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Having epididymal cyst on testicle. Having pain. Suffered testicular torsion?

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General Surgeon
Practicing since : 2002
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My age-32, sex- male
sir, I am having an epididymal cyst on the left testicle. The report of my scrotal ultrasound has been attached. When I was sleeping in the night on 18/10/2013, a sudden pain was felt on my right(not at the left) testicle for which I woke up. After 3/4 minutes the pain disappeared. The pain was like as if striking my testicle by finger after an interval of 10/12 seconds. Sir have I suffered testicular torsion ? I am very much afraid sir. If not then is it intermittent torsion and de-torsion.(Twisting and untwisting)?

On the very next morning I consulted an urologist in my area and he said there is no serious issue. But he didn’t examine me physically he said it only by listening the symptoms. I have attached his prescription with this query. Can intermittent torsion and de-torsion.(Twisting and untwisting) or any other testicular torsion be ruled out without examining physically or without doing any test ?

Today I saw my right testicle is moving a bit upward while I cough. My right testicle is moving more upward than the left one. When the right testicle moves upward then only skin of the scrotum is left in the right side. Is it anything serious ?? Does it mean that my right testicle has been attached loosely with the scrotum ‘s button part ??? My left testicle is not moving much while coughing is it anything serious ???

Can it be determined whether I have bell clapper deformity by my ultrasound report ??? (I have attached two reports of my scrotal ultrasound done in last April and last September).
Please help me sir. Thank U.
Posted Sun, 10 Nov 2013 in Testicle Problems
 
 
Answered by Dr. Deepak Kishore Kaltari 2 hours later
Brief Answer:
Unlikely to be torsion

Detailed Answer:

Welcome to Healthcare-Magic
Greetings of the day

The previous Ultrasound of Scrotum done in April also shows Right Epididymal cyst and the latest Ultrasound of Scrotum shows no such finding in right epididymis also there is slight decrease in size by 4 mm of the left epididymal cyst. So as per scan report there is no cause of concern.

Its unlikely to be torsion on right side, as you have mentioned the testis is moving up ie the cremasteric reflex is present. When at time of pain, cremasteric reflex is present and there is mobility of testis while either scratching the medial side of thigh or coughing and there is no tenderness, one can clinically rule out torsion of testis which can be collaborated by noting good vascularity of the symptomatic testis on Doppler scan.
Mobility of both the testis is usually different, as in majority of cases the left testis is lower than right, so virtually it appears that right testis is more mobile.
As you had pain in right testis and you noticed more mobility on right side, its highly unlikely that its torsion. Also there is a Epididymal cyst on left side so virtually will appear less mobile.

There is no much discrepancy in size of the testis, both the testis are approximately of same size( size difference of more than 1.5cm between the testis is considered significant) so it virtually rules out any intermittent or chronic torsion. In chronic or intermittent torsion, the testis will undergo atrophy and decrease in size.

It is difficult to tell Bell Clasp-er deformity on Ultrasound findings, its basically a intra-operative finding.

Good scrotal support and proper size Undergarment and mild analgesic will be helpful.

I hope it helped.

Take Care

Regards

Dr Deepak K K
MBBS,MS,MCH
Above answer was peer-reviewed by
 
Follow-up: Having epididymal cyst on testicle. Having pain. Suffered testicular torsion? 33 minutes later
thank u sir. sir can it so happen that in that night intermittent torsion and detorsion has occurred ??? (not a permanent torsion). Can it be ruled out without physical examination (because the local urologist didn't examine me physically but ruled out torsion). What may be the resond behind that symptom which I faced that night ??? Presently I am taking the medicines prescribed by that local urologist . What should I do next ??? I am much afraid of any torsion in future . I want to live like a normal man. I want to practice martial art in future can I do it sir ??? Thank U.
 
 
Answered by Dr. Deepak Kishore Kaltari 6 hours later
Brief Answer:
Unlikely to be torsion

Detailed Answer:
Namaste. Good morning

Get a repeat Ultrasound with color doppler looking for normal vascularity. If it's normal then there is no cause of further concern. It's only for your Reassurance.
Single episode of such a short duration pain does not call for any alert or concern. It's quite natural of many of normal people to have such pain and it's usually due to cremaster contraction.
Keeping in mind the very short duration of your symptoms, the urologist would have ruled it out without examination based on your history.
Your recent Ultrasound does not reveal any pathology of right testis. So rest be assured, continue talking medicine as prescribed. You can definitely do martial arts.

All the best.

Take care

Regards
Above answer was peer-reviewed by
 
Follow-up: Having epididymal cyst on testicle. Having pain. Suffered testicular torsion? 1 hour later
thank U sir. Sir this was your reply regarding my ultrasound report in my first query

"There is no much discrepancy in size of the testis, both the testis are approximately of same size( size difference of more than 1.5cm between the testis is considered significant) so it virtually rules out any intermittent or chronic torsion. In chronic or intermittent torsion, the testis will undergo atrophy and decrease in size."

Sir I have to say that this ultrasound was done on 28/09/2013before the incident I have described ( When I was sleeping in the night on 18/10/2013, a sudden pain was felt on my right(not at the left) testicle for which I woke up. After 3/4 minutes the pain disappeared. The pain was like as if striking my testicle by finger after an interval of 10/12 seconds. ) which I fear that it may intermittent torsion and de-torsion.(Twisting and untwisting).

Sir I could nt get your point that the difference of size of testicles lead to intermittent torsion and de-torsion.(Twisting and untwisting) or after intermittent torsion and de-torsion.(Twisting and untwisting) the size of testicles differ ??? I feared U have thought that ultrasound has been done after the pain. But actually it has been done before the pain to detect epididymal cyst on left (not at the right) but pain was felt in that night on right testicle.

Sir please mention about which test U have said that it will be done(is it required in my case ???) to detect past intermittent torsion and de-torsion.(Twisting and untwisting) ??? because here most of the labs asking for prescription to do test to know properly that which test is to be done ???

thank U.
 
 
Answered by Dr. Deepak Kishore Kaltari 29 minutes later
Brief Answer:
Follow up scan every 6months

Detailed Answer:
Namaste
Good morning

Your last scan was done in September and your complaint are dated 18th October 2013.

Let me Reassure you once again everything appears fine.
I do understand your worry about the pain. Let me assure you torsion pain usually occurs during exertion or sudden physical activity and unlikely to occur during sleep. Also the pain is of very short duration and after which you were alright even you have mentioned that the right testis was normally mobile.
At this point of time it does not warrant further investigation.

Comparison of the scan report virtually rules out any past asymptomatic torsion. Intermittent torsion slowly affects the vascularity and reduces the size of testis over period of time.

Also coming to your present symptoms which were following your scan, I don't think it's due to torsion.


As a follow up for left epididymal cyst I would suggest you to get Ultrasound of the scrotum every six months in Consultation with your Urologist and will also Reassure you about well being of right testis.

Any testicular pain irrespective of any previous pathology present in testis which last more than 20 minutes in spite of taking rest, one should seek medical advice at earliest to Clinico Radiologically rule out Torsion. It's a universal precaution for everyone of us.
Rest be assured you can have a normal life.

Take care
Regards
Above answer was peer-reviewed by
 
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