When Should You See a Urologist? – What to Know

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UUANJ earned the “Center of Excellence” destinction for BPH and Incontinence Care!

UUANJ earned the “Center of Excellence” destinction for BPH and Incontinence Care!

UUANJ earned the “Center of Excellence” destinction for BPH and Incontinence Care!

UUANJ earned the “Center of Excellence” destinction for BPH and Incontinence Care!

UUANJ earned the “Center of Excellence” destinction for BPH and Incontinence Care!

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When it comes to health problems, men are most likely to endure their symptoms longer before going to the doctor than women. Sometimes, it may be because they don’t feel like their condition is serious enough, and other times, they may find it embarrassing to have certain parts of their body checked.

The latter is the case when it comes to testicular issues. According to Urologic surgeon, Dr. Jonatahan Bingham, it takes the average man around six months to see a doctor after symptoms of testicular mass or tumor appear. Dr. Bingham is from Coordinated Health, which is part of Lehigh Valley Health Network.

Here’s when it’s time to visit your urologist:

Signs of prostate cancer

Your symptoms could mean you have prostate cancer, which is one of the most common cancers among men. Prostate cancer does not show noticeable symptoms at an early stage and can only be identified by having prostate cancer screenings. Having said that, you should highly consider going to the urologist if you feel worried about this condition.

Spotting early symptoms of prostate cancer makes it easier to cure. However, this means that you shouldn’t skip your appointments with your urologist to see symptoms and prevent them from becoming more serious.

Testicular pain

When you start to feel constant mild pains in your testicular area, it’s time to consult a urologist. If something doesn’t feel right, you need to have it checked right away to prevent any serious conditions. The urologist can also give you remedies and treatments to alleviate the pain.

Erectile dysfunction

Erectile dysfunction is common, particularly among older men. However, it is also typically tied to other medical issues that can be medical or psychological. When you observe that you have erectile dysfunction, consult the urologist right away to have any possible conditions treated.

Urinary issues

Issues like slowing of the urinary stream, painful urination, frequent urination, and sudden start and stop of the urinary stream are common among men as they grow older. That said, such issues could also be tied to the growth of the prostate gland.

It’s important to address these issues because they can lead to serious problems in the kidney or the bladder in the long run.

Blood in the urine

When you start to see blood in your urine, don’t delay testing and visit your urologist right away. Blood in the urine can signify prostate enlargement, kidney stones, or tumors in the kidney or bladder.

Kidney stones

Kidney stones may not be painful early on, but over time, it can cause excruciating pain and severe health conditions. Prolonging your treatment can lead to serious kidney issues that can be deadly. When you spot these symptoms, visit your urologist to prevent your condition from getting worse.

Conclusion

Men should not be ashamed or embarrassed to talk about testicular issues, especially if it’s for medical concerns. Visiting the urologist when symptoms first appear is essential to avoid any serious condition. More importantly, doing so will help relieve pain and stop issues that can be worrisome from appearing again.

We care about your health! Our team of expert urologists in New Jersey is more than willing to address your concerns. Request an appointment with us today!

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What Kind of Doctor Should I See For Testicular Pain?

Ball pain. Nuts aching. Sac is hurtin’. Regardless of what you call it, testicular pain is no fun.

You’re not alone. Testicular pain is really common. Unfortunately guys don’t talk about their berries being squeezed in vice grip.

Instead they suffer in silence and walk around like John Wayne just got off of a horse.

Maybe this is something serious though. Testicular torsion (twisted testicle) or epididymitis (bacterial infection) are no joke and require immediate medical attention. I’m certain cancer might be running through your mind as well.

So what kind of doctor should you see for testicular pain? At some point you’ll need a urologist. Maybe you had no idea there was a ball pain specialist. Or maybe you’ve seen 3 of them and no one seems to help.

Let’s get you some help for those achy breaky balls. Because when they’re aching, it’s hard to feel good about anything.

What causes testicular pain?

A good doctor develops a differential diagnosis for every patient complaint. A list of possible medical conditions that could be causing the symptom. For testicular pain this list includes but is not limited to:

Testicular torsion

Testicular torsion is fancy doctor speak for a twisted testicle. No blood is going to the testicle and this is not good.

It is usually seen in kids and young adults. It is exceedingly rare after age 40. It will cause severe, drop you to your knees pain with nausea or vomiting. Unless you get your ball “untwisted” with surgery in 4 hours or less, the testicle unfortunately dies due to lack of blood flow.

