Testicular Pain

Pain in the testicles can occur at any age and often associated with non-cancerous causes. Testicular cancer is usually painless but testicular pain should always be reported to your doctor. An evaluation by a urologist and proper imaging are the key to early diagnosis and treatment.


Testicular pain may be caused by a number of benign reasons. It is important to have any early evaluation to make sure that an underlying cancer is not present. Causes may include:

  • Infection
  • Trauma / Torsion (this may be an emergency)
  • Kidney Stones
  • Inflammation
  • Muscle pull / strain
  • Hernia (inguinal or groin)
  • Testicular cancer
  • Varicocele
  • Nerve damage
  • Hydrocele


In addition to a thorough history and physical, your doctor may order any of the following tests:

  • Urinalysis / Urine Culture
  • Scrotal Ultrasound
  • KUB / Plain X-ray of the abdomen
  • CT scan of the abdomen and pelvis
  • MRI of the Pelvis


Your urologist will discuss the findings with you and develop an appropriate plan depending on the underlying cause. Some options may include:

  • Antibiotics
  • Anti-inflammatory medication (e.g Motrin, Advil)
  • Athletic Supporter
  • Ice / Rest
  • Surgery

Urethral Stricture

A urethral stricture is a scar in or around the urethra (the tube that carries urine out of the bladder) that can block the flow of urine. This is commonly caused as a result of inflammation, injury or infection. Often, a minor trauma to the perineum (the area between the scrotum and the rectum) can cause a gradual narrowing of the urethral opening resulting in a weakened urinary stream, urinary spraying and straining. Strictures are more common in men because of their anatomy but can also be found in women in rare cases.


A urethral stricture may be formed by one or more of the following:

  • Trauma to the genitals (e.g. penis, scrotum, perineum)
  • Infections (e.g. STD infection such as gonorrhea)
  • Prior instrumentation of the urethra
  • Pelvic fractures
  • Congenital birth defects


A urethral stricture can cause a variety of urinary symptoms including:

  • Weak or interrupted urine stream
  • Difficulty starting urination
  • Painful urination
  • Spraying or sputtering of urine stream
  • Inability to completely empty the bladder
  • Blood in the urine
  • Urinary tract infections
  • Infertility


While a careful review of symptoms may suggest a urethral stricture, additional workup will be needed and may include:

  • Urinalysis / Urine culture
  • Urinary symptom score questionnaire
  • Urodynamics / Urine flow studies
  • Ultrasound or CT scan
  • Retrograde urethrogram (RUG)
  • Cystoscopy


The type of treatment will depend on the location and severity of the stricture. While some can be managed conservatively, others may require one or more of the following:

Urethral Dilation – a special dilator (called a “sound”) may be used to stretch the urethral opening and relieve the blockage. Dilation is rarely a cure and needs to be periodically repeated. If the stricture recurs too rapidly, the patient may be taught how to insert a catheter into the urethra periodically to prevent early closure.

Urethrotomy – this is done in the OR under sedation. A cystoscope (small camera) is passed through the urethra until the stricture is encountered. Using a small knife, the scar tissue is cut, creating a gap in the narrowing. A catheter is usually left in place for 5-7 days to allow the urethra to heal in the “open” position.

Urethroplasty – this is a more complex surgery that is also done in the OR under anesthesia. Several different options are available depending on the location and length of stricture.

  • End-to End Anastomosis - short strictures can often be repaired by removing the scarred segment and reconnecting the two healthy “cut” ends of the urethra. A catheter is left in place for 2-3 weeks to allow for healing.
  • Buccal Mucosal Grafting - when the stricture is longer, a piece of tissue (often taken from the inner cheek) is transferred to the scarred segment to enlarge the opening to a normal size. A catheter is left in place for 2-3 weeks to allow for healing.
  • Fasciocutaneous Flap – if the stricture is further towards the end of the urethra, a flap of skin can be rotated from the penis to ensure survival of the newly created urethra. These procedures are complex and may require a short hospital stay. A catheter is left in place for 2-3 weeks to allow for healing.
  • Staged Procedure – sometime the stricture is so complex that it cannot be repaired in one setting. This may take several weeks to months to complete and the patient will likely need to drain his bladder through a tube in the belly or by a temporary opening in the perineum, which would require the patient to sit down to urinate.

Follow Up

Because urethral strictures can recur at any time after surgery, patients should be monitored regularly by their urologist. After removal of the catheter, follow-up of the repair should be performed intermittently with physical examination and X-ray studies being performed as necessary. Sometimes, the doctor will perform cystoscopy to evaluate the repaired area. Some patients will have recurrence of stricture at the site of the prior repair. These are sometimes mild and require no intervention, but if they cause obstruction they can be treated with urethrotomy or dilation. A repeat open surgical repair may be needed for significant recurrent strictures.

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