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Had orchiectomy. Ultrasound revealed cysts on vas, epididymal remnant and granulomas and inguinal hernia. Suggestion?

In 1978 I had a left side orchiectomy at aged 17. Since then have always had lumps on the vas and a squashy mass at the cut end. Ever since I have had no problems other than a temporary dull pain after sex or masturbation but nothing to cause major concern for 35 years. However, since December last year these have been painful and the pain has been getting worse and constant. My GP sent me for an ultrasound scan which revealed cysts on the vas, epididymal remnant and granulomas at the cut end. These are now painful, especially when touched, they feel tight and twisted together, giving me constant pain. One of the lumps is enlarged. The ultrasound also revealed a small inguinal hernia on that side. I didn t know I had this. The other side of wedding tackle is fine. I experience no additional groin pain when lifting or twisting. A private self pay urologist has already recommended straightforward surgery. An incision in the groin, cut the vas which is not connected to anything useful, away. In the process he can pull back the hernia into place, gauzing it if necessary. I cannot afford the cost, however, so am on the NHS (publicly funded healthcare system). Now here s the problem. The urology department want the general surgery department to operate the hernia, and cut the vas as a favour. The general surgery department want the urology department to cut the vas and pull up the hernia themselves. This is the nature of the public healthcare system in England. Is there any separate operation that I can request of these two eminent clinicians? Ideally I d like the painful lumps removed and examined in case of anything more sinister. If hernia fixing is important I can address that later. Have been in chronic (will persist until operated upon) pain for four months. I suspect the private urologist I originally saw was the expert judging by this price list, and the two NHS chaps are juniors doing a budget ping-pong with me. Surely there must be a separate procedure I can ask my GP to request ?
Asked On : Sun, 10 Mar 2013
Answers:  2 Views:  98
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Gastroenterologist, Surgical 's  Response

Thanks for writing in and the detailed information

The only option that you are left with if you have to go for NHS, is that you need to ask them to remove the remnants of vas as the Granuloma may be the culprit

Hernia management can be done at a latter date if that is not causing you problems individually at this stage

Hope this helps
Do write back in case of concern
Answered: Tue, 6 Aug 2013
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General Surgeon Dr. M Y Shareef's  Response
Hi ! It will be ideal to remove the portion of the vas which has developed some cyst/granuloma at its end and send the cut portion for a histopathological study by the surgeon. The pain what you have could either be due to the pathology at the cut end of the vas or could also be due to the stretching of the peritoneum (inner fascial covering of the abdomen) by the developing unsuspected inguinal hernia. Both the hernia, and the excision of the portion of the cut end of vas with the said pathology for biopsy purpose can be dealt by the team of general surgeon itself. It is not such a specialized urological problem to be dealt by urologist only. However, I am not aware of the health care system in your location, and so you may have to discuss with your family physician keeping in view the constraints of your NHS. Wishing you an early recovery.
Answered: Wed, 7 Aug 2013
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