Resolved question:
After a month of continuing, persistent mostly right (but occasionally left) testicular pain, an internist tried me on Ciprofloxacin for 7 days, which had no effect. Subsequently, a testicular ultrasound revealed a 6mm epididymal cyst on the left side and a 4mm epididymal cyst on the right side. The pais usually about 2-4 out of 10, but always sufficient to deter me from sex. I have not ejaculated in a month, and have a bit more pain immediately following any momentary arousal.
My urologist, who doesn't seem to be the most competent, has told me to try a 7 day "therapeutic regimen" of Ibuprofen 800mg (3x a day). According to him, there's an "85% chance" that this will cause the fluids within these cysts to be reabsorbed by the body. I can find no support for this contention on the internet, and do not like the idea of taking such a high dose of ibuprofen. Also, I'm not even noticing any particular change in the pain symptoms. According to the urologist, I should likely have surgery to remove these "spermatoceles" if the one-week Ibuprofen regimen fails.
So,here is my two-part question: 1) Is there support for the notion that Ibuprofen 800mg (3x a day for 7 days) can somehow eliminate fluid from symptomatic spermatoceles, so they become asymptomatic? 2) Should surgery really be my next step to permanently eliminate pain, or is there something else I should try first?
Submitted:
4 Days
Category:
Urologist
Hello,
Thank you for your consult at DoctorSpring.com.
Ibuprofen shall not help to decrease the size of cysts. However, it can certainly reduce the inflammation, reduce the pain and thus improve your symptoms for a considerable duration of time. You should continue yourself on ibuprofen.
Surgery for such small cysts is not desirable. There is a good possibility that the pain shall persist even after the surgery. I want you to use scrotal support and start yourself on amitryptline under the care of your doctor. Surgery for epididymal cysts should be earned. If your pain does not subside even after all conservative measures then only you should consider surgery as an option.
Hope this helps, please feel free to discuss further.
Take care
Sincerely
Dr Rajiv Goel
MS (AIIMS), MCh (AIIMS), DNB ( Uro)
Fellow, Urooncology and Robotic urology, Australia
Fellow, Laparoscopic urology, Germany
Consultant Urologist
Thank you, Dr. Goel! Following-up on your advice, I'm concerned about high dose Ibuprofen due to stomach bleeding, stroke, and heart-attack risks. I also have a remote medical history of colitis, in remission. What Ibuprofen regimen (or alternative anti-inflammatory regimen) would you recommend on a permanent basis?
Given that Amitriptyline is an anti-depressant, can you tell me what you hope this might ultimately achieve in combination with continued Ibuprofen?
Can you explain why there is so much "back and forth" with the mildly recurrent pain, from one testicle to the other? This sensation makes me wonder whether a bacterial infection of some kind has not been properly ruled out. Perhaps that's wishful thinking on my part, as I dream of an easy fix. That said, I am a monogamous man in a 6 year marriage with no STDs.
If I follow all suggested conservative measures, how likely is it that my pain will ever dissipate to the point I can have a normal sex-life, and what kind of timeline do you think I can expect?
Going on a long plane trip to Malaysia (wife's homeland) in mid-December. Worried about prolonged sitting on a flight.
Thanks again for your thoughtful reply,
Paul
Hello,
You should take ibuprofen or 5-7 days and such short duration of ibuprofen shall not cause you any major side effects or the remission of your ulcerative colitis.
Amytriptyline is an antidepressant but it is a neuromodulator also working at the level of spinal cord and improves a lot of unexplained pains and is one of the proven and efficacious methods of controlling the pain.
I believe that your urologist has not done your prostate examination. Kindly get per rectal examination to rule out prostatitis. Kindly rule out prostatitis as prostatitis patients also can experience similar symptoms and the treatment is entirely different. You don't seem to have STD's; stop worrying about them.
With conservative measures the symptoms usually settle in 1-2 weeks and I believe you shall be in position to travel to Malaysia.
My apologies for the exceptional delay with the reply, Take care.
Sincerely