Testicular pain, sutures, prior surgery, varicoceles
Friday, December 2nd, 2011December 2, 2011
Dear Dr. Reed,
I am a 28 year old male who has had 2 orchidopexies done 8 years ago. I have had an orchidopexy done twice on my right testicle to fix it to the scrotum because it was retracting frequently and caused a lot of pain when it did. I had it done twice because the first time, the doctor used dissolvable sutures. It wad done laparoscopically. The second time, another doc used permanent sutures. This was done openly. The last surgery was in ?05. Since the surgery I have had chronic pain in my right testicle. This is very troublesome during most sexual activities and the pain occurs randomly throughout the day. I have done a lot to reduce the pain (pain meds, steroid and anti-inflammatory injections, nerve blocks, etc?). Nothing has worked. The pain has only gotten worse. And there are no specific triggers.
One urologist wants to perform a spermatic cord denervation (which I don?t want to do based on my own research and other doctors disagreeing with that procedure). I feel like the sutures themselves are causing me the majority of the pain, partly due to one of the suture locations being very painful when touched. I feel like the sutures maybe need to be removed. I have found a couple urologists who feel the sutures are the culprits. So they want to remove the sutures and remove the muscle (not cutting any nerves) to prevent involuntary retraction. So, I?m definitely leaning towards this procedure.
I also have a testicular pain that started shortly after the second surgery. I also developed a right varicocele after the surgeries, and so some of the docs recommended doing a varicocele repair along with removing the sutures and cremasteric muscle on the right testicle. I have cosmetic concerns that urologists don?t care to address.
So in summary:
Right Side: Remove sutures and cremasteric muscle
Concern #1: Even though the testicle cannot retract on its own?especially during sexual activities, it can still be lightly moved up and cause pain. Can that be fixed without sutures?
Concern #2: The incision location will be on the side of the scrotum. Will be unsightly.
Left Side: Varicocele Repair
Concern #1: Incision location is in pubic region above and to the left of the penis. Will be noticeable and unsightly.
When I had the second surgery, it was done openly and so they made a 2-3 inch incision across my scrotum and it also cut through and distorted the median raphe. I was and am very unhappy about this. Is there a way that these procedures can be made by one incision down the median raphe to minimize and camouflage the scarring and to make the median raphe straight again?
I appreciate it you reading this and hope for a response. I have not been given much information at all and my concerns are been brushed aside by many. Jimmy
December 2, 2011
Good morning Jimmy,
Thank you for your excellent case summary. No doctor has golden hands and the more procedures you have had in the past the less likely others will be completely successful without any further touch-ups or revisions.
If you feel palpable sutures are the culprit, they could be removed. You can also have a short term anesthetic administered above the area of sutures to see if that makes the pain go away. If it does not, removing the sutures may only be of psychologic advantage.
I would concur that removing cremasteric muscle or skeletonizing the cords may be helpful, but does not necessarily have to be done initially.
Lastly we must exercise caution that you do not have a superimposed testicular tumor that is the cause of pain or an epididymitis or chronic orchitis.
Sincerely,
Harold M. Reed, M.D.
305-865-2000