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Urology/Intermittent torsion, epididymitis, hernia...?



Dr. Leslie,

A year ago, I experienced what I'd refer to as "intermittent torsion" or maybe something like a "cremaster cramp" of the right testicle. When it occurred, my right testicle seized up to the superficial inguinal ring and was stuck there for approximately 7 hours until I arrived at an urgent care clinic. The doctor there examined me and the testicle relaxed a bit back down. He said it did not look like torsion, but that I should have an ultrasound the next day.

I've had 7 ultrasounds, a CT scan, and a MRI of the pelvic and scrotal area since then, and the radiologists and specialists state there are no signs of torsion or hernia on their reports. However, my right testicle is bulging upwards and to the front. I cannot rest in bed on my sides because it moves further forward until it is hanging horizontally (it looks as if the bottom of the testicle is pointing directly in front of the scrotum). I cannot lift my right leg or do any kind of abdominal muscle flexing without the right testicle riding up within the scrotum. The back of the scrotum feels as if there is some kind of edema or build up of liquid. When I manage to relax my scrotum and testicles, I can feel the epididymis on the left, but cannot get a good feel of it on the right or it feels like a jumbled mess rather than a definitive structure. In the beginning, this was very painful, but it has subsided into minor aches and discomfort. It is mentally
exhausting wondering what is wrong with my right testicle.

My questions are:

- Would I be able to have exploratory surgery to see what the problem might be or are imaging studies reliable in being able to distinguish hernias, intermittent torsion, epididymitis, and muscle tears on the spermatic cord?

- Is it possible something rare happened, such as the epididymis became detached, the testicle is hanging upside down (with the epididymis still at the back of the testicle), or that I have a hernia, which is bulging at the back of the scrotum and pushes the testicle forward?

- Would an abdominal nerve block be able to relax a testicle that might have an overactive cremaster reflex?

Thank you for your time in reading this long post and any information you might able to provide.




Exploratory surgery is not unreasonable in your case since you are continuing to have problems and the standard tests are not helping provide a definitive diagnosis.  

The problem is that your disorder is intermittent.  A testicular ultrasound is only helpful if you are having the problem at the time of the ultrasound.  Hernias and torsions can both be intermittent and hard to image if the timing is not right.

It would be extremely unlikely for the epididymis to become detached or for the testicle to hang upside down.  A hernia at the back of the scrotum is a possibility.

A nerve block may help the pain, but is not likely to permanently relax the creamsteric muscle.

Talk to a local urologist about your options.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


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.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

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.

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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