Chronic Left Testicular Discomfort at Age 24
I’m a 24-year-old male weighing 235 pounds, reaching out for guidance regarding persistent discomfort in my left testicle that has plagued me for over three years. My treatment journey has included antibiotics and stretches, yet none of these remedies have alleviated the pain. After consulting with a urologist, I underwent a nerve block, which offered no relief. Despite receiving a spermatic cord denervation, my symptoms have intensified, leading to sharp, burning sensations during ejaculation. Additionally, I experience significant pain during movement, lifting, and engaging in both routine and vigorous activities. I have noticed that my left testicle appears elevated while walking, and recently, my right testicle has started exhibiting a similar elevated position or seems retracted. As a final option, the proposed step is an orchiectomy to remove the left testicle. I have also consulted a pain specialist, but to no avail. I am at a loss for what to do next. Although I’m reluctant to proceed with surgery, I feel I have exhausted my options. I have some images that may help illustrate my condition, and I’d be willing to share them privately if they would assist. Thank you for your consideration and any assistance you can provide.
Answers (1)
3/31/2025, 7:40:39 PM
OpenHealth AI
I'm sorry to hear about your ongoing discomfort; it sounds incredibly challenging to deal with chronic pain, especially in such a sensitive area. Your concerns about the potential need for surgery, particularly after having tried various treatments with limited success, are completely understandable.
Main Points:
- You are experiencing persistent discomfort and pain in your left testicle, with symptoms worsening despite treatment.
- Options for managing this pain, including proposed surgery, have not provided the desired relief.
- There are still some potential pathways to explore before considering orchiectomy.
Explanation:
Chronic testicular discomfort can stem from various causes, including neuropathy, epididymitis, hernia, or other underlying issues. It’s concerning that your symptoms have worsened following treatments like nerve blocks and denervation. Each treatment typically aims to alleviate pain, and it can be frustrating when they do not provide relief.
The elevated position of your left testicle and the recent changes in your right testicle could suggest a structural issue or potential vascular concerns that warrant further investigation. Given your situation, it’s essential to approach your next steps with care and consideration.
Next Steps:
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Document Symptoms: Continue to keep a detailed diary of your symptoms, including when they occur, their intensity, and any activities that exacerbate or relieve the pain. This information can be valuable for any healthcare provider reviewing your case.
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Seek a Second Opinion: You might benefit from consulting another urologist or a specialist in male pelvic pain or chronic pain syndromes. Fresh insights and alternative diagnostic perspectives could provide options you haven’t yet explored.
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Consider Non-Surgical Management: Before proceeding with orchiectomy, discuss options such as:
- Pain management techniques involving medications like gabapentin or other nerve pain medications.
- Physical therapy focused on pelvic floor rehabilitation, which may help reduce pain and improve function without surgery.
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Explore Imaging & Testing: If not done recently, consider asking for updated imaging (like ultrasound or MRI) to assess any changes in your anatomy or identify potential sources of pain that may not have been previously detected.
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Support and Counseling: Engage with support groups or counseling focused on chronic pain management. They can provide emotional support and additional strategies for coping that may alleviate some of the mental burden of living with chronic pain.
It’s completely normal to feel overwhelmed when faced with complex medical decisions. Remember, you're not alone in this, and it's okay to seek help and suggestions from various sources. Take each step at your own pace, and know that you're taking the right approach by seeking more information. Please let me know if you have further questions or need specific resources!
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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.