Do I need surgery for swollen and painful testicles?

Q: I am suffering from abdominal pain for the last 4-5 months. My left testicle is swollen and lower as compared to my right one. I have gone through some tests (including semen count, which was slightly below normal (31.2 million/ml) and at first glance the doctor suggested that I have to undergo surgery for vas deferens. I took second opinion and the doctor suggested to wait for 6 months. He said he would operate only if the pain persisted. It's been 6 months and the pain is still there. What should be done as I am very sceptical about the surgery? I feel low and unenergetic. I can't walk more than 15-20 minutes at one go. My BMI is 27. Could this be a case of testicle cancer?

A:The events described, long term slight scrotal swelling, low sperm count, suggestion of a urologist for some surgery, and pain on walking, suggest that you have a varicocoele. Varicocoele is swelling of veins in scrotum due to defective venous valves, and these fill up when you are upright for a while. It is not a cancer. The test that confirms varicocoele is an ultrasound doppler of scrotum which should be done to confirm diagnosis, and exclude other possibilities.Varicocoele is not a significant disease. It is seen in upto 20% of normal young adults. Every varicocoele does not need treatment. Only varicocoeles associated with pain or a low sperm count needs surgical correction (unfortunately you have both). Best treatment for varicocoele today is microsurgical varicocoelectomy.