Testicular Pain: Causes, Diagnosis, and Treatment Options

excuse me?

Hello Dr.
Lin: I went for another check-up at the urology department today and asked more detailed questions.
The doctor performed a physical examination and confirmed that there is no varicocele.
He advised me to go to the ultrasound endoscopy center tomorrow, March 18, for an ultrasound to check for other conditions you mentioned, such as hydrocele, testicular tumors, etc.
The doctor suggested that it might be inflammation.
At the time, I wasn't able to articulate my feelings well, so I mentioned that I felt my testicles were somewhat misaligned.
However, the doctor said that testicles naturally move around.
After returning from the clinic, I researched online and found some information on the following website: http://www.webhospital.org.tw/essay/essay.html?pid=8809&category=%E6%80%A7%E6%84%9B%E5%A4%A9%E5%A0%82&type=*
* Age is important; epididymitis and orchitis are less common in men under 30, and even rarer in young boys.

* Testicular torsion can occur due to spasms of the cremaster muscle, causing the testicle to be positioned high in the scrotum; during inflammation, it remains in its original position.

* If there is only mild torsion, one may only experience temporary pain.
However, if the torsion is severe, blood flow in the internal vessels may be obstructed, leading to testicular necrosis.
Due to excessive mobility, it may even result in a transverse testicle.

I feel that my symptoms align more with the conditions mentioned above, such as the testicle being positioned high in the scrotum and possibly being transverse, as sometimes I feel a sensation similar to being "stuck" (forgive my use of phonetics).
I would like to ask if testicular torsion can be detected through ultrasound? Is ultrasound the same as Doppler ultrasound? Additionally, I have been experiencing these symptoms for two to three weeks now; if it is indeed mild torsion, could it lead to necrosis? The website states that as long as there is any possibility of the testicle surviving, it should be preserved, and only a completely necrotic testicle should be removed.
This concept is now being questioned.
If there is significant ischemia, not only is recovery of function impossible, but the contralateral side may also be affected due to autoimmunity.
This concerns me greatly...

Patients may experience pain that could resolve on its own, but it can be recurrent.
In fact, many patients cannot find a definitive cause.
Additionally, it is recommended to wear looser-fitting pants, as wearing tight clothing, such as jeans, can lead to chronic testicular pain.
Regardless, if your symptoms persist, I recommend returning to the urology clinic for a detailed examination.

ABC, 10~19 year old female. Ask Date: 2005/03/17

Dr. Lin Wenxu reply Urology

First of all, based on your complaints, your symptoms do not appear to be typical of testicular torsion.
(Testicular torsion commonly occurs in teenagers and often presents as sudden severe pain during sleep that wakes the individual up.) Additionally, ultrasound examinations cannot definitively confirm the presence of testicular torsion.
Generally, if testicular torsion is suspected, it is recommended to proceed with emergency surgery for confirmation, or alternatively, a nuclear medicine testicular scan can be performed for more accurate results.
As for ultrasound and Doppler ultrasound, both are types of ultrasound examinations, with the difference being that Doppler ultrasound enhances the detection of blood flow (allowing differentiation of blood movement).
Considering all of the above, I personally still believe that your condition does not resemble testicular torsion, and there is no need for excessive anxiety or worry.
You can continue to follow up with urology for treatment.
Thank you!

Reply Date: 2005/03/17

More Info

Testicular pain can be a complex issue with various potential causes, and it’s good that you are seeking further evaluation from a urologist. Based on your description, it seems you are experiencing discomfort that could be related to several conditions, including inflammation, torsion, or possibly other underlying issues.

Causes of Testicular Pain
1. Epididymitis: This is an inflammation of the epididymis, often caused by infections. Symptoms typically include swelling, pain, and sometimes fever. It is more common in younger men but can occur at any age.

2. Testicular Torsion: This is a medical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. Symptoms include sudden, severe pain, swelling, and sometimes nausea. If not treated promptly, it can lead to testicular necrosis (death of the tissue).

3. Hydrocele: This is a fluid-filled sac around the testicle that can cause swelling and discomfort but is usually not painful.

4. Varicocele: This condition involves enlarged veins within the scrotum and can cause a dull ache or discomfort.

5. Tumors: Although less common, testicular tumors can present with pain or discomfort and should be evaluated.

Diagnosis
You mentioned that your urologist performed a physical examination and ruled out varicocele. The next step, as suggested, is an ultrasound. An ultrasound is a non-invasive imaging technique that can help visualize the structures within the scrotum, including the testicles and epididymis.
- Ultrasound vs. Doppler Ultrasound: Regular ultrasound can show the size and structure of the testicles and any fluid collections. Doppler ultrasound specifically assesses blood flow, which is crucial in diagnosing conditions like testicular torsion. If there is reduced or absent blood flow to the affected testicle, it is a strong indicator of torsion.

Concerns About Torsion
You expressed concern about the possibility of testicular torsion and its implications. If torsion is suspected, it is critical to seek immediate medical attention, as the window for saving the testicle is limited (usually within 6 hours).
- Symptoms of Torsion: If you experience sudden severe pain, swelling, or changes in the position of the testicle, it is essential to go to the emergency room.

- Chronic Pain: If the pain has been persistent for two to three weeks, it may not be torsion but could still indicate another issue that requires treatment. Chronic pain can sometimes be due to conditions like epididymitis or even referred pain from other areas.

Recommendations
1. Follow-Up: Continue with your scheduled ultrasound and discuss the results with your urologist. They may recommend further tests or treatments based on the findings.

2. Loose Clothing: As suggested, wearing looser-fitting clothing can help alleviate discomfort, especially if tight clothing exacerbates your symptoms.

3. Pain Management: Over-the-counter pain relievers may help manage discomfort, but consult your doctor before starting any medication.

4. Monitor Symptoms: Keep a close watch on your symptoms. If they worsen or new symptoms arise, seek medical attention promptly.

5. Avoid Self-Diagnosis: While researching symptoms online can be informative, it’s important to rely on professional medical advice for diagnosis and treatment.

In conclusion, testicular pain can arise from various causes, and while some may resolve on their own, others may require medical intervention. Your proactive approach in seeking further evaluation is commendable, and I encourage you to continue working closely with your healthcare provider to address your symptoms effectively.

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