Posts Tagged ‘epididymis’

Big Ball Series: What You Need to Know About Epididymitis

November 10, 2018

Andrew Siegel MD  11/10/2018

This is a continuation of the “Big Ball” series of entries, which provide information about common maladies that affect the contents of the scrotum.

The epididymis is a comet-shaped organ located above and behind each testicle. It consists of multiple tiny twisted tubules and is the site where sperm mature, are stored and are transported.  At the time of sexual climax, sperm move from the epididymis into the vas deferens (sperm duct).

Epididymis-KDS

A. epididymal head, B. body, C. tail, D. vas deferens (sperm duct)                                             Attribution: By KDS444 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons  

Epididymitis is an inflammation, pain, and swelling of the epididymis, a common inflammatory and/or infectious condition seen in men of all ages.  The vast majority of the time it involves only one side.  If left untreated, it can spread to the testicle in which case it is known as epidiymo-orchitis.

Epididymitis can be caused by the spread of infection from the prostate, bladder or urethra. The most common cause in young, sexually-active men is from organisms that cause urethritis, an infection or inflammation of the channel that conducts urine through the penis. This is often due to a non-bacterial organism such as chlamydia. In older men, bacterial infection caused by an obstruction in the lower urinary tract is a common cause of epididymitis.  In this older population, typical microorganisms are pathogens that normally reside in the colon such as E.Coli. In about 5% of cases, epididymitis is viral in origin, often from the spread of a viral upper respiratory tract infection.  Epididymitis can be an inflammatory as opposed to an infectious process, with no infecting organisms responsible.  For uncertain reasons, epididymitis is more commonly seen in men who do weight training or are employed in occupations that require heavy lifting.  On occasion it can be induced by certain medications, e.g., amiodarone.

Acute epididymitis can vary greatly in severity, ranging from mild to severe. Mild epididymitis causes a low-grade discomfort, swelling, and tenderness of the epididymis. In moderate epididymitis, the extent of pain, swelling, discomfort, and tenderness are appreciably increased.  In severe epididymitis, the epididymis often cannot be differentiated from the testes on exam because of the extensive infectious/inflammatory process and it is common to have fever, chills, malaise and other systemic symptoms.  The entire scrotum can be swollen and red, its contents hard, irregular and exquisitely tender.

Scrotal ultrasonography is extremely helpful to ensure making the proper diagnosis and to rule out an abscess or infarction (tissue death) that might require surgical intervention.  In acute epididymitis, the ultrasound often reveals epididymal enlargement and increased blood flow because of the inflammatory process.  Ultrasound is essential in severe epididymitis, persistent infection, or when physical exam is hampered from pain, scrotal wall inflammation or a reactive hydrocele (a collection of fluid surrounding the testes). Ultrasound can distinguish epididymitis from other processes including a twisted testes or twisted appendix testes, testes cancer, groin hernia, varicocele, trauma and scrotal abscess. In years preceding the ready availability of ultrasound it was not uncommon to have to perform scrotal surgical exploration to sort out the problem.  Urinalysis and urine culture are useful to help identify a specific bacterial source and to guide the choice of antibiotic.  Sexual transmitted infection testing is important when appropriate.

The treatment of acute epididymitis is directed at the specific organism responsible. In young men, this is often a course of a tetracycline-derivative antibiotic such as Doxycycline in conjunction with activity restriction, scrotal elevation and anti-inflammatory medication. Supportive jockey shorts are particularly useful to help elevate and immobilize the testes. Locally applied heat can be beneficial as well. In older men, an antibiotic directed at the likely source, the colonic bacteria, is appropriate.  Epididymitis may require a prolonged course of antibiotics and several weeks before it normalizes. Occasionally, after resolution, there will be an irregularly firm and sensitive epididymis as a result of scar formation and inflammation. In the case of severe epididymitis, after complete resolution of the infection it is important to undergo urological evaluation to rule out structural abnormalities that could have given rise to the process.

