? Epididimytis/18 yr old son

Hi all,
Can't find another group relevant to this question, so thought I'd try here
(also posted to misc.kids.health) and hope some have older children or perhaps
there are some MDs on this group.
Our 18 year old son finally told me yesterday that he'd been having pretty
severe left testicle pain for over a week! He was too embarassed to tell me
sooner. His pediatrician was unable to see him yesterday and advised we get to
the ER. After 4 hours, labs, urinalysis and ultrasound, he was dx'd with
probable epididimytis (sp?). No masses or torsion present. He was prescribed
Cipro and Vicodin, with advice to see a urologist immediately because of
something he'd not told me before. His left testicle is much smaller than his
right and has been for as long as he can remember. He thought it was normal and
never mentioned it til yesterday. The ER doc was very concerned about this. The
testicle is descended, but, appears to be atrophied. She (and myself!) wondered
why his ped never picked up on this and is concerned about cause and his future
fertility.
She referred him to a urologist and hopefully, we'll be able to get him in
there today or tomorrow. My questions a
1) does anyone have any experience to share on this? 2) is it possible a
groin injury/pull which happened when he was 11 years old could have caused
this? 3) will this severely affect his fertility? and, 4) how could his ped
never have noticed this? I wasn't present for the ER doc's physical exam, due
to son's embarassment issues, so didn't see...but, ER doc said testicle is so
small, it's the first thing she noticed. He's had every required well visit,
including one just a few months ago. Hernia's are always checked for and, I
assumed, visual examination of the genital area was part of this. I guess this
was a sad and sorry assumption on my part. I love our ped, but, I am very
disturbed about this. Possibly, if this had been caught sooner, something
might have been done to preserve his fertility.
Anyway, we will be getting to a urologist ASAP. But, I was hoping someone
else could shed some light and/or comfort on this. Thanks in advance for any
help you can give.
-------------
Hoping your hills are never too steep!
Be well, Patty

Patty wrote:

I don't know much myself, but did a little looking.

Our 18 year old son finally told me yesterday that he'd been having pretty
severe left testicle pain for over a week! He was too embarassed to tell me
sooner. His pediatrician was unable to see him yesterday and advised we get to
the ER. After 4 hours, labs, urinalysis and ultrasound, he was dx'd with
probable epididimytis (sp?).

It's epididymitis, which is an infection of the epididymis,
which is the structure that connects the testicle with the vas deferens.
It is often associated with a UTI. A few places suggested that
most cases are caused by chlamydia these days, so it might be good
for him to get tested for that, since it's often asymptomatic. Some
other places said it can be caused by strenuous exertion with a
full bladder (leading to urine refluxing where it shouldn't).

No masses or torsion present.

That's definitely good. Torsion is bad, and masses aren't
great either.

1) does anyone have any experience to share on this? 2) is it possible a
groin injury/pull which happened when he was 11 years old could have caused
this?

I did read somewhere that testicular atrophy can be
caused by trauma, so I guess it's a possibility.

3) will this severely affect his fertility?

Depending on the underlying cause, it may or may not
be fixable. If it is not fixable, then it will likely
affect his fertility. However, the good news is that as
long as it's unilateral, that effect shouldn't cause major
problems.

and, 4) how could his ped never have noticed this?

That, I don't know. My boys are younger, but their
docs definitely check (since they're not old enough that
they don't want me in there yet). If t ped didn't check,
did he or she at least ask some questions about it?

Best wishes,
Ericka

I don't know much myself, but did a little looking.

Thanks Ericka!
I didn't know much either. This kinda knocked the wind out of us. With his
symptoms, I figured it was epididymitis from my research prior to the ER visit.
Because he'd had the pain for over a week and tolerated it well, I knew it
wasn't anything as serious as torsion. So, the infection dx was expected. The
atrophied testicle wasn't : (

good news is that as long as it's unilateral, that effect shouldn't cause
major
problems.

Yes. That is good news and pretty much what the ER doc told him with the
assumption that his other testicle is normal. Hopefully, the urologist he's
seeing tomorrow afternoon will be able to confirm that, in fact, he really is
just fine. I'm guessing since he's been like this for many years that there
probably isn't a surgical fix at this late a date.

their docs definitely check (since they're not old enough that
they don't want me in there yet)

This is really bugging me. I was present during the physical exam for all
of his well visits til the age of 13. After about age 8 though, he was very
embarassed, so I would cover my eyes during the 'privates' part of the exam. As
far as I knew, the ped was checking his genitals. But, it must have been a very
cursory exam. DH looked at DS last night and said there is no way in hell his
doc could NOT have noticed this difference. There is a huge discrepancy in
size. After seeing the urologist, I will be making an appt to talk to his ped
and see what in heck he was thinking (or not!).

did he or she at least ask some questions about it?

