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To all,
I'm presenting my current urology problem to you all. Hopefully,as aspiring and established doctors/urologists, you might be able to help me with my issue. I'm really worried, and I would appreciate any suggestions/advice.
For those of you that enjoy a challenge, this should interest you. A very established urologist/surgeon says he's never seen a case quite like mine. Please help!
I'm a 25 year old male.
Brief History: Patient had a few episodes of testicular pain during adolescence; episode in college ruled as epididymitis; treated with antibiotics and pain meds; ultrasound revealed microlithiasis in testicles
April 1st, 2011- Patient fools around with stranger from a bar
April 8th, 2011- Sudden onset of pain and severe inflammation of left testicle
Went to ED within an hour of pain onset
Ultrasound performed; showed blood flow in left testicle, so torsion was ruled out; patient sent home with a case of epididymitis; treated with pain meds and antibiotics
Pain and swelling did not subside over the next few weeks
Another ultrasound performed
Ultrasound shows no blood flow in left testicle and ultrasound tech says it looks like the left testicle is no longer functioning
Go to specialist
Ultrasound confirms left testicle is not receiving blood flow; speculated case of misdiagnosed torsion because sequence of events seem odd
August 2011- Left orchiectomy performed; right testicle "pexed" to avoid possible torsion in future; implant inserted Patient recovers over the next few months
Patient's forehead breaks out in pimples like never before
Patient's drinking and sexual activity increases (possible mental side effect of orchiectomy)
Patient starts getting sick a lot; strep and flu a few times; headache, temperature fluctuations, fatigue, weight gain
Labs and physicals show low iron and mononucleosis; everything else is normal including STD tests
Patient goes about his life; no major problems; some testicular phantom pains every now and then; forehead clears up
September 2013
Patient goes for checkup; headaches, temperature changes, and feeling different after the surgery.
Patient gets ultrasound and hormone panel
Ultrasound shows blood flow and a vast amount of microlithiasis in right testicle; hormone panel show normal testosterone level but elevated FSH and LH levels; doctor says he's never seen this much lithiasis in a patient and he wants to repeat hormone panel to confirm results
Repeat hormone panel; add HTG tumor marker test
Hormone panel confirms normal testosterone/HTG and elevated FSH and LH levels
Doctor orders a total semen analysis
Semen analysis shows decreased sperm production
September 19, 2013- Doctor calls and discusses results and next step
Summary:
1) normal testosterone level
2) normal HTG level
3) elevated LH level
4) elevated FSH level
5) decreased/low sperm production
6) microlithiasis
7) "primary testicular failure"
Specialists say they haven't really seen a case like this and will consult with other urologists/endocrinologists/specialists around the US to see if there have been any treatments successful in reducing LH and FSH levels
Next step: Doctor wants to perform a CT scan to check out pituitary gland. He also wants to cryopreserve my semen in case of testicular failure.
Any thoughts/suggestions would be greatly appreciated. I'm really worried now.
Thanks,
Patient
I'm presenting my current urology problem to you all. Hopefully,as aspiring and established doctors/urologists, you might be able to help me with my issue. I'm really worried, and I would appreciate any suggestions/advice.
For those of you that enjoy a challenge, this should interest you. A very established urologist/surgeon says he's never seen a case quite like mine. Please help!
I'm a 25 year old male.
Brief History: Patient had a few episodes of testicular pain during adolescence; episode in college ruled as epididymitis; treated with antibiotics and pain meds; ultrasound revealed microlithiasis in testicles
April 1st, 2011- Patient fools around with stranger from a bar
April 8th, 2011- Sudden onset of pain and severe inflammation of left testicle
Went to ED within an hour of pain onset
Ultrasound performed; showed blood flow in left testicle, so torsion was ruled out; patient sent home with a case of epididymitis; treated with pain meds and antibiotics
Pain and swelling did not subside over the next few weeks
Another ultrasound performed
Ultrasound shows no blood flow in left testicle and ultrasound tech says it looks like the left testicle is no longer functioning
Go to specialist
Ultrasound confirms left testicle is not receiving blood flow; speculated case of misdiagnosed torsion because sequence of events seem odd
August 2011- Left orchiectomy performed; right testicle "pexed" to avoid possible torsion in future; implant inserted Patient recovers over the next few months
Patient's forehead breaks out in pimples like never before
Patient's drinking and sexual activity increases (possible mental side effect of orchiectomy)
Patient starts getting sick a lot; strep and flu a few times; headache, temperature fluctuations, fatigue, weight gain
Labs and physicals show low iron and mononucleosis; everything else is normal including STD tests
Patient goes about his life; no major problems; some testicular phantom pains every now and then; forehead clears up
September 2013
Patient goes for checkup; headaches, temperature changes, and feeling different after the surgery.
Patient gets ultrasound and hormone panel
Ultrasound shows blood flow and a vast amount of microlithiasis in right testicle; hormone panel show normal testosterone level but elevated FSH and LH levels; doctor says he's never seen this much lithiasis in a patient and he wants to repeat hormone panel to confirm results
Repeat hormone panel; add HTG tumor marker test
Hormone panel confirms normal testosterone/HTG and elevated FSH and LH levels
Doctor orders a total semen analysis
Semen analysis shows decreased sperm production
September 19, 2013- Doctor calls and discusses results and next step
Summary:
1) normal testosterone level
2) normal HTG level
3) elevated LH level
4) elevated FSH level
5) decreased/low sperm production
6) microlithiasis
7) "primary testicular failure"
Specialists say they haven't really seen a case like this and will consult with other urologists/endocrinologists/specialists around the US to see if there have been any treatments successful in reducing LH and FSH levels
Next step: Doctor wants to perform a CT scan to check out pituitary gland. He also wants to cryopreserve my semen in case of testicular failure.
Any thoughts/suggestions would be greatly appreciated. I'm really worried now.
Thanks,
Patient
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