Occasionally, epididymitis can be so severe as to require hospitalization for intravenous antibiotics. Rarely, surgery is necessary to drain an epididymal abscess or remove the epididymis and at times, the infected testicle as well.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

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Big Ball Series: What You Need to Know About Spermatoceles

November 3, 2018

Andrew Siegel MD 11/3/2018

This is a continuation of the “Big Ball” series of entries, which provide information about common maladies that affect the contents of the scrotum.  The previous entry was on hydroceles and next week will cover epididymitis. 

Epididymis-KDS

A. epididymal head, B. body, C. tail, D. vas deferens (sperm duct)                             Attribution: By KDS444 [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, from Wikimedia Commons  

A spermatocele (“spermato” = sperm + “cele” = sac) is a benign cystic enlargement within the scrotum that results from a partial obstruction of the tubular system of the epididymis.   The epididymis is the comet-shaped organ located above and behind each testicle that consists of multiple tiny twisted tubules. The epididymis is the site where sperm cells mature and are stored until the time of sexual climax when they move from the epididymis into the vas deferens (sperm duct).     

Spermatoceles typically arise from the head of the epididymis and are found to contain sperm, hence the name.  They can vary greatly in size, ranging from a pea-size lump that does not cause any symptoms to a grapefruit-size enlargement that causes annoying symptoms.  Many men with spermatoceles often present to the urologist with the complaint of “growing a third testicle.”  They are evaluated by physical examination where they are found to be smooth, soft and regular masses typically located above the testicle.  They are often further characterized by scrotal ultrasonography that provides detailed anatomical imaging of the testes and epididymis and can differentiate a spermatocele from other causes of scrotal enlargement such as a hydrocele. However, an epididymal cyst may be impossible to distinguish from a spermatocele, the only difference being that an epididymal cyst does not contain sperm as does a spermatocele. 

Spermatocele

Ultrasound image of spermatocele,  public domain (spermatocele on left immediately adjacent to testes on right)

The majority of spermatoceles arise from the epididymal head, although they can arise from the body or tail. Many spermatoceles are not symptomatic, causing only a painless enlargement or are discovered on a routine physical exam or incidentally on a scrotal ultrasound done for another reason.  Larger spermatoceles can cause an uncomfortable dragging sensation, particularly while sitting or driving. Most small and moderate-size spermatoceles can be managed simply by careful periodic observation to ensure that they do not continue to enlarge or cause progressive symptoms. When a spermatocele progresses to the point where it causes discomfort, pain, or deformity, it can be repaired by a relatively simple surgical procedure performed on an outpatient basis.  The incision is typically through the midline “seam” of the scrotum; the involved testicle is delivered through the incision, the epididymis is exposed and the spermatocele is carefully excised, after which the scrotal contents are repositioned and the scrotal wall is closed.  This procedure is a highly successful means of treatment of the spermatocele.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

 

 

 

 

What The Heck is Urology?

August 24, 2013

Andrew Siegel, MD  Blog #116

“Urology” (uro—urinary tract and logos—study of) is a medical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in females and of the genitourinary tract in males. The organs under the “domain” of urology include the adrenal glands, kidneys, the ureters (tubes connecting the kidneys to the urinary bladder), the urinary bladder and the urethra (the channel that conducts urine from the bladder to the outside).  The male reproductive organs include the testes (i.e., testicles), epididymis (structures above and behind the testicle where sperm mature and are stored), vas deferens (sperm duct), seminal vesicles (the structure that produces the bulk of semen), prostate gland and, of course, the scrotum and penis.  The reproductive and urinary tracts are closely connected, and disorders of one oftentimes affect the other…thus urologists are referred to as  “genitourinary” specialists. Urology involves both medical and surgical strategies to approach a variety of conditions.

