Phone: 512-238-0762

Fax: 512-341-7370

July 25, 2020

What’s Your Ball Pain Sayin’?: Causes and Treatments For Testicular Pain

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m dr. Mystery, your host here as always with my stunning and mentally and psychologically stable cohost, Donna Lee.

Donna Lee: 

You referencing my therapy comments I keep throwing out at you.

Dr. Mistry: 

That’s correct. That’s nice, but it’s good. It’s good. It’s good to normalize.

Donna Lee: 

When you text your boss that you’re in therapy a lot, it’s probably a problem.

Dr. Mistry: 

It’s good. Mental health, mental wellness. We’re big supporters of that. We’re big supporters of that. This is a men’s health show. I’m a board certified urologist. The name of our show is the Armor Men’s Health Hour, and it’s available by podcast as well on anywhere you want to podcast.

Donna Lee: 

I learned all about that from you this year, this last year.

Dr. Mistry: 

You know, I don’t, I don’t do like social media stuff, but now I’m getting how people feel good about themselves based upon these things. The more downloads we get, the better I feel about myself.

Donna Lee: 

I know. It’s awful. I’m checking it, too!

Dr. Mistry: 

I’m going to stop. I’m going to, I’m going to stop looking.

Donna Lee: 

Yeah. If I post something about the show on Facebook, too, if I only get a few likes…

Dr. Mistry: 

I don’t have the Facebook.

Donna Lee: 

You do. You just don’t use it.

Dr. Mistry: 

I don’t use the Facebook.

Donna Lee: 

But your six beautiful kids are featured there.

Dr. Mistry: 

That’s the only picture there. We are a urology practice. The practice started in 2007. So we’re entering our 13th year–magic and happy number 13 this year.

Donna Lee: 

That’s right.

Dr. Mistry: 

We have an incredibly robust practice that’s really dedicated to individualizing treatment. I think that the kind of services that we offer in our practice are not only unique, but groundbreaking in terms of their scope. We have a nutritionist on staff. We treat sleep apnea here. We have a pelvic floor physical therapist here. We have sex therapy here. We have a curated set of supplements. That’s all in addition to the fact that we are amazing urologists here, too.

Donna Lee: 

That’s amazing. You’re award-winning!

Dr. Mistry: 

It’s an exciting time. This, we were about to add another partner.

Donna Lee: 

I know. Oh! Are you announcing that? Is it official?

Speaker 1: 

I don’t know. Nobody’s listening anyway. Dr. Lucas Jacomides is going to be joining us in the next few weeks, and we’re really excited about adding more capacity and hopefully adding more practitioners that share our philosophy on a holistic brand of urologic care. But if you email us your questions, we’d love to hear them. And Donna Lee, why don’t you tell people where our practices are, and then we’ll talk about ball pain.

Donna Lee: 

Yep. Oh, ball pain. That’s today? We are all over Austin. Our main locations in Round Rock on Hesters Crossing. We have a North Austin location, just south of Lakeline Mall by the terrible DPS office that just is awful to me. So when you need a break from there…

Dr. Mistry: 

Her name is Donna Lee, she drives the car with the license plate “Funny.” Please, take it out…

Donna Lee: 

The lines are too long there. We’re right by Westwood High School, that’s better. We have a location on South Congress in South Austin, just right by William Cannon. And we also have a Dripping Springs location. So that’s kinda cool. That’s awesome. Our number is (512) 238-0762. You can email your questions to Dr. Mistry or our new guy, Dr. Jacomides, or Dr. Yang, or Dr. Ong to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. And our website is armormenshealth.com.

Dr. Mistry: 

Donna Lee, today I wanted to talk about some, so it just seemed like this week in the clinic…

Donna Lee: 

There was a lot of ball pain?

Dr. Mistry: 

…seemed like ball pain theme.

Donna Lee: 

What, I wonder why?

Dr. Mistry: 

I thought what I would talk about are four of the types of testicular pain that we saw today, or this week, kind of one of our approach to each one is.

Donna Lee: 

Are they all four different?

Dr. Mistry: 

They’re all four different.

Donna Lee: 

There’s different ball pain?

Dr. Mistry: 

There’s different ball pains.

Donna Lee: 

That’s awful.

Dr. Mistry: 

There’s different ball pains. So the first patient was a 42 year old man. He was four years from a vasectomy…done by someone else.

Donna Lee: 

OK, good. I was about to say.

Dr. Mistry: 

…done by somebody else, another practice.

Donna Lee: 

Better not be you.

Dr. Mistry: 

I’m not going to say their name.

Donna Lee: 

Please do.

Dr. Mistry: 

And so, in any case, this can happen to any urologist that has nothing to do with technique in most cases. But this is a patient who came in with pain several years after of a vasectomy. He had pain right behind the testicle in a little organ called the epididymis. And sometimes that pain can be musculoskeletal, sometimes it can be nerve related. In most cases, it’s something called congestive epididymitis. And, you know, on the, on our vasectomy forms, we have that as the, as one of the potential risks. And people ask me after a vasectomy all the time, “What happens to the sperm?”

Donna Lee: 

Right?

Dr. Mistry: 

Have you heard of that?

Donna Lee: 

Yeah.

Dr. Mistry: 

Yeah. Well, maybe you’re wondering, maybe you’re not wondering.

Donna Lee: 

They’re wondering.

