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  • Positive Cough impulse but negative ultrasound

    Posted by Paul277 on August 24, 2016 at 3:59 pm

    Hello, im a 31 year old male from the uk. 2 years ago shortly after lifting a photocopier I developed pain in my left groin and testicle radiating down my left leg. After visiting my doctor he sent me off to have an ultrasound which showed testicular cancer in the right testicle and no abnormalities in the left side. I had surgery to remove the testicle which came back negative for cancer (ouch).

    Unfortunately my pain has persisted for 2 years now making the trauma of losing a ball for nothing very hard to overcome. I have had an mri scan and various antibiotics but the pain an inflammation seems to be getting worse. Believe it or not i was told by the doctors my pain was caused by the surgery eventhough i had the same pain before they operated! The. I was told i had epidydimitis but have always tested negative for any infection. The pain is always 10 times worse when i need a bowel movement or I go to the gym (which ive now stopped). Do these symptoms sound familiar?

    A few weeks ago i was getting desperate and booked to see a hernia specialist who after examining me said he felt an early deep inguinal hernia with positive cough impulse and booked me for an ultrasound.. Ive just had that ultrasound and am disappointed to say it came back negative for a hernia. Can anyone share any thoughts on this and should i push for surgery anyway? I am really suffering mentally and physically and starting to lose hope.

    Thanks

    Paul

    Paul277 replied 7 years, 5 months ago 4 Members · 8 Replies
  • 8 Replies
  • drtowfigh

    Moderator
    October 1, 2016 at 4:48 pm

    Positive Cough impulse but negative ultrasound

    So sorry to hear.

    Yes, it is possible that an inguinal hernia is missed on laparoscopy alone. That said, the chance is lower in men, as women tend to have occult hernias much more than women. Also, I am. It sure what your specific situation may be

    It seems that you shouldn’t suffer so much pain if there is a treatable cause.

    If you wish, you can choose to send me your images and any pictures and history so that I can help review them and provide you my opinion. Email me at [email protected] if that interests you.

  • Paul277

    Member
    October 1, 2016 at 11:56 am

    Positive Cough impulse but negative ultrasound

    Hello Dr Towfigh

    Thank you for your response. I had an exploratory laparoscopy last week and to my disappointment no hernia was found. The surgeon wasn’t prepared to investigate very deep as he didnt want to risk my only testicle and said everything looked fine inside. I am devastated by this as it means i am still plagued with pain in my left groin and testicle area and i paid £4000 for a needless operation where all i had was a camera pushed in through my belly button. Is it possible he couldve missed a hernia? The surgeons all seemed so certain from examining me that i had a deep inguinal hernia. I am now being referred to a pain specialist but there may be a 3 month wait to see him on the NHS and ive already paid thousands trying to get this resolved so will have to wait. What do u recommend i try next as i am starting to lose hope. My symptoms are extreme pressure in groin and testicle especially before a bowel movement. It feels like my testicle is being crushed and it will pull up extremely tight against my groin until after ive been toilet. I dont see how a pain specialist would help this problem since it feels more like something is physically wrong there? Maybe a varicocele or lipoma of the cord? I also have stabbing pains to the left of my belly button radiating down my left leg a bit. Ive had about 10 courses of antibiotics, colonoscopy, ultrasounds, mri scan, a trus and now exploratory laparoscopy. Still no closer to finding out whats wrong.

    Thanks

    Paul

  • drtowfigh

    Moderator
    September 8, 2016 at 9:00 am

    Positive Cough impulse but negative ultrasound

    Best of luck
    Make sure the laparoscopic exploration includes takedown of the peritoneum if normal laparoscopy does not show an obvious hernia.

  • Paul277

    Member
    August 29, 2016 at 5:34 pm

    Positive Cough impulse but negative ultrasound

    Hello, thanks again for ur reply its much appreciated. Just to update, I visited another hernia spacialist who examined me and said he feels a slight cough impulse and would like to do a laparoscopic examination. I’ll probably be getting it done in about a months time and I’m hopeful he’ll find a hernia or something there which has been causing me this pain. My only worries are that i dont have a bulge and the scans all come back clear but he said that doesnt matter, they very often find bit hernias when the scans are clear. Both doctors seem pretty certain i have a hernia and i wouldnt be surprised considering ive been a keen body builder for over 10 years and occasionally lift photocopiers at work. Fingers crossed thats what it is. If not then it may be more complicated such as nerve damage to my groin/testicle etc which is alot harder to treat.

    Thanks

    Paul

  • Chaunce123

    Member
    August 25, 2016 at 8:04 pm

    Positive Cough impulse but negative ultrasound

    Hey Paul, sorry you’re going through this and had the unnecessary surgery, that sounds really awful. I can relate to some of your other story however, with ambiguous ultrasound and cough impulse findings, groin pain, misdiagnosis, the works… so I can relay what I have learned.

    – Hernias are routinely overlooked on imaging, particularly if they are small. You might want to have another radiologist or hernia expert look at the actual images, CT or MRI results, not just the paper report.

    – Was your ultrasound done dynamic with valsava? Was it done standing up or laying down? Make sure you get one with valsava so that a valid picture can be seen when pressure is going on.

    Another option would be to consider a surgical laparoscopic exploration, but that has it’s own risks as well as potential benefits if they find something. You’d want to talk to a surgeon about this and only do it if there was genuine suspicion that it was worth pursuing.

    I am puzzled that you had a faint cough impulse though, and I wonder if that is suggestive of anything. Do you play soccer (football) or other sports? Are you physically active and fit physically? I ask because there are groin pulls, muscle tears, hip issues, and sports injuries that can mimic some hernia symptoms but without the typical workup.

