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Suggest Treatment For Swelling Post Open Inguinal Hernia Surgery
Question: Dear Doctor,
I wrote you a couple months ago concerning swelling after open inguinal hernia surgery.
I am still having problems.
The area around the cut is still a little swollen. However my problem is my spermatic cord. Whenever I ejaculate, I start experiencing severe pains about half an hour after.
It starts as a throbbing pain at the base of the penis and travels to the testes. The testes start feeling as if they are tightening and getting stiff. Then the pain spreads to the entire wound area and throbs at about the middle of the incision. The spermatic cord feels swollen and stiff just near the testicles. (right). About one hour after, standing up is extremely painful as it puts pressure (i assume) on the testes and spermatic cord. I usually take olfen to help with the pain but the pain still persists for hours.
Also, my ejaculation is no longer white and thick like sperms, it is now very liquid and clear (opaque)
I had gone to the urologist three weeks ago about it. He physically examined me and confirmed that the spermatic cord is swollen. He said that it must be an infection and gave me two weeks of antibiotics (Josalid). I finished them on Thursday and there is no relief. In fact, it progressively gets worse every time i ejaculate. I insisted on an ultrasound. The ultrasound showed no abnormalities in the cord BUT showed swelling in the area of the cut.
Doctor, i dont think this is an infection. I think something mechanical is going on with my spermatic cord.. I am beginning to think that the surgeon may have accidentally stitched it.
Are there any tests that can be done to determine this?
i forgot to mention the pain also goes to my lower back and that the whole area from testes to the incision feels hard and numb.
I wrote you a couple months ago concerning swelling after open inguinal hernia surgery.
I am still having problems.
The area around the cut is still a little swollen. However my problem is my spermatic cord. Whenever I ejaculate, I start experiencing severe pains about half an hour after.
It starts as a throbbing pain at the base of the penis and travels to the testes. The testes start feeling as if they are tightening and getting stiff. Then the pain spreads to the entire wound area and throbs at about the middle of the incision. The spermatic cord feels swollen and stiff just near the testicles. (right). About one hour after, standing up is extremely painful as it puts pressure (i assume) on the testes and spermatic cord. I usually take olfen to help with the pain but the pain still persists for hours.
Also, my ejaculation is no longer white and thick like sperms, it is now very liquid and clear (opaque)
I had gone to the urologist three weeks ago about it. He physically examined me and confirmed that the spermatic cord is swollen. He said that it must be an infection and gave me two weeks of antibiotics (Josalid). I finished them on Thursday and there is no relief. In fact, it progressively gets worse every time i ejaculate. I insisted on an ultrasound. The ultrasound showed no abnormalities in the cord BUT showed swelling in the area of the cut.
Doctor, i dont think this is an infection. I think something mechanical is going on with my spermatic cord.. I am beginning to think that the surgeon may have accidentally stitched it.
Are there any tests that can be done to determine this?
i forgot to mention the pain also goes to my lower back and that the whole area from testes to the incision feels hard and numb.
Brief Answer:
As tried to explain.
Detailed Answer:
Hi.
Thanks for your query and reference to the previous discussions we had in April 2015.
Read the present history and understood the concerns.
To recapitulate: Male/43 - open hernia surgery in March 2015 and had postop problems (it was 14 days after open hernia surgery (mesh) and i hardly had any pain left and almost no swelling left. I masturbated and upon ejaculation i had a sharp pain at the area of the incision, it felt like it was contracting. It was very painful. Then the pain started and the the area began to swell. It is still swollen up to today (a little bigger). And it has been painful. The area is also numb.) ->>
The area is still swollen - major problems is severe pain and swelling half an hour after ejaculation - starts as throbbing pain at the base of penis and travels to the testis - feeling of tightening and stiffness - spreads to the operated area and throbs at the middle of incision - cord feels swollen and stiff - standing becomes painful - takes Diclofenac - semen is thin and clear - took Urologist's opinion - antibiotic for 2 weeks - USG showed swelling in the area of the cut -
feeling mechanical problem - Wants to know the tests - pain goes to lower back testis to incision - hard and numb -
My thoughts after reading and re-reading:
Semen analysis to see the exact problem why it is thin and clear.
