Chronic Testicular Pain Please Help

[starrwind]

I have been having bouts of extreme testicular pain in my right testicle for almost 3 years now. I'm a 25 year old male. It started with a dull aching pain in the right testicle near the actual testicle itself. I went to the doctor and got an ultrasound and urinalysis and nothing was found to be wrong, i went on trying to ignore the pain. Eventually one night it got so bad I went to the ER and they did another ultrasound and found a very small epidytmal cyst which they said was probably causing the pain and gave me a prescription for 800mg of motrin. The Motrin never really helped and again I went on living with the pain. It eventually died down and started to occur less often.

Well around a few months ago the pain started to occur more frequently an much worse. Also instead of being the usual dull testicular pain from the past it was now a much higher up pain, felt high up in the cord almost into the groin and much sharper. I also have been getting pain in the very lower right quadrant of my abdomen, just above the pelvic bone, not sure if this is related. Anyways the pain is getting to be more frequent and very very hard to deal with. Doctors still seem to be stumped and I've been tried with ultrasounds, antibiotics for infection, physical exams and a CT scan. Also I know it's not an STD. I'm actually considering a surgery called "cord stripping" which separates all the pieces of the testicular cord to relieve nerve pain, though I am not sure of the results as its a fairly new procedure I believe.

I just want to know what the hell could be wrong! What causes pain high up in the testicular cord? Why does it disappear and reappear randomly lasting anywhere from a day to many days? Is it possible whatever it is can't be found on the tests I've received? or is it possible that it would show up on a test but only when the symptoms are present and not when the symptoms aren't present? Someone please help me out here, it's messing with my entire life.

[Dr J Singh]

Hello,
Apart from the possibility of epididymal cyst causing this testicular pain, infection (Epididymitis or Orchitis) or inflammation, testicular torsion -- most common in young men between 10 and 20 years old, excessive bicycle riding, hernia or kidney or ureteric stones can be responsible.

Since ultrasound of testicle is clear, it is important to rule out hernia and kidney and ureteric stones for which I suggest you to consult a urologist.

I hope it helps. Take care and regards.

[Shirokuma]

Read my journal?

Orchialgia is actually pretty common, doctors do not like treating it with anything other than meds though.

It messes with your entire life, I know I had it for 13 years, from the time I was 19. Unfortunately the most effective "cure" is the most difficult for most men to accept. That and finding a willing doctor in the US.

Cord stripping or denervation of the cord, yes fairly new, has the potential for a good outcome. Around 83% effective (according to the BEST surgeon in the USA). I could not bear the expense of travel to the US plus his fee to test it out though.

Possible downsides of the denervation are:
- further nerve damage, there are 3 nerves usually done some men have 4 and one is missed
- blood supply to the testicle is damaged or lost
- no change in pain levels (about 5% of cases) indicating that it is in the spine somewhere

This surgery seems to work best on extremely fit patients. Which is to say that they have textbook anatomy and little to no fat in the inguinal region.

Ever had a doppler ultrasound? That is a diagnostic tool for intermittent torsion which is what I was originally told I had and why I had 3 orchiopexy surgeries (I had a cyst removed as well)

The only other option for diagnostic testing is a nerve block, this I am told can be incredibly painful, I never had one as they are not offered here. This is traditionally the diagnostic test in the USA for a final option of orchiectomy. Now I would say that if the nerve block works for any length of time (some men report 2 hours and some get up to a month) then the denervation would be worth the risk.

I am 33 now and I ended up having a right orchiectomy in 2007 and a left radical inguinal orchiectomy in 2010, I had already married and had a son, plus my wife had a radical hysterectomy in April of 2010 before my final surgery so fertility was not an issue in my case.

I have 2 pieces of advice
1. bank sperm if you can
2. get a total testosterone level check

I never did either of those an they are the things I wish I did the most.