Patient's Query
Hello doctor,
I would like to ask for your opinion regarding my current condition. I have persistent swelling in the scrotum that becomes more obvious when standing, along with pain radiating from the testicle to the groin and up to the left kidney region. I had two previous surgeries for varicocele and testicular exploration, but the symptoms are still present. Below are the summarized results of my recent investigations:
1. Laboratory findings:
CBC: Platelet count mildly low (thrombocytopenia), otherwise normal blood counts.
Urine analysis: Presence of white blood cells and bacteria → suggestive of urinary tract infection or epididymitis.
Renal function tests: It is within normal range.
2. Scrotal ultrasound findings:
Right testis: Normal size and texture, no masses or lesions.
Left testis: Normal size and texture, no masses or lesions.
Left epididymis: Enlarged, containing a sac of sperm (23×12 mm) showing "dancing sperm sign" → Spermatocele.
Right epididymis: Abnormal enlargement with signs of inflammation and surrounding fluid (epididymitis suspected).
Tunica vaginalis: Mild bilateral hydrocele (more on the right side).
Veins: Mild left-sided varicocele (Grade I to II, ~3.5 mm, no reverse flow on Valsalva).
3. CT abdomen findings:
Liver, spleen, pancreas, gallbladder: normal.
Right kidney: Normal size and density.
Left kidney: Smaller in size (7.5 × 4 cm), but normal density and parenchymal thickness, no stones or dilatation.
Urinary bladder: Normal.
Other findings: Left inguinal hernia with fat seen in the canal (neck ~11 mm).
No ascites, no enlarged lymph nodes.
My questions:
1. What is the main cause of my ongoing swelling and pain?
2. Could the small left kidney or the inguinal hernia be contributing to the pain?
3. Do I need another surgical intervention (for hydrocele, varicocele, spermatocele, or hernia), or can these be managed conservatively?
4. What treatment plan would you recommend for infection control, pain relief, and long-term management?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I went through your reports carefully. You have multiple things going on together – mild bilateral hydrocele, spermatocele on the left, epididymitis changes on the right, mild varicocele left side, and also an inguinal hernia noted.
Add to that, you have a urinary infection on laboratory examination, which can flare the epididymis and cause pain radiating to the groin. The small left kidney by itself is not causing pain unless there is an infection, but the hernia and epididymal inflammation can definitely give you persistent swelling and dragging-type pain.
The probable causes:
Mainly infection-related epididymitis, plus existing hydrocele or varicocele and spermatocele, are contributing to swelling.
A hernia can also add to the groin heaviness.
Investigations to be done:
Repeat urine culture and sensitivity (to choose the exact antibiotic).
Semen analysis if fertility is a concern.
Follow-up ultrasound after infection settles (to reassess epididymis and hydrocele).
Surgical consult for inguinal hernia.
Differential diagnosis:
Chronic epididymo-orchitis.
Post-surgical scarring with congestion.
Hernia-related scrotal pain.
Probable diagnosis:
Mixed scrotal pathology with epididymitis, hydrocele, and spermatocele.
Treatment plan:
Treat the UTI (urinary tract infection), or epididymitis first with culture-guided antibiotics (oral, 10 to 14 days usually).
Anti-inflammatory and scrotal support to reduce pain and swelling.
Adequate hydration.
If a hydrocele or spermatocele remains symptomatic after infection control, surgery can be considered (hydrocelectomy, spermatocelectomy).
Hernia should ideally be repaired if it is symptomatic, because it would not resolve on its own.
Varicocele is mild with no reflux, so usually no need to touch again unless you have fertility issues.
Regarding follow-up:
Please upload your urine culture report once available, and also let me know if fever or increased redness appears.
After antibiotics, a repeat scan will help decide if surgery for a hydrocele, spermatocele, or hernia is needed.
I would also suggest a follow-up with a urologist for hernia and testis-related concerns.
Preventive measures:
Avoid heavy lifting and straining (will worsen hernia/varicocele).
Use scrotal support during prolonged standing.
Treat infections promptly.
Regular follow-up imaging if symptoms persist.
I hope this information will help you.
Kindly follow up if you have more concerns.
Thank you.
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