Chronic Pain in Left Testicle - Seeking Guidance
A 24-year-old male, weighing 235 pounds, seeks advice regarding persistent discomfort. For over three years, he has experienced pain, initially treated with antibiotics and stretching exercises, both of which proved ineffective. After consulting a urologist, he underwent a nerve block that did not alleviate his symptoms. Subsequently, he had a spermatic cord denervation, but this led to intensified pain, especially during ejaculation, characterized by a burning and stinging sensation. The discomfort extends to regular physical activities, whether they are strenuous or mild, making movement quite painful. Recently, he noticed that the left testicle hangs higher than usual while walking, and now the right testicle exhibits similar behavior or appears to be drawn upwards. As a final recourse, the prospect of removing the left testicle is being considered. Despite visiting a pain specialist, he has seen no improvement and is at a loss for further avenues of relief. While hesitant about surgery, he is eager for alternative solutions. He possesses images that could aid in diagnosis but prefers not to share them publicly. He expresses his gratitude in advance for any assistance offered.
Answers (1)
3/31/2025, 5:40:36 AM
OpenHealth AI
It sounds like you've been through quite a challenging journey with your chronic testicular pain, and it's understandable to seek further guidance. You've already tried multiple treatments, including antibiotics, nerve block, spermatic cord denervation, and consultation with specialists, but unfortunately, relief has been elusive.
Main Points:
Chronic testicular pain can stem from various causes, and while surgical options like testicle removal are a last resort, exploring additional non-surgical methods may offer some relief. Let's focus on practical steps you can take to manage pain and consider supportive therapies.
Explanation:
Chronic testicular pain, also known as orchalgia, can arise from various factors, including nerve damage, inflammation, or pelvic floor dysfunction. The pain you experience, especially during ejaculation, along with the change in the position of your testicles, can be frustrating and distressing. It's important to acknowledge the physical and emotional toll this has taken on your life.
Next Steps:
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Pelvic Floor Physical Therapy: Consider working with a specialized physical therapist who has experience with pelvic pain. They can help strengthen and relax muscles to alleviate pressure in the pelvic area. Many patients find significant relief through tailored exercises and manual therapy.
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Pain Management Techniques:
- Biofeedback or Cognitive-Behavioral Therapy (CBT): These can aid in managing chronic pain by helping you develop coping strategies and relaxation techniques.
- Pain-relief Medications: Discuss with your healthcare provider about medications that may help with nerve pain or inflammation, possibly including topical options or nerve-modulating agents.
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Lifestyle Adjustments:
- Heat Therapy: Applying a warm compress or heating pad can relax muscles and reduce discomfort temporarily.
- Gradual Activity Resumption: While it can be tough to navigate movements that provoke pain, gentle stretching and low-impact activities (like walking) may help you gradually become more active without overexertion.
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Further Diagnostic Evaluation: If you haven’t already, consider discussing imaging studies with your healthcare provider to rule out any underlying conditions that may not have been previously addressed or might have developed post-surgery.
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Pain and Symptom Diary: Keep a log of your pain levels, activities, and any triggers you notice. This can provide valuable insights to your healthcare provider and help in tailoring a more effective treatment approach.
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Support Groups: Connecting with others who have chronic pain through support groups (in-person or online) can provide emotional support and shared strategies for management.
It's crucial to keep open communication with your healthcare team about your ongoing symptoms and what you've tried, as they can help adjust your care plan. Please remember that you are not alone in this, and while it may take time, solutions can often be found with persistence and the right support. If you have more specific questions or concerns, feel free to ask.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.