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Urology/problem on testicles related to epididymal

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QUESTION: --
hello doctors
I m suffering from wekness of motiltiy and morphology of sperms for a long time , many years , for 3 days ago my doctors observed that my right testicles is too large swelled and dropped down , her asked me if I feel a pain , I tell hime yes for long time

he sus[ect thats it varcolcile or hydrocele but her required to make ultrasonic for both testis , I did it for 2 days ago , the results was as the following :

1- normal size , volume and echogentitcy of both testes with no focal lesion detected

2- normal intra-testicular vasculature seen bilaterlally

3- normal size and echologentically of left epididymal head

4- no right varcocile

5- no evidence of hydrocele

but

1- the largest vein mesasuring 3mm in diamter on valsalva

2- left sided varcocile is noted

3- two simple uniocullar cysts are noted within the right epididiymal head 4x2.4 cm and 3.1,8 cm on size


so doctor regarding to the report above , does that affect sperms to be weak  ,also how can  treat the large unilocular cysts ?

my fertlitiy doctor forward me to other urology , because he stated that he assured theat the testis is ok but he didnt know the reason for large epydinal cysts so her forwarded me to a urologist

please advise

noticed that

I had did varcolcie and hydroclele surgery for 2 times ago on 2002 and 2012

thanks

ANSWER: Jackie:

You need to clarify exactly what you mean by "sperms to be weak".  Since you are seeing a fertility doctor, I'm assuming you have low motility in the semen analysis.

The ultrasound is essentially normal except for a return of the varicocele and the cysts.  Both can be repaired surgically.  Fixing the varicocele may help with sperm motility.  Varicoceles can recur but usually not hydroceles.

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

QUESTION: yes my semen weak

motility is weak and morphology is a lot , but counts is too large , the positive thing on my several semen analysis usually counts but all other is negative

the doctor said the I have two cysts , one above the right testicle and other on right head of epididiymal , he said that this cysts danger to be left without surgery because it is too large and during exposing to any injury or microbe affected , it ll burst and affect the right testicle , so the right testicle ll be damaged , but he added that the testicles still OK till  this moment but he afraid for further deficiencies  on the future

1- please comment about that diagnosis

2- can someone leave with one testicle , if yes can he produce sperm and get babies ?

thanks

3- does large cysts on both positions mentioned is danger for testis without treatment and may affect my sperms production ?

thanks

Answer
Jackie:

Epididymal cysts are not usually considered dangerous if left alone, but they can cause discomfort which is the usual reason for a surgery.  

It is certainly possible to live with only 1 testicle and have normal sexual intercourse, interest, erections, and semen with good sperm counts.

The cysts may already be blocking sperm on the affected side but it is not possible currently to do differential sperm counts.  I do not agree that it is dangerous to leave it without surgery.  Finally, surgery to repair the cysts may not help sperm productionn which will likely depend on the function of the opposite side.

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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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