Epididymitis and Varicocele: A Patient's Concerns and Insights

Q: Epididymitis and Varicocele: A Patient's Concerns and Insights

A-Zhi： Hello. 1. Epididymitis, if it becomes chronic, may still present with localized swelling, but it will not be very painful, only causing mild discomfort. 2. It is generally recommended to treat the infection first. 3. Testicular cancer can be detecte

Epididymitis and varicocele?

Hello Dr.
Hsu! I am 34 years old and started experiencing pain in my left testicle in February.
I consulted at New Taipei City Hospital, where the doctor diagnosed me with epididymitis.
I have been taking antibiotics and pain relievers for about 10 weeks to alleviate the pain.
However, there is still a hard lump on the left epididymis.
During follow-up visits, I have undergone two ultrasounds, as well as blood and urine tests.
There were no signs of bacterial infection in my urine.
Additionally, the ultrasound and blood tests for cancer markers did not indicate any signs of testicular cancer.
During the ultrasound, it was also discovered that I have symptoms of a varicocele.
Currently, I still experience pain in the left scrotum, which is characterized by intermittent sharp pain.
I have a few questions for you:
1.
Today, during another ultrasound at the hospital, the doctor indicated that the current condition of my left epididymis is (swelling after treatment, not an inflamed state).
Based on your experience, do you think I will continue to experience pain? Also, do I need to continue taking the antibiotic Cephalexin? (I have been taking antibiotics continuously from the Lunar New Year until the Qingming Festival, and I am concerned that my liver and kidneys may not withstand it if I continue until the Dragon Boat Festival...)
2.
Regarding the varicocele, I have undergone a sperm analysis, and the report was quite normal.
The doctor also mentioned that my varicocele is quite mild and should not cause pain.
I would like to ask: Does a varicocele (normal semen + no testicular atrophy) mean that it will not cause pain? Sometimes, the pain occurring in the scrotum is not easy to identify.
Occasionally, I also experience soreness in the groin and left abdomen...
So, if these two pains occur simultaneously, which one should be treated first? For example, should I consider laparoscopic surgery first?
3.
Regarding testicular cancer...
I have already had the doctor perform a physical examination, ultrasound, and blood tests for cancer markers.
Is there any further testing that needs to be confirmed? How often should these tests be conducted?
4.
One more question about the ultrasound...
If the scrotum is thin but the testicle is round, could the ultrasound create blind spots? For example, could the head or tail of the epididymis be missed? I am very concerned that the hard lump at the head of the epididymis, which is said to be epididymitis, could actually be a tumor of testicular cancer.
I apologize for asking so many questions without paying the health insurance fee! I hope these questions can serve as a reference for future patients.
Thank you very much, Dr.
Hsu! I do a good deed every day to cover the consultation fee! Grateful.

A-Zhi, 30~39 year old female. Ask Date: 2015/04/15

Dr. Xu Weikai reply Urology

A-Zhi: Hello.
1.
Epididymitis, if it becomes chronic, may still present with localized swelling, but it will not be very painful, only causing mild discomfort.
2.
It is generally recommended to treat the infection first.
3.
Testicular cancer can be detected through self-examination.
Normally, the testicles have a smooth surface; if there is an enlargement of the testicle (not the epididymis) or if its shape becomes irregular, you should seek medical attention.
Note: You can ask your doctor to teach you how to palpate and differentiate between the epididymis and the testicle.
4.
Scrotal ultrasound is very accurate, and it is performed by urologists; general technicians rarely receive relevant training, so a proper diagnosis should be made.
Note: 99% of lesions in the epididymis are benign, while over 90% of testicular lesions are malignant.
I hope the above answers are helpful.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses can only serve as a reference; if necessary, you should still seek medical care at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/04/15

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding epididymitis and varicocele. It’s understandable to have questions and worries, especially when dealing with persistent pain and the complexities of your diagnosis. Let’s address your queries one by one.

1. Epididymitis and Ongoing Pain: It’s common for patients to experience lingering discomfort even after the inflammation has subsided. The hard lump you mentioned on the epididymis may be a result of the previous inflammation, which can lead to scarring or changes in the tissue. If your doctor has confirmed that the swelling is not due to active inflammation, it may not be necessary to continue antibiotics like Cephalexin, especially if you are concerned about the potential impact on your liver and kidneys from prolonged use. It’s crucial to have a discussion with your healthcare provider about the necessity of continuing antibiotics and any alternative treatments that may be appropriate.

2. Varicocele and Pain: Varicocele can sometimes cause discomfort, but it does not always correlate with pain, especially if the sperm analysis is normal and there is no testicular atrophy. The pain you experience could be multifactorial, potentially stemming from the varicocele, epididymitis, or even referred pain from other areas. If the pain persists and significantly affects your quality of life, surgical intervention, such as a laparoscopic varicocelectomy, may be considered. However, this decision should be made collaboratively with your urologist based on a thorough evaluation of your symptoms and overall health.

3. Testicular Cancer Screening: Given that you have undergone physical examination, ultrasound, and blood tests for tumor markers without any indication of testicular cancer, the risk appears low. However, regular self-examinations and follow-up with your physician are advisable. The frequency of follow-up exams can vary; typically, every 6 to 12 months is reasonable, but your doctor may suggest a tailored schedule based on your specific circumstances.

4. Ultrasound Limitations: Ultrasound is a valuable tool for evaluating testicular and scrotal conditions, but it does have limitations. While it provides excellent visualization of most structures, there can be areas that are less well-defined, particularly if there is significant scarring or if the anatomy is altered due to previous inflammation. If there are concerns about specific areas, your doctor may recommend additional imaging studies or follow-up ultrasounds to ensure comprehensive evaluation.

Regarding your worries about the hard lump on the epididymis, it’s important to remember that not all lumps are cancerous. However, if you notice any changes, such as rapid growth or new symptoms, you should seek immediate medical attention.
Lastly, I commend you for your commitment to daily acts of kindness; it’s a wonderful way to contribute positively to the world around you. Please continue to communicate openly with your healthcare providers about your concerns, as they can offer the best guidance tailored to your situation.

Wishing you the best in your health journey.

Warm regards.

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