The point of my writing is to show that multiple and unnecessary surgeries can cause more damage then they are worth.

From the time I was 18 to 18 months ago (about 11 years total) I had chronic testicular pain on the right side. I went to my GP multiple times and was always given antibiotics, then I was upgraded to a urologist who would do nothing before giving me antibiotics and sending me for an ultrasound. (Canadian system in Ontario was very slow at the time and all imaging tests had to be done at hospitals) Had the ultrasound and then when back to the urologist (this takes months) then was scheduled for a right scrotal exploratory at which point they did an orchiopexy on the right. At my followup after surgery I was told I had a congenital structural abnormality and I should have a orchiopexy on the left just for safety. So I did that. Then about a year later the pain returned on the right side. Went back to the same urologist and this time other options where discussed like a nerve block, I wanted to know the reason for the pain (the structural abnormality I was diagnosed with causes intermittent torsion so that was why the orchiopexies where performed) This time the surgery was more extensive that the last time on the right, the incision was inguinal and large (from the base of the penis all the way to the belt line) painful recovery. A cyst was found and an orchiopexy revised.

3 surgeries in Canada, all where unnecessary as was the following on and off pain for the next 8 years.

The end of the pain came because the pain reached beyond my ability to function and control it. I saw a urologist at the clinic my wife was working at, again I was given antibiotics for 2 weeks after which point I was getting injections from my wife several times per day. (she is a doctor) Again I had ultrasounds (this time all at the same time by the urologist in the office) then I got a second consult from another doctor in the same office. They then sent me the next day to the hospital with the understanding that given my pain level surgery would be the only option again. At the hospital the urologist was initially wanting to send me home again with antibiotics (this was in Japan and my explanation of my symptoms and history was lacking, when my wife explained my history the response was better) I was in surgery the same day for what ended up being a simple right sided orchiectomy. Pathology did not show a reason for my pain, the structural abnormality that I was diagnosed with in Canada had mysteriously disappeared. So the surgeon (head of the department) wrote up my case as nerve damage caused by previous surgeries.

The moral of my story is that young men should seek second opinions and avoid surgery if possible. If surgery is inevitable seek a highly qualified surgeon and not one just out of qualification.

19 months and counting completely pain free. Still have the left one so hormones are ok. Sex is fun again.

Some men do function well with one but have regular labs done. Such as at your yearly physical and have your wife maybe comment if you "seem" ok as well. We don't often clue into our own symptoms of hormone issues as well as others.

Anyway congrats on resolving your pain problems!

Thank you for telling your story Wellesley. Very interesting.

Wellesley (imported) wrote: Mon Feb 09, 2009 11:16 pm The moral of my story is that young men should seek second opinions and avoid surgery if possible. If surgery is inevitable seek a highly qualified surgeon and not one just out of qualification.

19 months and counting completely pain free. Still have the left one so hormones are ok. Sex is fun again.

I think it goes further than that. My view of older and presumably more experienced Dr's is that generally they have been raised in the old school that nothing should be done in the way of an orchiectomy except for cancer control or where torsion has killed of the ball. It may be that the younger Drs are less brain washed and able to view the issues more objectively.

Also, bear in mind that Dr's are somewhat restricted from doing non approved surgical proceedures by Medical boards who are generally directed by the ancient members of the profession. However the younger Dr's personally may feel, they are also limited by controls put on them by these boards etc if they want to keep their licenses.

And also insurance matters if the patient is going to utilize his insurance coverage. Several months ago, my urologist did a biopsy on my testicles. One was removed from the scrotum and a section cut out. It was sewed up and put back inside and that sutured. The other testicle had a needle biopsy. Sounds simple and much like a castration on the one side but the total bill was about $20K. We ended up paying $55. But the insurance guys need pre-authorization so there is another hoop the doctor must go thru.

BTW, things have worked out so that he is going to castrate me soon- just working out all the details again. He also commented that removing the testicle(s) is easier than doing the surgical biopsy.

I think its of value to report back to your doctor after your surgery *Assuming it works for pain control and your pleased with the outcome. One of my doctors told me that he only heard from the patients who were unhappy with the outcome of their Orchiectomies and that this jaded his view of offering this as a solution.

If you have it done in a teaching hospital I think its also of value to allow students to talk to you and get feedback on your situation. Orchialgia is rare enough that most doctors don't have a lot of experience with it. And while it doesn't help us it might make it a little easier for the next poor slob.

