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Ultrasound shows large epididymal cyst in left testicle. Will I have testicular torsion in future?

DOCTOR OF THE MONTH - Oct 2013
Oct 2013
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my age -32 , sex- male.

sir, I have done two different ultrasound of the scrotum by two different doctors the reports of which are attached with this. (one in April 2013 and another one in September 2013).

In the ultrasound which was done in last April there has been mentioned about a large epididymal cyst in Left testicle and a small epididymal cyst in right testicle. But in the ultrasound report of last September it has not been mentioned about the small epididymal cyst in right(although it detected the left epididymal cyst like last report). Sir is the small cyst is undetectable or it has been gone automatically or the report may not be proper ???

Sir, can ultrasound predict that whether one person can or can't have testicular torsion in future ??? If so then can I have testicular torsion in future based on these reports???

Since some days I often have a habit to pull my scrotum a bit forward by stretching it from the skin attached to right testicle when I go for sit/walk/sleep etc. Can it cause testicular torsion ??? can my such activity affect the fluid around the right testicle or by making any other change which can change the phenomena of not having testicular torsion which can be predicted by the previous ultrasounds ??? I have left this activity since last night when I felt pain in my right testicle while asleep and wake up due to it. The pain was like as if striking my testicle by finger tip repeatedly after an interval of 10/12 seconds. After 3/4 minutes the pain disappeared automatically . sir, is it testicular torsion or some other serious condition ?

I consulted one urologist in my locality. After hearing these symptoms . He said that this is not testicular torsion and nothing to worry about. But he didn't examine me physically only he saw my ultrasound report which was done on 28/09/2013 ( much before this incident which happened to me last night). He told me that no treatment is required for now. I have also attached his prescription with this query.

I am suffering from asthma for which I take Montek LC tablet daily. Can I take the prescribed medicines (Decet BD and Levotec 500) with Montek LC ???

I intend to learn martial art in future and may do physical exercise. Am I allowed to do so (I afraid if I am more prone to testicular torsion after this incident then I may not be allowed for learning martial art or doing physical exercise)

Hope U will be kind enough to help me.
Posted Sun, 10 Nov 2013 in General Health
 
 
Answered by Dr. Namala Bharadwaj 1 hour later
Brief Answer:
very less chances of torsion, hard to predict it

Detailed Answer:
hello dear
thanks for your query at XXXXXXX
i understand your concern.
i have seen your reports of the ultrasound even the first scan mentioned about left cyst in impression although mentioned right cyst in findings.
right cyst might have been very small around 2x2 mm size that might have missed in next scan because of its small size or may be location.
its very hard to predict development of testicular torsion just based on ultra sound findings.
there are some case reports of large epididymal cyst leading to torsion testis, but in very rare occasions. testicular torsion is acute condition its very hard to predict that.
but there are some abnormalities that could lead testicular torsion like
1 inversion of the testis in this testis is rotated
2 high investment of tunica
3 sepearation of epididymis from testis.
but these findings are not clearly found on ultrasound
as far as streching of skin is concerned it does not lead to testicular torsion or change in testis. the pain might be because you might have touched testis that is very very sensitive to external stimuli that might have caused pain.
if pain have subsided nothing to worry,
if pain reccur with more severity then you might require repeat ultrasound.
you can take medication prescribed by urologist and also your asthma medication.
as far as physical activity is concerned you can have physical exercise and martial art training under expert guidance or trainer.
hope i answered all your query.
if any query is there with you , you can ask me in follow up question,
regards
Above answer was peer-reviewed by
 
Follow-up: Ultrasound shows large epididymal cyst in left testicle. Will I have testicular torsion in future? 34 hours later
My age- 32 years , sex- male
thank u sir,
Sir my symptoms which I have suffered in that night (I felt pain in my right testicle while asleep and woke up due to it. The pain was like as if striking my testicle by finger tip repeatedly after an interval of 10/12 seconds. After 3/4 minutes the pain disappeared automatically). Sir can it be intermittent torsion and de-torsion.(Twisting and untwisting) ???

If so then am I having any chance of testicular torsion in future ??? (I have heard that history of intermittent torsion and de-torsion.(Twisting and untwisting) increases the chance of testicular torsion in future ).

Is there any test to determine whether I have suffered intermittent torsion and de-torsion.(Twisting and untwisting) in that night ??? (although it may has been back to normal position now). Or it can be determined whether it is intermittent torsion and de-torsion.(Twisting and untwisting) just by listening the symptoms which I have suffered ??? (The local urologist to whom I consulted didn’t examine me physically and ruled out any serious condition and also said that no test is required for now).

If there is any test to determine about my past intermittent torsion and de-torsion.(Twisting and untwisting) , then what is that test and where it can be done ???