Although intermittent torsion can occur, this is pretty rare. If you’ve been aching for weeks to months then torsion is very unlikely.

Epididymo-orchitis

An infection of the testicle or epididymis typically presents with an acute onset (fast) of one-sided pain and swelling. An examination will clearly show swelling and tenderness. Usually this is caused by a urinary tract infection or sexually transmitted disease.

Varicocele

Swollen veins draining the testicle are seen in up to 15% of men. Sometimes visible as a “bag of worms in the sac”, varicoceles are more common on the left side. They can cause a heavy, dull ache that’s usually worse with standing throughout the day.

The veins will not “burst” but they can cause male infertility in addition to chronic pain. A surgical repair by a micro-surgical specialist will fix this issue for good.

Inguinal hernia

A hernia is a weakness of the abdominal wall. Bulging and pain can occur at this site of weakness as your “insides” are “poking out.” When this bulging occurs in the groin area we call this an inguinal hernia.

An inguinal hernia can extend into the scrotum leading to ball pain and swelling. This is usually obvious on a physical examination but at times can be subtle. This is treated with surgery to repair the weakened tissues.

Hydrocele

Another cause of a painful “big sac” is an accumulation of fluid around the testicle. A hydrocele most often occurs for no good reason. It can be a consequence of a trauma, infection or even cancer. An ultrasound of the scrotum will confirm the diagnosis.

Sometimes a hydrocele will go away on it’s own. If it doesn’t then surgery does the trick.

Epididymal cyst

Speaking of swelling of the sac you can also have lumps next to the testicle. The epididymis sits behind the testicle and carries sperm. Cysts can develop leading to a “third nut” as men have told me. These are universally benign and can be cut out if they are causing pain.

Testicular cancer

Testicular cancer most often presents with a painless firm mass of the testicle itself. I’ve included it because cancer should always be considered in a differential diagnosis. The good news is that cancer rarely causes pain and is easily ruled out with an exam and ultrasound.

Kidney stone

Kidney stones are bad enough but ball pain as well? When a kidney stone is traveling down the urine tube (the ureter) it can cause a referred pain to the testicle. If you have associated back or abdominal pain, nausea/vomiting or a history of kidney stones, evaluation with CT scan should be considered.

Post-vasectomy pain syndrome

This rare condition (1/500 vasectomies) is distinguished by the start of pain shortly after a vasectomy. We are not certain why it happens but it is not fun. Local anesthesia blocks of the spermatic cord can temporarily relieve the pain.

When necessary, microscopic denervation procedures can be performed with success rates up to 85%. Sometimes men even elect to have the vasectomy reversed (vasovasostomy) to re-hook the plumbing pipes. This releases the back pressure and solves the post-vasectomy pain as well.

Musculoskeletal cause

The testicle is connected to the spermatic cord. An anatomic structure containing blood vessels, nerves, the vas deferens and muscles running to the testicle. The muscles are known as the cremaster muscles.

The reason your balls hug tight to the body in cold water is the cremaster muscle contracting to keep your berries warm. This muscle is a continuation of the internal oblique muscle; a series of muscles fibers that make up your core abdominal wall.

When you suffer from low back pain, are hanging on to 40 extra pounds of belly fluff, or lifting heavy objects all day, you are straining your core abdominal muscles. Since these muscles are connected to the cremaster muscle, your testicle hurts.

Musculoskeletal strain is probably the cause of 95% of testicular pain seen by a urologist. If you’ve had normal exams, ultrasounds, urine tests and no one has been able to help you yet, then this is probably what’s going on. As a urologist, it’s not unusual to see 5-10 men per week for a 2nd opinion on ball pain.

Testicular pain evaluation

Regardless of the kind of doctor you see for testicular pain, every evaluation starts with a good history. Bilateral (both sides) or alternating pain eliminates almost all of the above conditions with the exceptions of post-vasectomy pain syndrome and musculoskeletal causes.

A physical exam can detect masses, lumps and swellings. Tenderness with an otherwise normal exam is seen with many of these conditions. Some doctors you see for testicular pain may be experienced (urologist) or inexperienced (pretty much everyone else) with performed a thorough and accurate exam for testicular pain.

When necessary imaging can be performed. A CT scan should be considered for suspected kidney stones. A scrotal ultrasound will confirm findings on a physical exam.

Sometimes a scrotal ultrasound will show incidental findings that are not felt on an exam (small hydrocele or cyst). If a doctor can’t feel it then it’s not the source of the pain.