Urology has always been on the cutting edge of surgical advancements (no pun intended) and urologists employ minimally invasive technologies including fiber-optic scopes to be able to view the entire inside aspect of the urinary tract, as well as ultrasound, lasers, laparoscopy and robotics.  There is a great deal of overlap in what urologists do with other medical and surgical disciplines, including nephrology (doctors who specialize in medical diseases of the kidney); oncology (cancer specialists); radiation oncologists (radiation cancer specialists); radiology (imaging); gynecology (female specialists); and endocrinology (hormone specialists).

Urologists are the male counterparts to gynecologists and the go-to physicians when it comes to expertise in male pelvic health.  Urologists, in addition to being physicians, are also surgeons who care for serious and potentially life-threatening illnesses, particularly cancers of the genital and urinary tracts.  In terms of new cancer cases per year in American men, prostate cancer is number one accounting for almost 30% of cases; bladder cancer is number four accounting for 6% of cases; and cancer of the kidney and renal pelvis (the inner part of the kidney that collects the urine) are number six accounting for 5% of cases.  Urologists are also the specialists who treat testicular cancer.  Urologists also treat women with kidney and bladder cancer, although the prevalence of these cancers is much less so than in males. 

Very common reasons for a referral to a urologist are the following: blood in the urine, whether it is visible or picked up on a urinalysis done as part of an annual physical; an elevated PSA (Prostate Specific Antigen) or an accelerated increase of PSA over time; prostate enlargement; irregularities of the prostate on examination; urinary difficulties ranging the gamut from urinary incontinence to the inability to urinate (urinary retention).

Urologists manage a variety of non-cancer issues. Kidney stones, which can be extraordinarily painful, keep us very busy, especially in the hot summer months when dehydration (a major risk factor) is more prevalent. Infections are a large part of our practice and can involve the bladder, kidneys, prostate, or the testicles and epididymis.  Urinary infections is one problem that is much more prevalent in women than in men.  Sexual dysfunction is a very prevalent condition that occupies much of the time of the urologist—under this category are problems of erectile dysfunction, problems of ejaculation, and testosterone issues. Urologists treat not only male infertility, but create male infertility when it is desired by performing voluntary male sterilization (vasectomy).   Urologists are responsible for caring for scrotal issues including testicular pain and swelling.   Many referrals are made to urologists for blood in the semen.

Training to become a urologist involves attending 4 years of medical school after college and 1–2 years of general surgery training followed by 4 years of urology residency. Thereafter, many urologists like myself pursue additional sub-specialty training in the form of a fellowship that can last anywhere from 1–3 years.  Urology board certification can be achieved if one graduates from an accredited residency and passes a written exam and an oral exam and has an appropriate log of cases that are reviewed by the board committee.  One must thereafter maintain board certification by participating in continuing medical education and passing a recertification exam every ten years.  Becoming board certified is the equivalent of a lawyer passing the bar exam.

In addition to obtaining board certification in general urology, there are 2 sub-specialties within the scope of urology in which sub-specialty board certification can be obtained—pediatric urology, which is the practice of urology limited to children and female pelvic medicine and reconstructive surgery (FPMRS), which involves female urinary incontinence, pelvic organ prolapse, and other female uro-gynecological issues.  The FPMRS boards were offered for the very first time in June 2013, and I am pleased to announce that I am now board certified in both general urology and FPMRS.  There are approximately 100 or so urologists in the entire country who are board certified in the urology subspecialty of FPMRS.

In terms of the demographics of urology, although urology is largely a male specialty, women have been entering the urological workforce with increasing frequency.  This is because female students now comprise approximately 50% of United States medical school population. There are 10,000 practicing urologists in the USA, of which about 500 are women. Urologists have a median age of 53, so we are not a particularly young specialty. The aging population will demand more urological health services and the Affordable Care Act will result in the dramatic expansion of the number of American citizens with health insurance. These factors combined with the aging of the urological workforce and the contraction due to retirement, all in the face of growing demands, does not augur well for a balance of supply and demand in the forthcoming years.  Hopefully there will be enough of us to provide urological care to those in the population that need it.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in Kindle edition

Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health, in press and available in e-book and paperback formats in the Autumn 2013.