Hope U will be kind enough to clear m doubts. Thank U sir.
Follow-up: Ultrasound shows large epididymal cyst in left testicle. Will I have testicular torsion in future? 1 hour later
My age- 32 years , sex- male
thank u sir,
Sir my symptoms which I have suffered in that night (I felt pain in my right testicle while asleep and woke up due to it. The pain was like as if striking my testicle by finger tip repeatedly after an interval of 10/12 seconds. After 3/4 minutes the pain disappeared automatically). Sir can it be intermittent torsion and de-torsion.(Twisting and untwisting) ???

If so then am I having any chance of testicular torsion in future ??? (I have heard that history of intermittent torsion and de-torsion.(Twisting and untwisting) increases the chance of testicular torsion in future ).

Is there any test to determine whether I have suffered intermittent torsion and de-torsion.(Twisting and untwisting) in that night ??? (although it may has been back to normal position now). Or it can be determined whether it is intermittent torsion and de-torsion.(Twisting and untwisting) just by listening the symptoms which I have suffered ??? (The local urologist to whom I consulted didn’t examine me physically and ruled out any serious condition and also said that no test is required for now).

If there is any test to determine about my past intermittent torsion and de-torsion.(Twisting and untwisting) , then what is that test and where it can be done ???

Is there any test to determine whether I have Bell Clapper deformity or not ???

Hope U will be kind enough to clear m doubts. Thank U sir.
 
 
Answered by Dr. Namala Bharadwaj 13 hours later
Brief Answer:
clinical symptoms are important than imaging

Detailed Answer:
Hello dear,

Intermittent testicular torsion (ITT) which is characterized by recurrent rapid acute onset of pain in one testis which will temporarily assume a horizontal or elevated position in the scrotum similar to that of a full torsion followed by eventual spontaneous de-tortion and rapid solution of pain. Nausea or vomiting may also occur, this is typical presentation of the intermittent testicular torsion. pain you have experienced might be this , cannot be ruled out.

Yes there are chances of complete torsion of the testis in patients with intermittent testicular torsion, some literature says up to 10 % chances are present.

Imaging studies are often misleading, as the intermittent testicular torsion may resolve before imaging, but changes caused by ischaemia are detectable. Ultrasonographic findings of decreased blood flow, hyperechogenicity and hydrocele . Testicular nuclide scanning may show hypervascularity soon after spontaneous detorsion, but other inflammatory processes, e.g. epididymo-orchitis or infarction of a testicular appendage, can give a similar appearance.

So imaging studies can help to predict previous attack but sensitivity is very low, similar changes can be found with other diseases also.

Symptoms are very typical for this condition than any imaging procedure.
The finding of the horizontal lie of the testis in association with intermittent torsion is thought to result from abnormal intrascrotal attachments of the testis (the so-called ‘bell-clapper’ deformity); this deformity describes a condition in which there is an abnormally high attachment of the tunica vaginalis to the spermatic cord, a long mesorchium, and a lack of the normal posterior attachment to the tunica vaginalis . Without proper attachment of the testis, epididymis and distal spermatic cord to the tunica vaginalis, the entire unit can twist in the intravaginal space and result in the horizontal lie and/or torsion.

So physical examination has very high sensitivity and specificity in determining the bell clapper defect no need for imaging studies. A good physician can identify defect without help of any imaging procedure.

I hope that this time I have provided you complete details regarding your query.
I answered your each and every query in detail so that your question are answered in proper way to clear all your doubts.
Regards
Above answer was peer-reviewed by
 
Follow-up: Ultrasound shows large epididymal cyst in left testicle. Will I have testicular torsion in future? 32 minutes later
thank u sir. sir If I will be examined after 7/8 days of torsion and detorsion then can it still be revealed that whether or not that incident was torsion detorsion or not ?

I didn't have nausea or vomiting in that night.
I am presently taking the medicines which was prescribed by the local urologist.
Then what should I do now ? I am much afraid of torsion in future. I want to practice martial art and want to live like a normal person without having any fear for future torsion. then what to do now sir ? Please advise me. thank u.
 
 
Answered by Dr. Namala Bharadwaj 9 minutes later
Brief Answer:
Recommend good clinical examination

Detailed Answer:
Hello dear

Thanks for your immediate response to my answer.

Ultrasound and nuclear scan can help you with previous episode but as i mentioned above there are very less specific to disease.

There are some disease where lab data will not be of much help , instead clinical examination would be quite useful.

My recommendation is consult general surgeon so that doctor can examine and determine the extent of any deformity like bell clapper one and advice on further management like surgery.

Most of the studies have mentioned that surgery can be quite helpful in these condition and more over importantly they will reduce any future recurrence of these attacks.

Once you go for surgical option you can live normal life and you can practice martial arts your dream.

Hope I have answered your query.


Regards
Above answer was peer-reviewed by
 
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