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A 45 year old man presented with right testicular chronic pain. He had a vasectomy 7 years ago. Upon physical examination and an ultrasound, a solid nodule in the right epididymis was found, and medical staff suspected a tumor. After findings of sperm that had undergone phagocytosis, a final diagnosis of sperm granuloma was determined. [14]
Pain generally begins suddenly and typically involves only one side. [6] There is often associated nausea and vomiting. [2] The testicle may lie higher in the scrotum due to twisting and subsequent shortening of the spermatic cord [6] or may be positioned in a horizontal orientation. Mild warmth and redness of the overlying area may be present.
Chronic scrotal pain (pain for greater than 3 months) may occur due to a number of underlying conditions. [3] It occurs in 15-19% of men post vasectomy, due to infections such as epididymitis, prostatitis, and orchitis, as well as varicocele, hydrocele, spermatocele, polyarteritis nodosa, testicular torsion, previous surgery and trauma. [3]
Chronic epididymitis is most commonly associated with lower back pain, and the onset of pain often co-occurs with activity that stresses the low back (i.e., heavy lifting, long periods of car driving, poor posture while sitting, or any other activity that interferes with the normal curve of the lumbar lordosis region).
In case of proven fertility but unresolved pelvic pain, even one or both partially obstructed ejaculatory ducts may be the origin of pelvic pain and oligospermia. [ 1 ] Ejaculatory duct obstruction may result in a complete lack of semen ( aspermia ) or a very low-volume semen ( oligospermia ) which may contain only the secretion of accessory ...
One study reported that denervation of the spermatic cord provided complete relief at the first follow-up visit in 13 of 17 cases, and that the other four patients reported improvement. [12] As nerves may regrow, long-term studies are needed. One study found that epididymectomy provided relief for 50% of patients with post-vasectomy pain ...
The spermatic cord is the cord-like structure in males formed by the vas deferens (ductus deferens) and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis , is an extension of the peritoneum that passes through the transversalis fascia .
Epididymitis and epididymo-orchitis are common causes of acute scrotal pain in adolescent boys and adults. At physical examination, they usually are palpable as tender and enlarged structures. Clinically, this disease can be differentiated from torsion of the spermatic cord by elevation of the testes above the pubic symphysis.