Author: Tin-Kay Goh (---.nsw.bigpond.net.au)
Date: 01-05-05 03:09
FM Liew emailed me about your query at the Chinese Medicine section.
The first principle prior to treatment is to get the correct diagnosis. If you have a testicular swelling, the priority is to identify whether the swelling is actually in the testis (such as an epididymal cyst, testicular abscess or tumor) or external to the testis (such as a hernia or varicocoele). An ultrasound will solve this straightaway.
From your description, it is about 1 cm diameter, rounded and painful. The small size will most likely eliminate a hernia which will extend all the way from the pubic region into the scrotum. Since it is well defined it will eliminate a varicocoele, which feels like a bag of small worms at the lower pole of the testis.
Hence, a clinical first guess will be an epididymal cyst, though an abscess or tumour cannot be fully excluded. It is because of pain, indicative of inflammation, that antibiotic was given. However, it would be more prudent to wait for an Ultrasound finding before jumping onto antibiotics and their inherent side effects. If an abscess is suspected because the swelling is hot and painful, a needle tap will revealed pus which can be sent for culture and sensitivity in order that the germ can be identified and the correct antibiotic given.
If the lump is an epididymal cyst, it can be left alone, tapped or excised. If it is a tumour, then excision is the only choice. Chinese medication may help to reduce the inflammatory aspect of a cyst. Generally speaking, a painful testis is usually an orchitis, which is a global swelling or pain, and not a small 1 cm lump as is your case.
To me the primary diagnosis will an epidymal cyst, followed by a testicular abscess and then a tumor. The tumor to watch out in a young man is a seminoma.
Let me tell you a joke about a testicular infection that a man acquired from a sexual encounter. He consulted a Western-trained doctor who advised that his only option is surgical removal. Fearing of losing half his manhood, he went to see a Chinese sinseh (physician) for a second opinion.
After careful examination and indepth consideration, the Chinese sinseh concluded that the disease can be cured without any surgery. The treatment would be a course of Chinese herbal mixture. Much relieved, the man was so pleased and thank the Chinese sinseh profusely. Just before leaving, the man asked whether he should return for a review. "No need" said the Chinese sinseh, "The testis will dropped off by itself in a week".
Ha! Chinese medicine after 5000 years has enough kungfu to bypass the surgical knife!