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.

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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. 

Testicular cancer (testicular cancer) 3 stages: doctors, clinics, prices

Prognosis and survival

Tumors in testicular cancer occur in 2 varieties: seminoma and nonseminoma. They are treated differently. In general, nonseminomas require more complex treatment and are insensitive to radiation.

Metastases appear very early in testicular cancer. Starting from stage II, the lymph nodes of the abdominal cavity are already affected, causing back pain. The lymph nodes closest to the tumor are affected, which complicates the treatment.

Stage III has three additional stages: A, B and C. This depends on the level of tumor markers and on which organs metastases have spread.

• A – metastases enter the lungs, mediastinal lymph nodes
• B – metastases in the lungs, distant lymph nodes are affected
• C – metastases in the brain, liver

The 5-year survival rate at stage III is about 85%, at stage IV the survival rate is 56%. Compared to other cancers, testicular cancer is well treated with modern methods. Without treatment, the average life expectancy is 2-3 years.

What is the treatment for testicular cancer?

Need an operation to remove the testicle called radical orchiectomy . It is psychologically difficult to decide on this operation, but without it there is practically no chance of a cure. Moreover, the decision to go for surgery must be made quickly, some tumors can double in size in two to three weeks. An operation is needed to remove the primary focus and examine the histological type of the tumor in order to prescribe further treatment.

In addition, in the later stages, it is necessary to remove the affected lymph nodes surgically, because chemotherapy drugs are not always effective for the retroperitoneal lymph nodes. The surgery is called retroperitoneal lymphadenectomy . This is especially important for nonseminoma tumors to prevent their further spread. For seminoma tumors, radiation therapy may be used instead of surgery, because the cells of such tumors are sensitive to radiation. After the operation, a mandatory determination of tumor markers is carried out in order to understand whether the tumor has been completely removed or additional treatment is needed.

Testicular cancer is treated with cytostatic drugs. If metastases are up to 3 cm in size, then further surgical intervention may not be necessary, chemotherapy drugs will cope with them. Large lesions may require additional surgery to remove metastases.

Before starting treatment, doctors usually recommend cryopreserving semen . This is justified, since it is impossible to foresee in advance whether a violation of spermatogenesis is possible or not. To eliminate discomfort during removal of the testicle, an implant can be placed. In some cases, this can be done at the same time as the removal operation, in others only after the operation. Complete infertility occurs if both testicles are removed.

Where can I find a testicular cancer clinic?

While the patient and his family are trying to understand their disease and understand what treatment is needed, the tumor can move to a later stage. Therefore, treatment even in the later stages should not be postponed. You need to find a doctor who will prescribe the right treatment.

On the RussianHospitals portal you can find doctors and clinics specializing in the treatment of testicular cancer. In order to contact the clinic, you need to take 3 simple steps:

1. Choose a clinic at RussianHospitals
2. Fill out the application form and upload your medical documents
3. Get an answer from the clinic

Testicular biopsy – articles from the specialists of the clinic “Mother and Child”

Ryzhkov Alexey Igorevich

Urologist, Andrologist

Clinic “Mother and Child” Yaroslavl

Testicular biopsy – surgical removal of spermatozoa from the testicle and its epididymis. This approach is mainly used in obstructive and non-obstructive azoospermia to obtain spermatozoa for their subsequent use in the IVF/ICSI procedure.

The choice of biopsy method depends on the cause of azoospermia. If the absence of spermatozoa in the semen is due to impaired patency of the vas deferens (obstructive form), the probability of the presence of germ cells (gametes) in the gonads is high, the preferred method is microsurgical open biopsy of the epididymis (MESE). As an alternative, it is possible and often practiced to use puncture techniques (PESA, TESA).

Percutaneous Epididymal Needle Biopsy (PESA)

A butterfly needle is passed through the skin of the scrotum into the head of the appendage, aspiration (absorption) of the liquid is performed, from which gametes are subsequently extracted. If no motile spermatozoa are found during the examination of the obtained material, the procedure is repeated, puncturing another part of the epididymis.

Percutaneous Needle Testicular Biopsy (TESA)

A needle is passed through the skin into the testicle, aspiration (suction) of the testicular tissue is performed, from which spermatozoa are then removed. This technique is used if during PESA it was not possible to detect germ cells of adequate quality for ICSI, or for special indications. For example, with high DNA fragmentation of spermatozoa that cannot be corrected, testicular spermatozoa obtained as a result of TESE, which contain intact DNA, are used for ICSI.

Microsurgical open epididymal biopsy (MESE)

An open operation, during which the testicle is accessed through a 2–3 cm transverse incision in the scrotum. Under an operating microscope with a 15-20-fold magnification, the epididymal membrane is dissected and the widest part of the tubule is found, its lumen is opened and the liquid contained in it is aspirated. If, according to the results of the study of the obtained material, the quantity and quality of spermatozoa is insufficient, the procedure is repeated on another part of the epididymis. MESE is a much more efficient procedure than PESE, it allows obtaining sperm of better quality and in greater quantity, often enough not only for ICSI, but also for cryopreservation for use in subsequent procedures.

In case of non-obstructive azoospermia (absence of germ cells in the semen, due to a violation of the process of their creation by the gonads), when the probability of detecting spermatozoa in the testicles is lower than in the obstructive form, the most effective procedure is microsurgical testicular biopsy (microTESE). Classical open testicular biopsy (TESE) is also used.

Open testicular biopsy (TESE)

A small (1.5–2 cm) incision is made in the skin of the scrotum, the surface of the testicle is exposed, and its membrane is dissected over a short distance (3 mm). A small piece of tissue is taken from the resulting incision, the incision is sutured, and the resulting material is examined for the presence of germ cells. Both monofocal (from one site) and multifocal (from 2–3 cuts) biopsy are used. The average probability of finding sperm in non-obstructive azoospermia for TESE is 40–50%.

Microsurgical testicular biopsy (microTESE)

Through a transverse incision of the scrotum 2–3 cm, access to the testicle is made. The albuginea is dissected transversely in the middle part (equatorial zone), the parenchyma (the main functional tissue) is widely exposed. The parenchyma is examined under an operating microscope with a 16-25x magnification in order to search for and isolate dilated seminiferous tubules in which spermatogenesis occurs and are more likely to contain spermatozoa compared to non-dilated or collapsed ones.