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Urology/Chronic epididymitis pain

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QUESTION: Good evening Doctor, thank you for taking the time to answer my question, it is greatly appreciated.

I am going through a pretty nightmarish ordeal and wanted to ask your opinion. A bit of background:

June 2005: Diagnosed with right-side epididymitis due to chlamydia. Treated with a 7-day course of doxycycline. Went back a week later and confirmed that chlamydia was treated.

December 2005 (6 months later): Returned to the doctor due to persistent epididymal discomfort. Ultrasound showed enlarged epididymis head with heterogenous echotexture. No infection found. Was told no big deal and to use anti-inflammatories for discomfort.

Soon after, the pain subsided and I had no trouble for nearly 10 years, other than that my right epididymis would always swell to a hard lump at the bottom whenever I was about to ejaculate. This didn't cause pain so I did not worry.

1/9/2015:  Began to experience severe epididymal pain on the right side, such that I went to the emergency room. Was given a referral to urology. An ultrasound and MRI of the scrotum have both come back normal, although I have had persistent pain since.

This past Monday, my urologist performed a right spermatic cord stripping procedure on me in an effort to cure the pain. I know it has only been a few days, but I am still having the same epididymal pain that I was having before. This has really affected my quality of life. The only thing that helps with the pain is Percocet, but of course I don't want to make this a long term solution.

I just wanted to ask how you would proceed at this point? To be honest, at this point I would be willing to have the testicle removed if it would take my pain away. Have you seen a case of chalmydial epididymitis cause this much havoc for someone? It is still hard for me to believe that this is happening. All I know is that it is ruining my life. Thanks Doctor.

ANSWER: Tyler

At this point, only a surgical procedure to remove the testicle is likely to help. Even that is not certain to relieve ghd pain completely.





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

QUESTION: Thank you Dr. That obviously isn't what I want to do, but if it will give me my life back, I'll do it. Is it likely that a urologist would agree to remove my testicle due to my chronic pain? I know that this is usually only performed for testicular cancer. But i'm in a lot of agony and have no quality of life with this pain. Thanks Doctor.

Answer
Tyler

Obviously I can't tell you what another physician will recommend, but when there is chronic pain in the tezticle not responding to medical treatment, removal is reasonable especially when a surgery has already been tried and failed.  One other option to discuss is a.spermatic. cord anesthetic block. Good Luck.

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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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