Of course I think its of value to try the non surgical schemes first and give them a chance but... Its hard to understand how you can have pain from parts that are removed when all else fails.

I think older or younger doctors it "may" not matter much. Some go through a surgical board? Of some type to decide if they want to proceed and its a crap shoot when your getting advice from doctors who have never met you.

Do your homework. Bring some data that shows it is a valid treatment and be ready to be grilled on all the long term factors, fertility, hormones, etc. And don't take it lightly as these really are life changing things.

Wellesley,

Nice of you to relate your story for others. I too had inexplicible pain for years, although I dealt with it for almost 30 before finding a surgeon who would try.

My doctor was hesitant to do surgery , since the liklihood of curing pain with surgery was slim. We did one side at a time, and from the moment I recived the local anesthetic the pain was gone. The success was so great , much to my surgeons surprise, that we did the second side one month later.

It is a real joy to be pain free, and not having testicles is a total non issue for me.

Sex is once again a free ,and easy thing, and I have no fears of being bumped wrong , and having pain. HRT does a way better job than my testicles ever did, and I have no issues with performance even at age 50.

Having a surgeon who is well versed in the procedure is a very important step. No one that has not performed many orchiectomies should be doing so without the presence of a more qualified surgeon.

Even though my surgery was thru the scrotum, in a scan , the cord stumps are retracted way up into the abdomen, so there is no chance that they could adhere to anything. I distinctly remember her really pulling hard, in each surgery , so she could clamp and tie the cords very high up.

months and counting since the last surgery, and I could not be more pleased with the result. Pain free is a joy I thought I would never have again,

Ray

I think that curing chronic Testicular pain with surgery "can" be a poor choice but it greatly depends on what type of surgery.

Check out the following medical papers. And if your a patient with Orchialgia and have tried the non surgical treatments without success this is good information to use to avoid the types of surgery that rarely do work.

- Mr T

Management of chronic orchialgia of unknown etiology by Yamamoto M, Hibi H, Katsuno S, Miyake K.

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American Family Physician, July 15, 2003 by Anne D. Walling

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Chronic testicular pain: an overview. by Granitsiotis P, Kirk D.

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Analysis and management of chronic testicular pain. by

* Davis BE,

* Noble MJ,

* Weigel JW,

* Foret JD,

* Mebust WK.

"Of 15 patients who underwent inguinal orchiectomy 11 (73%) reported complete relief of pain, while 4 had partial relief."

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Chronic Epididymitis: A Practical Approach to Understanding and Managing a Difficult Urologic Enigma by J. Curtis Nickel, MD, FRCSC

"based on this experience, the authors recommended inguinal orchidectomy as the procedure of choice for testicular pain when conservative measures were unsuccessful."

Thank you for the replies.

It is a justification issue. 25% of cases seem to have no reason that the medical community can justify and those ones cause the problems. Or like my case that they blame it on a previous doctor or previous treatment.

I wonder if steroids would work. Having read more about autoimmune diseases now. I wonder if anyone has tried it. Women have endometriosis that behaves as an autoimmune disease would but not quite (my wife has that one) Because there is something visible on MRIs now women are acknowledged and given treatment and taken seriously. Before MRIs they got nothing really except disbelief. I tend to think there must be some kind of chemical of physiological reason that is not considered by most doctors.

Wellesley (imported) wrote: Fri Feb 13, 2009 11:53 pm Thank you for the replies.

It is a justification issue. 25% of cases seem to have no reason that the medical community can justify and those ones cause the problems. Or like my case that they blame it on a previous doctor or previous treatment.

I wonder if steroids would work. Having read more about autoimmune diseases now. I wonder if anyone has tried it. Women have endometriosis that behaves as an autoimmune disease would but not quite (my wife has that one) Because there is something visible on MRIs now women are acknowledged and given treatment and taken seriously. Before MRIs they got nothing really except disbelief. I tend to think there must be some kind of chemical of physiological reason that is not considered by most doctors.

Guess it would really depend on the situation, if you use steroids it may atrophy the testicles however I have heard in some with infections such as Orchitis of the testicles it does not help a whole lot. It sometimes may cause the testicles to swell more in cases of bacterial Orchitis of the testicles resulting in continued pain.

It depends on the specific paitne himself and the situation as well as the reason and possible cause of the pain.