Pain disorders in Urology

Various pain disorders in urology can cause long-standing bothersome pain affecting daily routine and mental health.

What are the causes of testis pain?

The common reasons for testis pain are varicocele, ureteric stone, chronic pelvic pain syndrome, epididymo-orchitis (infection), testicular torsion, inguinal hernia, mumps, and rarely cancer.

When should I consult a doctor for testis pain?

Any child who complains of testis pain should be brought to the hospital immediately for an early evaluation by a doctor so that the serious conditions like testicular torsion can receive early intervention. An adult may seek doctor consultation if his mild dull aching testis pain does not subside after 2-3 days of oral paracetamol tablet. If there is moderate-severe testis pain, then the adult should seek an early consultation with a doctor.

Is testis torsion serious?

Testis torsion is an emergency condition and commonly presents between 12-18 years of age but can happen at any age. Testis torsion is partly diagnosed by physical examination by a doctor but confirmed on ultrasound scan. Testis twists on its pedicle resulting in testis receiving less or no blood supply. One attempt at manual de-rotation of testis can be done if no severe pain, but most receive immediate surgical exploration to fix the rotated testis in normal position.

Can any surgery cure testis pain?

If no obvious cause for testis pain has been found (idiopathic) in adults after a detailed evaluation, then various options available to treat chronic orchalgia are oral medications, spermatic cord block injection, botox injection to spermatic cord, orchiopexy (? intermittent torsion) and microscopic spermatic cord denervation surgery.

Can sperm build up cause testis pain?

Sperm build-up can happen in spermatocele which can lead to bothersome pain if it increases rapidly in size over a period of few weeks.

Blue balls or epididymal hypertension refers to scrotal pain or a feeling of heaviness after sustained sexual arousal without orgasm and ejaculation.

Some men do notice relief of testis pain after ejaculation (masturbation or sexual intercourse).

What is chronic pelvic pain syndrome (CPPS) ?

Chronic pelvic pain syndrome is a diagnosis of exclusion where no obvious cause for pelvic pain is found by any investigations. This condition is frustrating both to the patient and doctor as there are no established treatment protocols offering complete relief to these patients. It could be due to intermittent pelvic muscle spasms which may require Botox injections, chronic infections of prostate requiring long term antibiotics, neuropathic disorders requiring medications to improve the nerves, pelvic physiotherapy, bladder neck relaxation medications , antidepressants and so on.