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Patient's Query
Hi doctor,
I need an opinion. A sonographer who does my testicle ultrasound suggested a varicocele on my left testicle. This is not on the surface of the testicle. Still, I circled in the picture where the veins or cords are. They are very hard pea size lumps and firm - I saw a urologist he was not concerned. The largest size looks like 0.19 inch. There are around four or five of these; I can not squeeze them as they are firm. Do varicocele present like this, or could this be something more sinister? They are asymptomatic.
Hi,
Welcome to icliniq.com.
I understand your concern. The hard, uncompressible, and round structures are sebaceous cysts in the scrotal wall or skin. The radiologist saw dilated veins on the cord inside the wall, which you can not see. But, of course, varicoceles are dilated vines and are compressible. So there are two different things there, and each treatment is different. First, the hard cysts of the skin should be surgically removed, and the varicocele should be ligated with a microscope through a small incision, and both can be done in one procedure.
If you have any more questions, please let me know.
Kind regards.
Patient's Query
Hi doctor,
Thank you for the reply.
These are not on the skin. They are a part of the cord or veins. I have only pushed it onto the skin to make it visible; when I feel it, I can feel the cord, then the hard lumps. I have attached the report here. They did not mention anything about the lumps. However, I want to know if they can be seen on the ultrasound. Should I get this checked?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Yes, it would help if you got them checked and examined because the ultrasound showed epididymal cysts, which can be uncompressible, and varicocele on the left side. So two things are there. I would like to examine you then I can know exactly. Since you said you could feel them near the cord, it is epididymal cysts. And it’s separate from the cord and not in the skin. It is deeper. For epididymal cysts, no treatment is required but the treatment for varicocele should be done as we mentioned.
Patient's Query
Hello doctor,
However, I want to know if they can be seen on the ultrasound.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Ultrasound probes are different and can see for different depths. One probe can see only deep structures, the other can see only superficial ones, and since the ultrasound can see deeper ones, they ca not see the superficial ones. The hard ones in the skin are sebaceous cysts, and if they are deeply separated from the skin, then they are epididymal cysts, and the varicocele of grade three should be obvious on ultrasound. So examination and ultrasound should be sufficient to detect all.
Patient's Query
Hi doctor,
Thank you for the reply.
As mentioned, there is nothing on the skin. If they are epididymal cysts, is there a reason there would be six of them? They are all firm and round but of different sizes largest, like 0.23 inch. My ultrasound was only recent two months ago; the urologist did not pay attention to these extra lumps and was not concerned and only examined the surface; the ultrasound did not pick them up and only saw enlarged cords and veins. It is like in a line and four different hard lumps of different sizes on the cord. Should I get these extra ones examined physically, or is it alright?
Hi,
Welcome back to icliniq.com.
I understand your concern. You should see a urologist again and see another urologist with no issue. According to the ultrasound you attached (attachment removed to protect the patient's identity), there are multiple epididymal cysts on both sides largest one is 0.11 inch on the left and 0.07 inch on the right; those cysts do not need treatment. But in the picture you showed, I can see skin lesions that look like sebaceous cysts. So physical examination is important to confirm. Hence you should see another urologist. Regarding varicocele 0.133 inch with no reflux, no need for treatment. However, you should follow up with an ultrasound after six months as varicocele is a progressive issue and can be observed without treatment at grade two, but grades three and four should be treated. If you have any other questions, please feel free to contact me.
Kind regards.
Patient's Query
Hello doctor,
Varicocele and testicles are fine. I have had a persistent fever usually 37.8 to 38.3 during most of the day for 3 to 4 weeks now, I have had bubbles in my urine. Sometimes it is cloudy but rarely. No weird smell, no burning, nothing seen in urine, no frequent urination or anything. I have had gut issues in the past 3 months. The urologist suggested a colovesical fistula due to the bubbles and my gut issues via CT - he said it is unlikely but wants to rule it out, my gastroenterologist said if the dipstick is clear then no need to do CT as I am young. The dipstick was normal, however, I requested culture and PCR. I have attached updated blood and urine culture and PCR - please advise.
Hello,
Welcome back to icliniq.com.
Bubbles in the toilet are not a fistula at all. The fistula is a dangerous thing that will cause dirty urine and infections going to blood bloodstream. Your urine analysis is clear and no signs of infection. So for the urinary system, no CT scan is required.
Patient's Query
Hello doctor,
Thank you for your reply.
I have done a lot of tests in the past 3 months due to my gut issue (including upper abdomen MRI, ultrasound, gastroscopy, and ECG, I have attached my 3 bloodwork previously. I have had cervical lymph node ultrasound and axillary lymph node which were both normal. I am going to have a flexible sigmoidoscopy as I have mucus in my stool and sometimes blood when I wipe. I guess the urologist suggested it as I have had bubbles or foam in my urine for 4 weeks now in addition to the fever. It is also sometimes cloudy, so that is possibly two of the criteria.
Hello,
Welcome back to icliniq.com.
Yes, you do have a fistula and you do not have organisms in your urine or any infection in your urine. Even cloudy urine is fine as long as you do not have WBCs in your urine. Mycobacteria and atypical infections might be there but not in urine. Unexplained fever will require CT TAP. Low-grade fever causes are mostly viral infections. An internal medicine doctor is the one to be seen.
Patient's Query
Hello doctor,
Sorry please could you check my urine report again it says there are organisms as it is showing positive. Please suggest if this could mean a fistula or if this requires further investigation.
Hello,
Welcome back to icliniq.com
The urine analysis is clear and nothing is mentioned about organisms. And some times skin contamination can be in the sample. How we differentiate is by inflammatory cells if there are WBCS or leukocytes in the urine in the presence of organisms then it is an infection. And if no infection then no fistula.
Patient's Query
Hello doctor,
It was on the 2nd page of the attachment, I have attached it here. You will see next to the organism there is a positive, the urine culture says 'no significant growth'. Please suggest if this could mean a fistula or if this requires further investigation. Or do your comments still apply re fistula etc.? The urine issues (foamy and sometimes cloudy) seem to have started same time as my fever. Secondly is it possible anxiety and stress can cause this type of fever?
Hello,
Welcome back to icliniq.com.
Organism one is contamination only no infection and no body reaction to infection no fistula at all and no need for investigations. Cloudy urine might be due to semen in the urine which is normal. Stress can cause fever sometimes and less sleep can also raise the body temperature. Other causes can be there as well. Your urinary tract is fine. As I mentioned you should see an internal medicine doctor for further evaluation.
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