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Testicular Torsion

January 5, 2013

Andrew Siegel, M.D.   Blog # 89

 

All organs and tissues need a blood supply to remain alive and vital.  The blood supply to each testicle is located within a rope-like “cord” of tissue that travels from the groin into the scrotum.  Both the testicular artery and the testicular vein are within this spermatic cord that can be considered to be the life support of the testicle. The artery delivers oxygen and other vital nutrients to the testicle; the veins convey carbon dioxide and other products of cellular metabolism from the testicle to the heart.

Anything that can jeopardize the blood supply to the testicles can affect their vitality. Torsion is defined as a twist of the testes and spermatic cord around a vertical axis, resulting in a kink and thus compromise to the blood flow—this can lead to possible strangulation of the blood supply and infarction (death by lack of blood flow) of the testicle. The testicle can spin 360°, 720° or any conceivable amount.  When this occurs, it typically causes an acute onset of pain and swelling in the testicle, and often the pain radiates to the groin and lower abdomen; it can be easily confused with appendicitis when it involves the right testicle.  Although torsion can occur at any age, it is most common among adolescents at the time of or shortly after puberty, typically ages 12-20.

When torsion occurs, the spermatic cord is foreshortened and the testicle tends to rise higher in the scrotum than its normal anatomical location.  On examination, the twisted testicle is usually very tender and swollen.  Torsion is a surgical emergency, because if the testicle is not untwisted on a timely basis, the testicle can die (suffer an infarction).   However, when diagnosed on a timely basis, the testis can be untwisted and surgically fixated to prevent recurrent episodes.   When it comes to torsion, time is of the essence.  It is for this reason that testicular pain needs to be expediently checked out by a medical professional.

Torsion of the testicle can be misdiagnosed as epididymitis, an infection/inflammation of the epididymis which is the sperm storing structure located immediately above and behind the testicle. If the situation is equivocal, a color Doppler ultrasound or testicular scan can be helpful in making the distinction.  If there is any doubt, a trip to the operating room is in order.

At times, the testicle can be untwisted in the office or emergency room and the patient can then be electively brought to the operating room where the testicle is fixated to the scrotal skin to prevent it from re-torting in the future. Typically the other testicle is fixated as well.  The fixation is done by placing three or so sutures in each testicle, thereby anchoring the testicle to the scrotal wall with this three-point fixation technique.

At other times, the testicle cannot be untwisted and the patient must be brought to the operating room in an emergency (as opposed to elective) basis for a scrotal exploration and untwisting of the testicle under direct vision to determine its viability. Typically once it is untwisted, the testicle shows signs of life (turning from a dusky color to pink), but if too much time has transpired, the testis can appear to be black and necrotic (dead) and instead of being fixed to the scrotal skin, it must be surgically removed.   Correction within 6 hours of the onset of pain usually will salvage a testicle.

 

Bottom Line:  Torsion of the testicle is a surgical emergency. If you or someone you know has acute onset of unremitting testicular pain, make sure you/they get to the emergency room ASAP, because time is of the essence with respect to being able to salvage a twisted testicle.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.  On the lower right margin of the blog you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Testes Exam

December 8, 2012

Testes Exam

 

Andrew Siegel, M.D.   Blog # 85

Question: For genital health issues, women have gynecologists, but who do men have for their genital health issues?

 Answer: Urologists

 

The next five blogs will be dedicated to men’s health issues.  Today’s blog will cover examination of the testicles and the next three will cover penile issues—fracture of the penis, priapism, and Peyronie’s disease—and the final will be on testicular torsion.