Nope. Doc didn't ask or even mention it, nor did DS, as he thought it was
normal.
Sigh It is so hard when they get old enough not to want their Mom's in with
them during their exams.
Thanks for your help and understanding
-------------
Hoping your hills are never too steep!
Be well, Patty

Patty, I thought Erika's post was good - but I have to add another
comment. An 18 year old male should have an "adult" doctor, not a
pediatrician. He's not a kid anymore.

Mary G.

My husband has had epididimytis twice since we have been together. I am amazed
that your son was able to keep it hidden that long. The first time that he had
it we didn't have a car and we walked to the dr. This was about 5 blocks. It
took us almost 20 minutes because he was in so much pain walking was difficult.
The second time he new what it was and went in before it got too bad. I
vaguely remember the dr saying it was related to the heat. Both times were in
the summer.
I can't help much on the size issue. If he had an undescended testicle I would
have thought they would have noticed before now.
Rose
Mamma to Caity Feb 13 1999 ( Daddy's best birthday present)

"Mary Gordon" wrote in message
om...
Patty, I thought Erika's post was good - but I have to add another
comment. An 18 year old male should have an "adult" doctor, not a
pediatrician. He's not a kid anymore.

Mary G.

My mom owned an answering service and you would not believe the calls we
would get. "My son is away ot college and needs to schedual an apointment
with dr. so and so." I would say you do realize you called a pediatric
office right? The other thing was 16- 17 year old girls would call for
pregnancy tests.. do the have those at pediatric offices? I never found out
since I could not do schedualing just take messages but I always thought it
was goofy

Tori

--
Bonnie 3/20/02
Anna or Xavier due 10/17/04

"Tori M." wrote in message
...


My mom owned an answering service and you would not believe the calls we
would get. "My son is away ot college and needs to schedual an apointment
with dr. so and so." I would say you do realize you called a pediatric
office right? The other thing was 16- 17 year old girls would call for
pregnancy tests.. do the have those at pediatric offices? I never found
out
since I could not do schedualing just take messages but I always thought
it
was goofy

Tori

--

Yes you can get a pregnancy test at a pediatrician's office. When I was 16,
I was still seeing a pediatrician because that's the way the Navy hospital
was set up. I also got my first pap smear in a pediatrician's office.

Denise

Bonnie 3/20/02
Anna or Xavier due 10/17/04

In ,
Tori M. wrote:

*My mom owned an answering service and you would not believe the calls we
*would get. "My son is away ot college and needs to schedual an apointment
*with dr. so and so." I would say you do realize you called a pediatric
*office right? The other thing was 16- 17 year old girls would call for
*pregnancy tests.. do the have those at pediatric offices? I never found out

Most pediatricians (at least, the ones I have talked to about this stuff,
which is a decent number when you factor in those I know both
professionally and personally) seem to keep pregnancy tests around, yes.
There is this whole epidemic of teen pregnancy, not to mention child
abuse, and so they end up needing them. Heck, my own pediatrician (um, the
one who takes care of my kids) was nice enough to give me a pregnancy test
(free of charge) one time. She had them lying around and was concerned
about the dizzy spell I suffered in her office

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

I thought Erika's post was good

Hi Mary,
Yes, it was a great post! I responded to it, rather lengthily, over an hour
ago. It still hasn't shown up here : ( I'll have to go back and look for
Erika's post, so I can try to answer it again.

An 18 year old male should have an "adult" doctor, not a
pediatrician. He's not a kid anymore.

Our pediatrician, and ALL of the others in our area treat 'kids' until they
are 21. Their waiting room is filled with as many teens and young adults as it
is with babies and toddlers. Aside from this latest problem, this group of peds
is wonderful and knows my kids' histories and problems well. My children are
also very comfortable with the docs here. I see no reason to switch to an
'adult' doctor until my children reach 21. My own physician does not see adults
under the age of 21. I don't know any other doctors I'd feel comfortable
switching to at this point.
Thanks for your thoughts : )
-------------
Hoping your hills are never too steep!
Be well, Patty

I would say you do realize you called a pediatric
office right?

All of the pediatric practices in my area treat until age 21. The American
Academy of Pediatrics groups 'older adolescents' for treatment as ages 16-21.
So, it's not unusual for a pediatrician to treat someone until they're 21 years
old.

17 year old girls would call for pregnancy tests.. do the have those at
pediatric offices?

Yes, they should have (and do, in my area) pregnancy tests available in
their offices. It's not goofy and would be irresponsible, IMHO, to not have
them available since girls have been known to get pregnant as young as 9 years
old. Sad, but, true
-------------
Hoping your hills are never too steep!
Be well, Patty