this pain affect my libido or sex life? i have noticed a loss of libido but obviously there is no way for me to know if its directly as a result of what is happening or just psychological. Both are valid possibilities.

ANSWER: Jim:

The healing and development of scar tissue is relatively constant and typically not episodic.  Not all scarring and damage to the tissues can be identified by examination or imaging leaving only pain.

Remaining pain may or may not affect your sex life and libido.  There is no direct cause and effect relationship other than psychological.

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QUESTION: this is not really making sense to me. How can there be any inflammation or damage without infection anyway? This is the mystery which urologists do not understand well. This whole thing is a mystery. I woke up one day with a feeling of discomfort which has persisted now and not gone away. There is no injury or incident which is linked to these symptoms. And there is nothing found in an ultrasound either.

It seems to me that nothing is actually known about the pathophysiology of testicular pain in some cases. am I correct in saying this? we dont have the tools or knowledge to investigate just what is going on. The testicles and other surrounding areas could be a far more intricate structure than the current understanding of it.

This is the key question you seem to be avoiding. Its not a question of you not being able to examine me that is not allowing you to provide more information, Its simply that you dont know the answers. What I am dealing with here in my view, is a common and very poorly understood illness.

and quite frankly the options available to us are very unsatisfactory.

Its like if your car has broken down. It turns out something has gone wrong in the engine. But because its too much trouble to investigate exactly what has gone wrong you simply take the whole engine out.

This is the same approach with the testicles. Because you do not understand what is going on in the testis you simply remove them. Except in this case you cannot do a transplant.

Answer
Jim:

To some degree, I agree with you.  Chronic orchalgia is not well understood.  The available tools we have do not always indicate the source of the pain.  

I don't agree with your analogy of the car that has broken down.  It's more like the tire that keeps going flat.  You keep taking it back to the mechanic who checks the valve and tries to find the leak by filling and placing the tire underwater, but if these things don't work it's often better to just get a new tire.

At this point I have to admit we don't always know the source of the pain in many of these cases, but we still have to deal with them and I've indicate the current standard of care.  SInce there is no money for additional research in this area, it is unlikely anything new will be discovered in the near future.

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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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