Treatment for Testicular Pain

I’m going to assume that you’ve had a normal exam, imaging tests and have never had a vasectomy. This leads us to our diagnosis of chronic testicular pain (also known as orchialgia).

First and foremost, we recommend viewing this condition like headaches and backaches. Most headaches aren’t due to brain cancer. Most backaches don’t require a visit to the spine surgeon. They are musculoskeletal in nature.

When muscles and nerves are irritated, most exams are normal. Unfortunately quick fixes are not always possible.

Here are some options for treating chronic testicular pain:

Improved diet and exercise

It’s amazing how often clean eating and moving our body is the answer to chronic medical conditions. Eating chalupas on the couch never served anybody except the business owners of Taco Bell. The crap we eat causes inflammation. Inflammation causes chronic pain.

When we exercise we release our body’s natural pain killers called endorphins. Strengthening your core and lower back can help testicular pain over time.

As a result of diet and exercise you should start shedding some pounds from your belly. All this extra weight we carry in our midsection strains our back and core muscles. Lose the weight, lose the ball pain.

I’ve had more patients tell me their testicular pain resolved after weight loss than any other thing I’m about to suggest.

Pelvic physical therapy

Muscle tension of the lower abdomen and pelvic floor is associated with chronic testicular pain. An experienced pelvic physical therapist can identify any muscle imbalances, improving chronic pain. It doesn’t work for everybody, but there’s little risk in giving a session a try.

Off-label medications

Sometimes medications designed for another purpose are helpful for seemingly unrelated medical conditions. This is known as an off-label medication. For chronic testicular pain I’ve had success with Tamsulosin (prostate medication), hydroxyzine (anti-histamine) and amitriptyline (anti-depressant).

Every urologist has his or her favorite for helping men get a little relief. It’s really important to avoid narcotics at all costs. This is a chronic condition and the last thing you want is an opioid dependence.

Surgery

Some of the same microsurgical options are available for testicular pain. Referral to a urologist fellowship trained in microsurgery may be your last option for treating unresolved testicular pain. Performed under anesthesia in the office or surgery center, spermatic cord denervation or cryotherapy can have success rates of 70-85%.

Who’s The Best Doctor For Testicular Pain?

If you haven’t had an in-person visit with a doctor then you should start there. This is one of those instances where a physical examination is important. A scrotal ultrasound is not a bad idea either to dot the “I’s” and cross the “T’s. ”

If you’ve already been to a urologist, and are frustrated, then why not consider a second opinion with a VirtuCare specialist. We can review any medical records that you provide and do a deep dive to make certain nothing has been missed.

Our second opinion visits last on average 30 minutes so you know you won’t be rushed for time. We are hear to listen to you.

With our network of colleagues, we’d be happy to make a referral to a microsurgical expert if that’s what it takes to cure your testicular pain.

Unfortunately there are certain medical conditions that can’t be cured. But you at least deserve care from an expert who will listen and do everything they can to help.

Your family jewels deserve the best. 

Pediatric urology – features and indications for visiting a specialist

A pediatric urologist is a doctor who specializes in the prevention, diagnosis and treatment of diseases of the urogenital area in boys.

A pediatric urologist is a doctor who deals with the prevention, diagnosis and treatment of diseases of the urogenital area in boys. We asked Oleg Vladimirovich ABAIMOV, an urologist-andrologist at Euromed, about when to show a child to a pediatric urologist and what diseases children have to deal with most often.

When is a boy shown to a pediatric urologist?

The neonatologist examines the child immediately after birth. He assesses the child’s condition by a variety of parameters, looks at how all body systems work, including the urinary and genital systems, and looks at the state of the genital organs.

The next scheduled examination is at the age of three, before kindergarten, and then at the age of 7, before school. The doctor looks at how the baby is developing, whether it corresponds to his age.

Of course, if there are any problems, then they come to the pediatric urologist with specific questions, most often, the pediatrician directs.

What are the most common urological problems in boys?

The first thing they look at in the hospital is whether the testicles have descended into the scrotum, this is usually well understood even by a non-specialist. The testicles of a boy develop during the period when he is in the womb. Normally, they descend into the scrotum (the sac that sits behind the penis) before birth. If this does not happen, put diagnosis of cryptorchidism (undescended testicle). In rare cases, both testicles fail to descend.

This diagnosis is made in 5 out of 100 newborns. It usually occurs in premature babies or low birth weight babies.

In most cases, the testicles descend on their own within the first three months of life. If this does not happen before 6 months, treatment is prescribed. This can be a conservative way (give hormonal drugs) or surgical.

