Mystery Pain of 6 Years

[eunuch2001 (imported)]

Well The doctors are still not listening. I have gotten a refural to the urologest I saw last to ask him to remove my balls again and if not. they get removed by a bander on the 19th. I have to do something. this pain is just ruining my life. I have to so something about it.

I know from reading your posts on here how desperate you are to resolve this issue, but I beg you to think very carefully before banding. I used that method in 2001 and got really close to death. My nuts and sac had to be removed in an emergency operation and I was also treated for a gangrene infection. I would not want that, or worse, to happen to you.

[DavidB (imported)]

Hey Gareth:

I would agree that one should deffinetly try to find if certain things trigger more pain, my Doc told me the same thing about avoiding the same things, I am very glad that worked well for you. But as they say your milage may vary. In my case removing all of those, which to be honest wasnt a big deal, never smoked, and not a big drinker, didnt effect the level of pain.

the only thing that helps is hot showers, but that may be symptomatic for me becasue hot showers have always helped me with any kind of pain i am having.

Very glad to hear though that you are able to manage it.

[SharakoLunarWolf (imported)]

Well I went to the urologist and leveled with him. He was quite understanding and Is going through with the process to remove my testicles. I will get a call tomorrow to set up a standard Physiological evaluation and then I will talk with another urologist, whom will most likely be doing the procedure. Things are going better with the doctors, and I will not be getting banded. Sorry I didn't respond much to the other posts. I feel like I have tried everything I am willing to. I don't drink, smoke or have lots of caffeine. but any who. I will keep you guys updated. I hope to be done with this soon.

[eunuch2001 (imported)]

Hi Wolf

Seems you have the doctors on your side at last and I'm really relieved you won't be banding. I look forward to hearing good news from you in the near future.

Very best wishes.

[Riverwind (imported)]

I had pain for years, felt like I was being kicked in the nuts 6 to 8 times a day. I finally got castrated, it was right for me and I have no regrets

River

[SharakoLunarWolf (imported)]

Yeah I think being neutered is right for me to. I am just glad I was given the medical option to have it done by professionals.

[SharakoLunarWolf (imported)]

The Phycological evaluation went well. The shrink pretty much said if I was at my last option I was at my last option and it sounds like I will be able to be pain free soon. I see the urologist again this Friday to talk over the results of the mental exam and all is hoping seclude an appointment for the procedure.

[Milkman (imported)]

Congrats on getting close to your goal!!

[Riverwind (imported)]

I am very late coming into this thread but I too suffered for years with pain, it

felt like I was being kicked in the nuts

5 or 6 times a day. I understand what your going through and there is a wonderful life after castration, I am not totally pain free now I get a pain much less then before and only once every couple months.

I wish you the best and hope this works for you, it has for me.

River

[mrt (imported)]

It sounds like you did well with the eval. Here is a copy of the Orchialgia Playbook which (I think) details all the standard steps. If you've missed any it might be worth taking a step back and getting it covered so you don't go into the OR with any second thoughts or regrets.

# Take Patient History

1. Characteristics of Testicular Pain

1. Duration of pain (chronic defined as > 3 months)

2. Location of pain

3. May be unilateral or bilateral

2. Associated urologic symptoms

1. Hematuria

2. Hematospermia

3. Dysuria

4. Erectile Dysfunction (Impotence)

3. Previous urologic surgery

1. Vasectomy

2. Genital trauma

3. Prior Hernia Repair

4. Comorbid conditions

1. Major Depression

# Seek Causes

1. Idiopathic in 25% of cases

2. Intermittent Testicular Torsion

3. Post-genitourinary surgery

4. Sperm granuloma (post-Vasectomy)

5. Varicocele

6. Testicular Cancer (painless in 60% of cases)

7. Genitourinary infection (e.g. STD)

# Evaluation

1. Assessment for Acute Testicular Pain is critical

2. Assess for referred pain

1. Nephrolithiasis in the mid-ureter (most common)

2. Radiculopathy

1. Genitofemoral and ilioinguinal nerves (T10-L1)

2. Causes

1. Inguinal Hernia

2. Radiculitis

3. Entrapment Neuropathy after Hernia Repair

4. Sperm granuloma

# Signs

1. Complete Male Genital Exam including rectal exam / DRE.

# Labs

1. Urinalysis

2. Urine Culture

3. Expressed Prostatic Secretions when indicated

4. Gonorrhea and Chlamydia cultures

# Radiology

1. Ultrasound with color flow doppler of scrotum

2. Consider Spiral CT abdomen or intravenous pyelogram

# Management

Step 1 (Basics)

1. NSAIDs

2. Adjust posture if due to radiculopathy

3. Empiric antibiotics for 2 weeks or more

a. Cover Chlamydia and Ureaplasma

b. Doxycycline

c. Ciprofloxacin

Step 2 (Nerve Blocks & Tens)

1. Spermatic cord block at pubic tubercle – use either

a. Bupivicaine (Marcaine) 0.25% 3 ml and

b. Methylprednisolone 40 mg

*Note: Inject no more often than once monthly

2. Trascutaneous Electrical Nerve Stimulation (TENS)

Step 3 (Meds and Psychotherapy)

1. Multidisciplinary Pain Management

2. Antidepressant medication

3. Psychotherapy

4. Nerve meds or Anticonvulsants (Lyrica)

Step 4: (Urologic Surgery)

1. Inguinal Orchiectomy

2. Surgical denervation Testes along spermatic cord