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Severe Lower Abdominal Pain. Ultrasound Showed No Blood Supply To Inferior Part Of Testicle. Reason?

Posted on Thu, 9 May 2013

Question: Hi, I have very acute severe pain in the lower abdominal about 5 days ago, admitted to the hospital but nothing was found serious. Two days later, the pain subsided, however i felt great tenderness in my right testicle, especially upon palpating the testicle and walking. I went to see a urologist, had an ultrasound and found the inferior part of the testicle has no blood supply. The superior part of the testicle, however, are well perfused. They could not rule out the possibility of torsion or tumour and advised me to observe it for another 1 week and then go for a second ultrasound. After a few days, the pain became much much better. One thing i didn't tell the Urologist (i was too embarrassed to tell the doctor) is that the pain occur few hours after masturbation. My question is, could this pain come from masturbation twisting the testicle leading to torsion? and if yes, do I need any form of surgery to remove the testicle? If i lose one testicle, does this entails to infertility?
Thanks
XXXXXXX

Answered by Dr. Grzegorz Stanko (1 hour later)

Hello!

Thank you for the query.

No, masturbation can not be a reason of testicle twisting. It does not work that way. Testicle torsion is caused by inadequate fixation of the testis (usually inherited) and masturbation has no impact on it.
In my opinion, your symptoms like sudden testicular pain, lower abdominal pain and lack of blood supply to the part of the testicle definitely tells that some part of your testis is ischemic. Most likely it is caused by testicle torsion. It does not have to be complete torsion as some part of the testicle has correct blood supply. There is a condition called intermittent testicular torsion where the testicle can spontaneously detort. It can result with partial testicle ischemia.
And the consequence of partial testicle ischemia can be necrosis of this part of testicle. If necrosis appears, the pain usually goes away due to nerves necrosis.
That is why it is not advisable to wait whole week for another ultrasound.
I suggest you to visit your doctor and have at least blood work, CRP performed to check if there is an inflammation process. If so, ultrasound should be repeated and urologist consult performed.
It may be need of surgical testicle removal. In such case, you still have second testicle and it should not affect your fertility.

Hope this will help. Feel free to ask further questions.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (3 hours later)

Thanks very much for your reply, the answers were really helpful.

There is another question i would like to ask. I am not quite keen to undergo surgery to remove the affected testicle. For the part of the testicle undergoing necrosis, can I leave it alone and allow the body to heal the ischemic part? There are still blood supply to the superior part, would the necrotic part repair or regenerate from the superior blood supply?

Regards,

Answered by Dr. Grzegorz Stanko (18 minutes later)

First of all we are not sure if the necrosis has appeared. In some cases the blood supply reappears and the tissues wont get necrotic.
But if the necrosis has appeared, it is advisable to remove it. Its because every dead tissue gets infected by really bad bacteria. Moreover, our immune system tries to get rid of this tissue what cause toxic substances appearance in the blood. Such process, when left alone, leads to SEPSIS and is life threatening.

That is why I suggested CRP and blood work first. If inflammation caused by necrosis will appear, CRP and WBC (white blood cells) will be elevated.

Hope this will help.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Grzegorz Stanko (1 hour later)

Thank you for your kind answers

I have one final question to ask. For the surgery, are you referring to removing the whole testicle on the right or would the surgery only remove the necrotic part of the testicle? What are the probability/risks of losing the whole testicle? Just before you mentioned that infertility shouldn't be a concern because still have the second testicle. But having only one testicle, would the chance of fertilization reduce/ more difficult to make my wife pregnant? I think having one testicle remaining implies less sperm production/count? No?

Thanks again for your time, have a very good day.

Kind Regards, XXXXXXX

Answered by Dr. Grzegorz Stanko (18 minutes later)

Partial testicle removal is also possible (it is called partial orchiectomy). But it all depends of the condition of this testis (we still dont know if such surgery is necessary, its all just a theory). If the necrosis will be in small part of the area, partial removal can solve the problem. It all depends of the scale of necrosis.
One healthy testicle is enough for proper fertilization. Average sperm contains 500-200 millions of spermatozoons. If you will eliminate one testis, the count can drop to 250-100 millions what is more than enough for proper fertilization (20 million is still enough). So no reason to worry about it.

Regards.

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar