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Suggest treatment for cyst near testicle and low lying scrotum

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Posted on Thu, 28 May 2015
Question: Hi, I am a 26 year old male and was diagnosed with epididymitis about seven years ago. My left testicle had been swollen for some time and in a lot of pain. After going to the ER, I took an antibiotic which relieved both the swelling and the pain. However, there remains a cyst (about the size of a flattened pea) on the back of the testicle and that testicle 'hangs lower.' Off and on over the past few years, I will feel discomfort (not necessarily pain) in that area--specifically the left testicle and into my lower abdomen. At one point about a year ago, the testicle seemed to harden and I was in quite a bit of pain and almost went back to the ER. However, the pain subsided and has not returned to that level since then. The discomfort still comes and goes though and is focused on the left side--both at the testcile and above. My question is: should I be concerned? Is this something I just have to deal with? I would like more information on what exactly is going on.

doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
This is something you should be concerned about,

Detailed Answer:
Hi.
Thank you for your query and a clear history.
I have read and understood your issue.

Allow me to recapitulate :

You are a Male / 26 y/o .Who has suffered with Epididymitis for 7 years. There is history of pain and swelling of the left testicle which was settled with medication.

As a complication, though, a cyst remains and one testicle hangs lower. There is intermittent discomfort in this testicle as well as parts of the lower abdomen. Approximately 1 year ago there was hardening and pain bac,k but not again - discomfort still comes and goes in testicle and above -

To answer your question :
Yes you should be concerned.
With proper guidance you can get a cure.

On clinical grounds, with the history you have given, this looks to be a case of :
Chronic Epididymo-orchitis,

This Needs further evaluation:
1) Clinical evaluation and examination by an Urologist or a General Surgeon.
2) Color Doppler and Ultrasonography of the abdomen and scrotum, MRI if available and possible.
3) X-ray of the chest
4) Mantoux, to rule out TB
5) Tests of blood : CBC, ESR, urea, creatinine, Gold Quantiferon for TB,
6) Urine :routine, microscopic, culture and sensitivity.

All these will help to come to a diagnosis and can give plans for proper curative treatment.

Please give me some details
Are you Married? Kids?
Previous reports, opinions, treatments. Any information would be useful.

I hope this will help us to get a diagnosis.

Please give feedback, ask relevant queries if you need to or if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. T Chandrakant (9 hours later)
Dr. Chandrakant,

Thank you for your response. Very helpful. Real quick I wanted to clarify about what I meant when I said my pain extends up to my lower abdomen. It remains confined to my pelvic area--specifically the epididymis. I wanted to convey that there is discomfort that goes above my scrotum but so far it seems to mainly be where the epididymis is located. I rushed in my explanation. My apologies.

Urination is unaffected. No discoloration or blood. Never has been. No fever or any other symptoms as well. While I am not at all a doctor, tb does seem to be unlikely mainly because there are no other symptoms that would indicate such a diagnosis. I could be wrong.

I have not sought medical treatment for this in seven years. When I did, the urologist diagnosed it as epididymitis. I believe the only medicine I took was the antibiotic--do not remember the name.

On occasion, the discomfort comes in slight palpatations near where the epididymis is (or maybe slightly above). It is rythmic, almost like a heartbeat. It doesn't hurt but I do feel a bit uncomfortable when it happens. It will come and go for an hour or two and then go away and not happen for a long time.

I am married. No kids. I am 5 foot 9 inches, 135 pounds. Fairly thin build. I am active a lot and almost always, my activity does not affect the scrotum's discomfort. My wife and I have sex about every other day. There did seem to be a bit more regularity in the discomfort when we got married compared to beforehand. Not necessarily worse, but just a bit more often. I would also notice that my left testicle would have a bit more difficulty than my right testicle "elevating" during sex. I assume this was due to the cyst and it taking a bit longer to get in position.

Hopefully this helps. I really appreciate you helping me out.

doctor
Answered by Dr. T Chandrakant (13 hours later)
Brief Answer:
Ultrasonography with color doppler and Examination by Surgeon.

Detailed Answer:
Hi.
Thanks for your feedback.
Understood the area of discomfort or pain mainly at epididymis but also goes above scrotum .

Agreed, TB may not be the diagnosis at all, but this is by exclusion that it should be ruled out in all cases of chronic epididymitis, this is sort of a protocol which helps. Hence I suggested.

So at least go for a color doppler and ultrasonography of the area as you have symptoms and a local examination done by a General Surgeon or an Urologist.
This may help you to get a final diagnosis and possibly symptom-free life by proper treatment. Please give the feedback of the clinical evaluation and the investigations.

Let the problem be diagnosed and treated for ever to have great life.




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

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Practicing since :1984

Answered : 19465 Questions

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Suggest treatment for cyst near testicle and low lying scrotum

Brief Answer: This is something you should be concerned about, Detailed Answer: Hi. Thank you for your query and a clear history. I have read and understood your issue. Allow me to recapitulate : You are a Male / 26 y/o .Who has suffered with Epididymitis for 7 years. There is history of pain and swelling of the left testicle which was settled with medication. As a complication, though, a cyst remains and one testicle hangs lower. There is intermittent discomfort in this testicle as well as parts of the lower abdomen. Approximately 1 year ago there was hardening and pain bac,k but not again - discomfort still comes and goes in testicle and above - To answer your question : Yes you should be concerned. With proper guidance you can get a cure. On clinical grounds, with the history you have given, this looks to be a case of : Chronic Epididymo-orchitis, This Needs further evaluation: 1) Clinical evaluation and examination by an Urologist or a General Surgeon. 2) Color Doppler and Ultrasonography of the abdomen and scrotum, MRI if available and possible. 3) X-ray of the chest 4) Mantoux, to rule out TB 5) Tests of blood : CBC, ESR, urea, creatinine, Gold Quantiferon for TB, 6) Urine :routine, microscopic, culture and sensitivity. All these will help to come to a diagnosis and can give plans for proper curative treatment. Please give me some details Are you Married? Kids? Previous reports, opinions, treatments. Any information would be useful. I hope this will help us to get a diagnosis. Please give feedback, ask relevant queries if you need to or if you feel that there is a gap of communication.