Do I Need a Follow-Up for Testicular Pain and Varicocele Concerns?

Do I need to return for a follow-up appointment regarding the issue I encountered at the beginning of the month?

At the beginning of the month, I suddenly experienced severe pain in my testicle in the middle of the night.
Upon self-examination, I discovered that my testicle was twisted.
I went to the emergency room, where the doctor used an ultrasound to confirm that it was not testicular torsion.
Then, the doctor performed a digital rectal examination, which was very painful, and later diagnosed me with chronic non-bacterial prostatitis due to prolonged sitting.
This condition also caused inflammation of the right epididymis, which was visibly more prominent, with a heavy sensation and difficulty urinating, as well as frequent urination.
I was prescribed anti-inflammatory medication, pain relievers, and antibiotics.
After two follow-up visits, the doctor said I could stop the medication, and during the last visit, the prostate examination was less painful.
This week, I suddenly experienced pain again, which was not as severe as the previous episode but was accompanied by nausea, abdominal pain, and loss of appetite (which I did not have last time).
I endured the pain for about thirty minutes, and then it subsided.
While showering today, I checked and found that there is a varicose vein at the bottom of my right testicle, which is visibly swollen when I exert pressure on my abdomen.
The right testicle remains swollen, and I occasionally experience sharp pain and loss of appetite, all on the right side.
I have been taking my medication as prescribed, and I have been active after sitting for about thirty minutes.
During periods of reduced pain, I have also engaged in masturbation and ejaculation without discomfort.
Additionally, during the first visit, I underwent both ultrasound and physical examination.
Could the doctor have overlooked the varicose vein? Should I be concerned about the varicose vein issue? Is it related to the inflammation of the epididymis and the symptoms mentioned above? Or is it sufficient to continue taking antibiotics as long as I do not have any discomfort? Currently, I experience swelling and pain in my testicle and abdominal pain about five to six times a day, with intermittent difficulty urinating and frequent urination, as well as fluctuating loss of appetite.
Ideally, I would prefer not to return for another visit.
Could you please help me with a diagnosis? Thank you.

A-Wen, 10~19 year old female. Ask Date: 2018/07/21

Dr. Xu Wencang reply Urology

There is a possibility of a bacterial infection; please return to the outpatient clinic for examination and treatment.

Reply Date: 2018/07/21

More Info

It sounds like you are experiencing a complex set of symptoms related to your testicular pain and varicocele concerns. Given your description, it is crucial to address these issues with a healthcare professional, as they can provide a thorough evaluation and appropriate management.

Follow-Up Necessity
1. Symptoms of Concern: You mentioned experiencing sudden testicular pain, nausea, abdominal pain, and changes in appetite. These symptoms, especially the acute onset of pain, warrant a follow-up appointment. While your previous visits resulted in some improvement, the recurrence of pain, especially with new symptoms like nausea and appetite changes, suggests that further investigation is necessary.

2. Varicocele: The presence of a visible varicocele (enlarged veins in the scrotum) can be associated with discomfort and may contribute to testicular pain. Varicoceles can affect fertility and may require treatment if they are symptomatic or if they lead to complications. The fact that you have noticed this change in your condition indicates that it should not be overlooked.

3. Chronic Prostatitis: You were diagnosed with chronic non-bacterial prostatitis, which can cause pelvic pain and discomfort. While your symptoms have improved with medication, the recurrence of pain suggests that the underlying issue may not be fully resolved. Chronic prostatitis can sometimes be challenging to treat, and ongoing symptoms may require a reevaluation of your treatment plan.

Recommendations
1. Return to Your Doctor: It is advisable to schedule a follow-up appointment with your urologist or primary care physician. They can perform a physical examination, including a thorough evaluation of the varicocele, and possibly order imaging studies such as an ultrasound to assess the blood flow and structure of the testicles and surrounding areas.

2. Discuss Symptoms: During your appointment, be sure to discuss all your symptoms in detail, including the frequency and intensity of your pain, any changes in urination, and your appetite. This information will help your doctor determine the best course of action.

3. Medication Review: Since you are currently taking antibiotics and anti-inflammatory medications, it’s important to discuss their effectiveness and any side effects you may be experiencing. Your doctor may consider adjusting your treatment plan based on your current symptoms.

4. Lifestyle Modifications: While waiting for your appointment, consider lifestyle changes that may alleviate some discomfort. This includes avoiding prolonged sitting, practicing good hydration, and managing stress, which can sometimes exacerbate pelvic pain.

5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in understanding your condition.

Conclusion
In summary, given the complexity of your symptoms and the potential implications of a varicocele, it is essential to seek further medical evaluation. Your health and well-being are paramount, and a follow-up appointment will help ensure that any underlying issues are addressed appropriately. Do not hesitate to reach out to your healthcare provider to discuss your concerns and arrange for a follow-up visit.

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