MRI of the area of the scrotum, operated site and prostate after telling the Radiologist your complaints and that he knows what to look for. This really helps to get a better and most probable diagnosis.
The most probable reasons for the symptom-complex that you have now are:
- Recurrence of the hernia in a small way as you had the popping after surgery.
- Nerves getting entrapped into the scar tissues, adding to the symptoms that you have.
- Tightening around the spermatic cord at the external inguinal ring due to fibrosis. This gives that swelling of the cord and the pain and swelling that you get as also confirmed by the Urologist.
- Prostatitis can cause some of the symptoms that you have like pain after ejaculation.
I would advise you the following:
Review the clinical evaluation and examination including the per-rectal digital examination for the palpation of prostate, seminal vesicles and base of urethra. This is one evaluation that can not be got by any investigations. This can be done by the Surgeon who operated you or get a second opinion of another XXXXXXX Surgeon. This clinical evaluation is very important.
Review will also help to see for recurrence of hernia- test of palpation of the operated area and scrotal contents on coughing or straining to see the exact problems and to correlate these findings with the MRI and so on.
Once a proper diagnosis is done the treatment can be well guided and can give you the positive results.
I hope this answer helps you, Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap-of-communication.
As tried to explain.
Detailed Answer:
Hi.
Thanks for your query and reference to the previous discussions we had in April 2015.
Read the present history and understood the concerns.
To recapitulate: Male/43 - open hernia surgery in March 2015 and had postop problems (it was 14 days after open hernia surgery (mesh) and i hardly had any pain left and almost no swelling left. I masturbated and upon ejaculation i had a sharp pain at the area of the incision, it felt like it was contracting. It was very painful. Then the pain started and the the area began to swell. It is still swollen up to today (a little bigger). And it has been painful. The area is also numb.) ->>
The area is still swollen - major problems is severe pain and swelling half an hour after ejaculation - starts as throbbing pain at the base of penis and travels to the testis - feeling of tightening and stiffness - spreads to the operated area and throbs at the middle of incision - cord feels swollen and stiff - standing becomes painful - takes Diclofenac - semen is thin and clear - took Urologist's opinion - antibiotic for 2 weeks - USG showed swelling in the area of the cut -
feeling mechanical problem - Wants to know the tests - pain goes to lower back testis to incision - hard and numb -
My thoughts after reading and re-reading:
Semen analysis to see the exact problem why it is thin and clear.
MRI of the area of the scrotum, operated site and prostate after telling the Radiologist your complaints and that he knows what to look for. This really helps to get a better and most probable diagnosis.
The most probable reasons for the symptom-complex that you have now are:
- Recurrence of the hernia in a small way as you had the popping after surgery.
- Nerves getting entrapped into the scar tissues, adding to the symptoms that you have.
- Tightening around the spermatic cord at the external inguinal ring due to fibrosis. This gives that swelling of the cord and the pain and swelling that you get as also confirmed by the Urologist.
- Prostatitis can cause some of the symptoms that you have like pain after ejaculation.
I would advise you the following:
Review the clinical evaluation and examination including the per-rectal digital examination for the palpation of prostate, seminal vesicles and base of urethra. This is one evaluation that can not be got by any investigations. This can be done by the Surgeon who operated you or get a second opinion of another XXXXXXX Surgeon. This clinical evaluation is very important.
Review will also help to see for recurrence of hernia- test of palpation of the operated area and scrotal contents on coughing or straining to see the exact problems and to correlate these findings with the MRI and so on.
Once a proper diagnosis is done the treatment can be well guided and can give you the positive results.
I hope this answer helps you, Please feel free to ask for further relevant queries if you need to or if you feel that there is a gap-of-communication.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor.
Couple comments
1. I did the ultrasound with the coughing etc and did not detect any recurrence of hernia
2. Wouldnt the two week antibiotic take care of prostatitis if there was?
Also, if they have to re-open the surgery, do they have to do it open cut or can they do it laproscopically this time?