Dr. Mistry: 

And so the sperm get made and then are stored in the epididymis because of the vas deferens is blocked. And so….

Donna Lee: 

And tell people what the vas deferens is.

Dr. Mistry: 

The vas deferens is the difference between a man and a woman. The vas deferens is the tube that connects the testicle to where the sperm are deposited in the urethra, in the region of the prostate. And so that’s where the vasectomy or that, that tube, that vas deferens is transected. The sperm are stored in this epididymis and this epididymis swells ever so slightly. And then every 120 days, your body goes through and eats up the old sperm. But some men are very sensitive to that little bit of swelling that occurs, and it can even have it on one or both sides. And that’s called congestive epididymitis. It causes either like kind of a pain all the time, or you can have episodes of worsening pain several times a year. So this particular patient we’re going to take him for an epididymectomy, that’s a relatively simple procedure. It takes me about an hour epidemic. There’s a lot of P’s and D’s in that. It’s covered by insurance.

Donna Lee: 

That’s what she said!

Dr. Mistry: 

It’s done as an outpatient… there’s a lot of P’s and D’s. We’re going to get kicked off the show. And it’s something that resolves the pain in the vast majority of patients. So if you testicular pain, post vasectomy and you want to get somebody to take a look at it, we’d love to take a look at it for you. Not all urologists do the epididymectomy. I was surprised to hear that. When I was asked by another urologist to help me, help him do one, I was like, “Okay.” You know.

Donna Lee: 

You were like, “This is what I do.”

Dr. Mistry: 

This is what I do. So you know, if you have this kind of condition but haven’t been offered that procedure, it could just be as simple as that your urologist doesn’t know or doesn’t do them routinely. So then we had a patient who came to us for a fertility evaluation. He was about 37 and his testicles were relatively small and he had infertility because he’s been on testosterone for the last three years.

Donna Lee: 

Oh, snap.

Dr. Mistry: 

So that involves a lot of different components. Number one is if you’re trying to have kids and you’re on testosterone, you may have trouble having kids, because that medicine is going to shut down your testicals.

Donna Lee: 

It’s so contradictory, because you think the more testosterone you’re taking, the more manly you are, the more virile.

Dr. Mistry: 

Well, I am extremely virile and extremely manly…But if you take testosterone externally, it’s going to shrink your balls and it’s going to make you infertile. And so this patient had smaller testicles than I would have usually like attributed to testosterone use. But then he had a condition called a varicocele, and this are the veins that are coming from the test score enlarged. It’s similar to varicose veins in the legs. He had been having chronic pain in his testicals for many years. He was 37, he’d been having them for 20 years.

Donna Lee: 

Wow.

Dr. Mistry: 

A long time. And that kind of pain, we usually describe as a dull ache in the testicles, especially with prolonged lifting or standing. And he said that’s exactly what it was. And so I think, and that varicocele can cause pain, but it can also cause the testical to not function that well. So I think the varicocele not only caused his testicle not to be big to start with, but also causes low testosterone or contributed to it and causes testicular pain. And so we’re going to fix him with something called a varicocelectomy that can be done laparoscopically or microscopically. I do the microscopically because I think I get a better outcome. We’re going to make two small incisions in your lower groin. We’re going to find those veins and tie them off. And then your body makes new ones that are better behaved. And I do probably between 70 and 120 a year. So it’s a very commonly performed surgery in our clinic. And that’s because we do it also for fertility and also for testicular pain. So if you get, if you have varicoceles, if you think that this could be contributing to testicular pain, it’s definitely something that we would like to take a look at and could probably give you some help with.

Donna Lee: 

Wonderful. No, that was two.

Dr. Mistry: 

That was two. I dunno. I think we’re done with this segment, I don’t know if we have enough time, you think? We’ve time you think?

Donna Lee: 

No, we’ve got….

Dr. Mistry: 

Do you think we have time? Okay. Well good. Then we had a patient this week that had a cyst of the epididymis. So they could feel like a lesion in there or some kind of, some kind of mass. And that pain came and then went away and it was associated with swelling. And so they had an done at Scott and White and they thought that it could be a testicular mass, but were unsure, could be an infection, could not be. He came to us for a second opinion. I examined it, felt it was consistent with a testicular mass. And so, but he initially presented with pain, which was the interesting part. And 10% of patients with testis cancer will initially present with pain.

Donna Lee: 

Oh my.

Dr. Mistry: 

And so we went, took his testicle out, and he ended up having a lymphoma of the testicle, which is a relatively uncommon, you know, in young people, but more common and old people kind of testis cancer. It’s going to require chemotherapy. But what’s interesting is that it really did present just like an infection might. So, it just reminded me to never ignore ball pain. That’s something that you get taught in residency. Never ignore it. Always make sure you’re getting it evaluated by a professional. Make sure that an ultrasound is ordered when appropriate and make sure that the cause of it’s determined because it could be something dangerous.

Donna Lee: 

Wow. That’s fascinating.

Dr. Mistry: 

So that was only three, but I think that’s it. Why don’t you tell people how to get a hold of us?

Speaker 2: 

You can call us, talk about your ball pain! Ask us questions if you’ve got a specific ball pain. Armormenshealth@gmail.com. Email us anytime, armormenshealth@gmail.com. Our phone number is (512) 238-0762, during the week, give us a call. You can ask for me. And our website is armormenshealth.com.

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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