I often palpate spermatoceles measuring 0.5 cm. What level of impotence occurs with each grade of a varicocele? What percentage of epididymitis cases are not infectious but rather are caused by an idiopathic inflammatory process? What credence do you place on cremasteric reflex, as it is almost always absent in cases of testicular torsion? — Gerald Vega, MPAS, PA-C, Orlando, Fla.

Spermatoceles that are <0.5 cm are difficult to palpate. You can feel normal epididymal tissue, which can be confusing. The size of a varicocele does not correlate with the degree of infertility; there is no correlation between spermatocele and erectile dysfunction.

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I am not aware of specific data regarding infectious vs. noninfectious epididymitis. An indurated epididymis in a patient with no fever or ill feeling is much less likely to be associated with infection. A significant number of men present with scrotal pain that is misdiagnosed as epididymitis. The cremasteric response can be diminished or reduced with scrotal pain from any source. Swelling and a high-riding testicle in the scrotum are more consistent indications for torsion. — Craig Ensign, MPAS, PA-C (168-5)

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