    If you’re in the UK, you could consider going to The Gilmore Groin & Hernia Clinic.

    http://www.thegilmoregroinandherniaclinic.co.uk/

    Also sometimes in London, Dr Muschaweck does surgery there, but she is primarily based out of Munich Germany.

    http://www.leistenbruch.de/english/index.html

    Both of these clinics should be able to workup a hernia, a tiny hernia, a groin muscle tear, groin nerve entrapment, or related conditions. Personally if I was in Europe and had an ambiguous groin case, I would see Dr Muschaweck for a workup and testing, she is extremely well regarded in athletic communities.

    Best of luck to you, keep us updated on your progress, diagnosis, and plans.

  • WasInTN

    Member
    August 25, 2016 at 8:02 pm

    Positive Cough impulse but negative ultrasound

    Paul
    See this link. http://www.mayoclinic.org/diseases-conditions/testicular-cancer/basics/tests-diagnosis/con-20043068

    Immediately after ultrasound there must be at least one more test to make sure you had cancer. Sorry about this constant arguing but I am trying to say that one step process you followed was really bad. Should not you go to second opinion? Or even third?

    Any case let us discuss what is ahead. While I had IH, for 4 to 5 years I had nothing – no pain no pressure nothing. But as I started jogging, playing basketball in the driveway etc, a bulge developed near the base of penis (about 4, 5″ above) and it started to grow. I knew at this stage that the IH has progressed and needed cut.

    Pain was not regular but it came and went. When sleeping no pain. I also made sure I had good and easy bowel movement daily but when I had a pizza or something like that (high fat), I had to force a bit. It was then I had some kind of block But when holding the IH with hand I could push a bit and had clear bowel movement. Also I never had any major stomach problems related to digestion. Always had my bowel movement every morning and no trouble at all.

    So the IH pain was like pinching pain at the bulge when I was sitting long and driving. Also while sitting on toilet seat. I did not feel any groin pain or pain down the legs/hips etc. I tried to use some exercises on the Google and you tube but frankly they were of no use.

    I am not medical guy but I think you may have some other problem coupled with “watch out” IH it means the other problem might be messing up with the IH you may have (smaller and can probably wait). That’s my guess.

    Does your problem aggravate with some foods, some special movements, some kind of lifting etc? My first IH was diagnosed by my doctor back in 2008 when he asked me to cough and tested. He said I had it and needed to be careful. I ignored that doctor. By 2014 I could not ignore anymore due to the bulge. So I waited 6 years. My brother waited 20+ and had surgery on both sides. My dad had it all his life and never lifted heavy stuff and passed away with it.

    So watchful waiting worked for my dad. For me for 6 years and for my brother for 20+ but my brother recently lamented “What a waste of time! I waited 20 years and destroyed quality of my life!”

    Please update your condition when you can.

  • Paul277

    Member
    August 25, 2016 at 6:16 pm

    Positive Cough impulse but negative ultrasound

    Hi, thanks for your reply its much appreciated. Unfortunately these days one ultrasound is enough to operate for testicular cancer as they cant do biopsies on testicles. I did seek legal advice and it was ongoing for about a year but unfortunately the 3 nominated medical experts appointed by my solicitors said the hospital followed protocol. The ultrasound is 99% accurate for testicular cancer so unfortunately theres still the 1% who are misdiagnosed.

    I am no longer seeing those doctors anyway and am paying privately now as im desperate to get this sorted out. I have seen the uks top urologist in harley street and he hasnt been able to cure me as he thought i had a prostate problem but every time i type my symptoms in online it comes back as inguinal hernia.

    I have pain in my groin and my scrotum tightens up alot before bowel movements with relief after ive been. Its a feeling of intense pressure in my groin area and ive noticed a pattern with non stop pain for 2 days after every gym session so ive stopped going now.

    Do these symptoms sound like hernia to anyone? Im seeing the specialist again tomorrow so hopefully I’ll have more answers then.

    Thanks

    Paul

  • WasInTN

    Member
    August 25, 2016 at 4:16 pm

    Positive Cough impulse but negative ultrasound

    Paul,
    I am not a medical professional but I see there seems to be too many loose ends in your story. No doctor will recommend surgery after one simple ultrasound of the testes. Cancer is usually diagnosed with multiple scans/tests. One ultrasound to confirm cancer that warranted surgery and removal of your testicle? Sounds too fishy to me. If it really happened have you heard about words “biopsy,” “blood test?” Biopsy is done on a LIVING tissue to confirm cancer. Ultrasound cannot confirm cancer. It may show some growth or water in testicle but cancer? hmmmm… it could have been a hydrocele due to the lifting which usually happens in males.

    You probably have some other problem and you need to find out what it is. I am not sure when you said you are in UK whether you are in Europian country or some university of Kansas or such. But wherever you are, the doctor royally (if UK call it Kingly because the system still has that royal stuff, just kidding) screwed up the diagnosis that removed your testicle.

    Time to rethink about the doctor who is attending on you. How on earth did you agree to go under knife without second medical opinion and blood tests? You said 2 years ago. Google would have helped you and if it didn’t at least one of your friends or relatives should have. You went to doctor, had ultrasound, found cancer and testicle gone in a jiffy? Oh oh, something seriously needs to be considered.

    Read the sentence you typed here.. ” I developed pain in my left groin and testicle radiating down my left leg. After visiting my doctor he sent me off to have an ultrasound which showed testicular cancer in the right testicle and no abnormalities in the left side. I had surgery to remove the testicle which came back negative for cancer (ouch). ”

    You had pain on left and it was caused by cancer on right?

    I will have the doctor, scanning facilities and guys in court right away.

    Having said that, please check with other specialists what exactly is causing your problem. Could be it another location hernia or inflammation?

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