 

Examining one’s testicles is a simple task that can be lifesaving.  For most men, touching/manipulating/rearranging their nether parts is a natural and almost reflex activity that—supplemented with a little instruction, knowledge and direction—can be put to some very good clinical use.  What follows will also be appropriate for the partner of the man in question.  Several times in my career as a urologist, it has been the man’s partner that was astute enough to recognize a problem that prompted the patient visit in which a diagnosis of testicular cancer was made.

Although rare, testicular cancer is the most common solid malignancy in young men, with the greatest incidence being in the late 20’s, striking men at the peak of life.  Lance Armstrong, Scott Hamilton, Eric Shanteau, Tom Green, John Kruk, Brian Piccolo, Richard Belzer, and Bernard Goetz are all members of the testicular cancer club.

The great news is that it is a very treatable cancer, especially so when picked up in its earliest stages, when it is commonly curable.  One of the great advantages of having one’s gonads positioned in such an accessible locale (as opposed to the ovaries) is that examination and early cancer diagnosis is a cinch (once again, as opposed to the ovarian cancer, which most often presents at an advanced stage).

The goal of self or partner-exam is to pick up an abnormality in a very early—and treatable—stage, at a time when testes cancer is a localized issue that has not spread to the lymph nodes or lung, which are common sites of metastasis in advanced testicular cancer.

In its earliest phases, testes cancer will cause a lump, irregularity, asymmetry, enlargement or heaviness of the testicle.  It most often does not cause pain, so the absence of pain is not a feature that should dissuade you from getting an abnormality looked into.  If you feel something that was not present previously, please see a urologist—I promise that you will never be chided for being a “hypochondriac” for getting something checked out.  It is truly better to be safe and cautious.

The testicles can be examined anywhere, but a warm shower or bath is an ideal setting as the warm water tends to relax and thin the scrotal sac and allow the testes to descend to a position that is most accessible.  Soapy skin will eliminate friction and allow the examining fingers to easily roll over the testicles.

The exam is best performed with the thumb in front and the remaining fingers behind the testicles.  The four fingers immobilize and support the testicle and the thumb does the important work in examining the front, sides, top and bottom of the testicle; then the thumb immobilizes the front while the four fingers examine the back of the testes.  When examining the back surface of the testicle, the index and middle fingers will do most of the work. The motion is a gentle rolling one, feeling the size, shape, and contour and checking for the presence of lumps and bumps.

Compare the two testes in terms of size, shape and consistency.  Generally, the testicle feels firm, similar to the consistency of a hard-boiled egg, although it can vary between individuals and even in an individual.  Lumps can vary in size from a kernel of rice to a large mass many times the size of the normal testes.  It is important to know that not every testes abnormality is a cancer; in fact, most are benign.  The epididymis is a comet-shaped structure located above and behind the testes that is responsible for sperm storage and maturation.  It has a head, a body and tail, and it is worthwhile running your fingers over this structure as well.

 

This exam should be done regularly—perhaps every couple of weeks or so—such that you get to know your (or your partner’s) anatomy to the extent that you will be attuned to a subtle change.  Once you get in the habit of doing this on a regular basis, it will become second nature and virtually a subconscious activity that only takes a few moments.

And to every wife, girlfriend, partner…if your man is a stoic kind of guy who is not likely to examine himself here is what to do—at a passionate moment, pursue a subtle, not-too-clinical exam under the guise of intimacy—it may just end up saving his life.

Bottom line: Have the “cajones” to check your or your partner’s cajones.  Because sperm production requires that the testicles are kept cooler than core temperature, nature has conveniently designed man with his testicles gift wrapped in a satchel dangling from his mid-section. There is no organ in the body—save the breasts—that are more external and easily accessible.  Take advantage of that accessibility to do regular exams—it just might be lifesaving.

For more info:

http://www.seankimerling.org/

 

 Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every Saturday morning.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts by email. Please avail yourself of these educational materials and share them with your friends and family.