Another common condition that may require the attention of a urologist is phimosis. This is a condition in which the glans penis does not fully or partially open due to constriction of the foreskin. There are physiological and pathological phimosis. Physiological phimosis is often observed in children, its appearance is associated with structural features of the genital organs of the child. Only in 10% of newborn boys, the glans penis opens. In the majority, the skin of the foreskin is fused with the head of the penis, and this is considered a normal condition up to 3-4 years. In the process of penis growth, the head independently pushes the foreskin apart and opens. This process can continue until adolescence, during the puberty of the boy, hormones are activated that make the tissue of the foreskin more elastic and extensible, and the situation returns to normal.

Surgical intervention in this situation may be required only if phimosis prevents the separation of smegma (it stagnates and provokes swelling and inflammation) and / or urination, this is easy to understand: urine does not flow normally, the foreskin swells, an inflammatory process may begin due to stagnation of urine . In this case, of course, it is necessary to show the child to a pediatric urologist as soon as possible.

In no case do not try to dilute the foreskin yourself; this can lead to tissue ruptures and subsequent scarring and, as a result, cicatricial phimosis, which is treated only promptly.

Another disease that I would like to mention is hydrocele. With dropsy, there is an accumulation of fluid in the membranes of the testis, which leads to an increase in the scrotum, usually one half of it becomes noticeably larger than the other. The cause of this disease is usually a failure of the communication between the scrotum and the abdominal cavity, which normally releases fluid. Sometimes dropsy of the testicle goes away on its own by the age of three. If this does not happen, surgical treatment is performed. In any case, in the presence of dropsy of the testicle, a consultation with a urologist is required.

What symptoms should parents look for in order to understand that a child needs to be seen by a urologist?

You should contact a pediatric urologist if:

• the child has problems with urination, pain, swelling;

• you have noticed a decrease in urination, often this is due to the fact that the child is afraid to urinate because of pain and endures to the last;

• discharge from the penis;

• redness, rash on the genitals;

• swelling and redness of the penis and / or scrotum;

• injury to the scrotum;

• pain in the lumbar region, lower abdomen;

• urinary incontinence;

• infrequent urination;

• undescended testicle.

Almost all urological diseases are treated quickly and effectively, the main thing is not to delay contacting a doctor!

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Pediatric urologist consultation

The author of the article

Abaimov Oleg Vladimirovich
Head of the urological service, urologist, oncologist

Pain in the testicles

The male testicles are not only the most important organ of the male reproductive system. The anatomical location of the testicles is due to the fact that the maturation of spermatozoa occurs at a temperature slightly below normal body temperature, so they are located in the skin-muscle formation – the scrotum. In addition, the testicles are permeated with a dense network of nerve fibers and blood vessels.

This organ is vulnerable to various factors of the external and internal environment: it is subject to injuries, infectious attacks, as well as vascular pathologies and tumor neoplasms.

Meanwhile, it is in the testicles that testosterone is produced – the main male sex hormone and spermatozoa necessary for the fertilization of the female egg. That is, damage to the testicles not only reduces the quality of life of a man, but can also lead to a complete loss of reproductive function.

Causes and symptoms

Causes of pain in the testicles can be very diverse, and each of them has its own symptoms. Here are just a few of the conditions that can cause testicular pain:

1. Inflammation of the testicle (orchitis) or epididymis (epididymitis). In these cases the pain in the testicle is intense and constant. In addition, these diseases are usually accompanied by general malaise and fever up to 38-39degrees Celcius. The scrotum on the side of the inflammation turns red, becomes enlarged, tense and painful on palpation. A rapidly onset and growing inflammation of the testicle or its epididymis requires emergency medical care, treatment and daily medical supervision. The sooner treatment is started for orchitis or epididymitis, the more likely it is to maintain their reproductive function. Late treatment increases the risk of surgery.

2. Varicocele – testicular varicose veins. It develops due to the peculiarities of the anatomical structure of the circulatory system and may be accompanied by aching pain in the lower abdomen and in the scrotum, or be asymptomatic. A varicocele can result in visual dilation of the testicular veins, a decrease in the size of the involved testicle, and a decrease in the ability to conceive.

3. Prostate disorders : exacerbation of chronic prostatitis, adenoma (benign hyperplasia) or malignant tumor. An important symptom pointing to the prostate gland as the root of the problem is pain that radiates to the lower back, leg, lower abdomen or scrotum. The testicles themselves remain the same to the touch as they were, without pronounced changes, and the intensity of pain in them varies from discomfort to moderate pain.

