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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Urologist
Category: Urology
Satisfied Customers: 45145
Experience:  MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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I seem to have a case of chronic inflammation on the left

Customer Question

I seem to have a case of chronic inflammation on the left epididymis. Which is the cause of epididymitis 5 years ago.The infection was gone after taking antibiotics for 4 weeks. The ultrasound showes that the infection was clear.Then 2 years later on a random day I felt a sharp pain when ejaculating and a few hours later I started feeling tingles in my scrotum. After another scan it was clear that there was inflammation.I was given a course of trimethoprim and the inflammation went. 6 months later it happen again and I was again given antibiotics. Since then and now for 3 years I have this happen 2/3 times a year.Although, this last time it doesn't seems to go away. I have tried all kinds of anti biotics for 2 weeks with breaks inbetween.I have had arguments with urologists that my testicles seem to shrink everytime this flare up happens. I was told that it was psychological.But I did a scan privately in November 2018. This october 2019 I saw another urologists who has sent me for another ultrascanAnd the results in comparison are below2018R = 3.51 x 2.17 x 3.99L = 3.97 x 2.07 x 3.032019R = 4.1 x 1.9 x 3.1L = 3.7 x 2.1 x 2.4These are in centimetres. Is this normal ? The left testicle shrank by like .64 of a cmMany thanks
Submitted: 8 days ago.
Category: Urology
Customer: replied 8 days ago.
2018 report
Customer: replied 8 days ago.
2019 report
Customer: replied 8 days ago.
I converted the 2019 report measurements from mm to cm
Expert:  Dr. Arun Phophalia replied 8 days ago.

The difference in size is not considered significant as two ultrasound machines and tow operators can put the cursors on the film at different places, which can lead to calculation change by the ultrasound computer.

Customer: replied 8 days ago.
understood doctor. In your expert knowledge is the testicular volume normal.

what do you suggest I do? cause antibiotics aren't working anymore and the urologist I saw says I just have to live with it
Expert:  Dr. Arun Phophalia replied 8 days ago.

The testes volume is normal.

There may be concomitant prostatitis which can give referred pain/symptoms to testes and epididymis.

You may get the following investigations;

1) A digital rectal exam by the doctor would elicit tenderness on the prostate.

2) A urine culture

3) Semen culture

4) Culture of prostate fluid after prostate massage expressed from the penis.

The culture tests not only confirm the infection and causative organisms but also tells about the most efficacious antibiotic to treat it.

 

Customer: replied 8 days ago.
I am afraid I have done all the above. prostate has been looked at by 2 different doctors and all is well.

one thing I remember that I can mention is that when this happens my testicles rise very high.

the right testicles will rise into the public bone. when I either have to push it down slowly or wait for it to come down after a minute or so
Customer: replied 8 days ago.
The symptoms only returns after ejaculation. it's not always it just happens randomly.
Expert:  Dr. Arun Phophalia replied 8 days ago.

This is called retractile testes. Retractile testes can be fixed surgically.

You may get an MRI of the testes and prostate which is the best investigation to asses them.

Customer: replied 8 days ago.
understood, but I thought that retractile testes would would retract and random times of the day?

this only happens during ejaculation. I know rising testicles are normal in ejaculation. but at these measures only after I had the infection that this started happening
Customer: replied 8 days ago.
the sharp pain is random when ejaculating it can happen today then I take antibiotics then it will happen again in a few months then antibiotics and there forth.
Customer: replied 8 days ago.
my right testicle does not hang as low as it used to either. I did have atrophy due to the lack of blood flow when I had the infection 5 years ago
Expert:  Dr. Arun Phophalia replied 8 days ago.

As discussed, the persistent chronic symptoms will require MRI for the evaluation as the next step.

You would also require semen culture for the mycobacterium, which needs a specific culture medium.

It seems you have anxiety disorder too which can affect overall the intensity, severity and frequency of the symptoms (secondary to hormonal changes in the body).

Customer: replied 8 days ago.
I did a semen test 4 years ago in order to check the flora and I was given specific anti biotics before I tested again and all was clear after.

I will try and get the MRI done and hopefully something is spotted
Customer: replied 8 days ago.
apologies for the multiple messages. I am just trying to remember as much detail to assist.

I have actually made peace with the issue. I would just like to get a concrete answer. I actually don't really think about it until it happens so I would like to believe that anxiety is not an issue.
Expert:  Dr. Arun Phophalia replied 8 days ago.

MRI is likely to give an answer to the persistent/chronic issue.

Wishing you a speedy resolution and all the very best in life.

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Expert:  Dr. Arun Phophalia replied 8 days ago.

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