Couple comments
1. I did the ultrasound with the coughing etc and did not detect any recurrence of hernia
2. Wouldnt the two week antibiotic take care of prostatitis if there was?
Also, if they have to re-open the surgery, do they have to do it open cut or can they do it laproscopically this time?
Brief Answer:
Open surgery preferably and only is required on proper diagnosis.
Detailed Answer:
Hi.
It is a very good news that ultrasonography with coughing is showing no recurrence.
Some parts of the genito-urinary system like prostate and epididymis are really resistant to short courses and can take weeks to months to get cured.
It would be better first to get a proper diagnosis so that a proper treatment can be planned. Hence the need of good evaluation as discussed above.
If at all a re-surgery is required, it should be open.
The fibrosis of the first surgery will not allow laparoscopic surgery to get any results.
Let us get the proper diagnosis first.
Please give the feedback about the clinical evaluation and tests so that we can try to get the proper diagnosis and discuss further till you are cured.
I shall be happy to assist you.
Open surgery preferably and only is required on proper diagnosis.
Detailed Answer:
Hi.
It is a very good news that ultrasonography with coughing is showing no recurrence.
Some parts of the genito-urinary system like prostate and epididymis are really resistant to short courses and can take weeks to months to get cured.
It would be better first to get a proper diagnosis so that a proper treatment can be planned. Hence the need of good evaluation as discussed above.
If at all a re-surgery is required, it should be open.
The fibrosis of the first surgery will not allow laparoscopic surgery to get any results.
Let us get the proper diagnosis first.
Please give the feedback about the clinical evaluation and tests so that we can try to get the proper diagnosis and discuss further till you are cured.
I shall be happy to assist you.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you Doctor, I am seeing the urologist this week and will insist on the tests to be performed before any more medications
Brief Answer:
Yes, please.
Detailed Answer:
Please, let us see the results.
If possible get a ''second opinion'' of a General Surgeon too.
Awaiting for the reports.
Yes, please.
Detailed Answer:
Please, let us see the results.
If possible get a ''second opinion'' of a General Surgeon too.
Awaiting for the reports.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thanks
I have been avoiding my general surgeon since he only keeps telling me to give it time, give it time. Something is obviously wrong and he is not running any tests.
That's how i went to route of urology and my urologist. He also seems unwilling to run tests. In fact he said that MRI wont show anything since this is soft tissue!
Now i am wondering if i should see a different urologist as well as general surgeon for second opinions.
Do you think its necessary to see a urologist anymore or should i go straight to a second surgeon for his opinion?
I have been avoiding my general surgeon since he only keeps telling me to give it time, give it time. Something is obviously wrong and he is not running any tests.
That's how i went to route of urology and my urologist. He also seems unwilling to run tests. In fact he said that MRI wont show anything since this is soft tissue!
Now i am wondering if i should see a different urologist as well as general surgeon for second opinions.
Do you think its necessary to see a urologist anymore or should i go straight to a second surgeon for his opinion?
Brief Answer:
Second opinion of a XXXXXXX General Surgeon.
Detailed Answer:
I can understand the agony one is going through after such an incidence.
Alas, the Urologist would have known that the MRI is the best one for the soft tissues. You may contact a Radiologist at MRI center and ask if they can do MRI without a prescription from a Doctor.
I think it would be better to consult a XXXXXXX General Surgeon who might have faced similar problem in any of his patients (more the practice, more is the experience) and hence would help us to diagnose better and get investigated and treated too.
Second opinion of a XXXXXXX General Surgeon.
Detailed Answer:
I can understand the agony one is going through after such an incidence.
Alas, the Urologist would have known that the MRI is the best one for the soft tissues. You may contact a Radiologist at MRI center and ask if they can do MRI without a prescription from a Doctor.
I think it would be better to consult a XXXXXXX General Surgeon who might have faced similar problem in any of his patients (more the practice, more is the experience) and hence would help us to diagnose better and get investigated and treated too.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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