4. Testicular torsion. It can be provoked by wearing tight clothing, sudden movements or overexertion of the press (for example, during exercise), and even awkward movements in sleep or a strong, hysterical cough. The symptoms of torsion are:

• Acute pain in the scrotum
• Testicle pull up
• Nausea and vomiting
• The color and shape of the scrotum may change
• Increase in testicle size

This pathology is more typical for young people, but also occurs over the age of 18-20 years. In this case, immediate medical attention is required – it is best to call an ambulance. In the absence of medical attention within 3-4 hours after the onset of acute pain, testicular necrosis may begin – as a result, you risk losing this organ.

5. Unrealized sexual arousal. Sexual arousal is accompanied by an increase in blood flow in the genitals and the accumulation in them of the components that make up the sperm. Thus, the accumulated contents of the gonads with delayed or absent ejaculation often causes discomfort or aching pain in the testicles and lower abdomen.

6. Prolonged sexual abstinence. Testicular pain in an adult male may appear after a week of sexual abstinence.

7. Hydrocele (hydrocele) – accumulation of fluid between the membranes of the testis. The disease is more common in young men aged 20-30 years. This is due to impaired blood supply and lymph flow. One of the most common causes of this pathology is an inflammatory process that can develop under the influence of a viral, bacterial infection, trauma, or as a result of surgery. The main symptom of a hydrocele is an enlargement of one or both halves of the scrotum. At the same time, the testicle itself in the shells filled with liquid is not palpable.

8. Epididymis or spermatic cord cyst. The causes of pathology are diverse – endocrine disorders, exposure to infection, trauma. With a small size, the cyst does not cause discomfort to a man and is usually found by chance, during a medical examination during palpation or ultrasound. But over time, it can progress, increasing in size, causing discomfort, which becomes the reason for going to the doctor.

9. Testicular cancer is a malignant tumor that develops from the tissues of the testicles. The risk group includes young people aged 20 to 40 years. The likelihood of the disease is higher in those men who in childhood suffered from cryptorchidism – an undescended testicle. Requires a specialized examination, is subject to radical treatment.

Benefits of treatment at the First Men’s Clinic:

• Highly specialized urological clinic.
• Possibility of examination in one day (reception, tests, ultrasound)
• Comfortable reception area.
• Duration of reception – 40 minutes.
• Analyzes can be taken at any laboratory in the city.
• The reception includes: consultation, examination, drawing up an examination plan.

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Reception conducted:

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Diagnosis and treatment

There are no two identical patients: the same disease can manifest itself in completely different ways depending on its form and stage, on the state of the patient’s body and his age, on the presence of concomitant diseases and medications that a person takes, as well as on many others. factors. That is why the diagnosis and treatment of testicular pain is always individualized. First you need to assess the current state of health. At the initial consultation, the doctor conducts a conversation, which includes the collection of complaints and anamnesis, as well as an examination. Based on this, the examination program and the list of analyzes are determined. Depending on their results and the patient’s complaints, the doctor draws up a treatment plan, as a result of which it is necessary to come for a second appointment to monitor the treatment result and, if necessary, make adjustments.

It may also turn out that urologists will not find any disease that could cause pain in the testicle. In this case, you will be referred to a neurologist and a chiropractor – the staff of the First Men’s Clinic also has such specialists. The fact is that pain can be the result of violations in the muscular corset – we are talking primarily about the muscles of the back and pelvic floor. In addition, the causes may lie in damage to the nerves of the lumbar and sacral plexus or different parts of the spine – in this case, unilateral or bilateral spread of pain along the leg, buttock and lower back is characteristic, sometimes this is accompanied by loss of sensation in the toes, segments of the limb or a tingling sensation, goosebumps in the projection of the genitals. In this case, CT or MRI will help determine which nerve is involved in the pathological process.

The first men’s clinic is characterized by a comprehensive approach to treatment, combining medication, surgery and physiotherapy.

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In preparing the article, the following materials were used:

Clinical uroandrology, edited by V. Mirone, translated from English by Chaly M.E., 2019year.

Clinical guidelines of the European Association of Urology. 2019

Urology: National Guide. Lopatkin N.A. (ed.) 2009

Andrology. Pharmacotherapy without mistakes. Guide for doctors. Kamalov A.A. 2017

National Guidelines for Oncourology Ed. IN AND. Chissova, B.Ya. Alekseeva, I.G. Rusakova, 2012

Author of the article: urologist, therapist Pyrov A.