Common causes of testicular pain?

  • Diabetic neuropathy (nerve damage caused by diabetes)
  • Epididymitis (testicle inflammation)
  • Hydrocele (fluid buildup that causes swelling of the scrotum)
  • Idiopathic testicular pain (unknown cause)
  • Inguinal hernia
  • Kidney stones
  • Mumps
  • Orchitis (inflamed testicle)
  • Prostatitis (infection or inflammation of the prostate)
  • Scrotal masses
  • Spermatocele (fluid buildup in the testicle)
  • Testicle injury or hard hit to the testicles
  • Testicular torsion (twisted testicle)
  • Urinary tract infection (UTI)
  • Varicocele (enlarged veins in the scrotum)

What is painful Ejaculation?

Painful ejaculation, (other name- dysorgasmia or orgasmalgia) can range from mild discomfort to severe pain during or after ejaculation. The pain can involve the penis, scrotum, and perineal or perianal area.

Painful ejaculation can have a serious impact on your sex life.

What causes painful ejaculation?

The following are common causes for painful ejaculation:

1. Prostatitis

It is the term for inflammation or infection of the prostate gland. It’s the most common urologic problem in men under 50 years old.

It can cause painful or frequent urination, so it’s easy to mistake for a urinary tract infection. Other symptoms include lower abdominal pain and difficulty getting an erection.

2. Surgery (ExamplePost TURP, Post Hernia Surgery)

3. Cysts or stones

It’s possible to develop cysts or stones in the ejaculatory duct. They can block ejaculate, causing infertility and painful ejaculation.

4. Antidepressant drugs

Antidepressant drugs can cause sexual dysfunction, including painful ejaculation. The types that are most likely to cause sexual side effects are:

• ( SSRI-selective serotonin reuptake inhibitors)

• ( SNRI-serotonin and norepinephrine reuptake inhibitors

• ( TCS- tricyclics and tetracyclics)

• ( MOA- monoamine oxidase inhibitors)

5. Pudendal neuropathy

In this condition there’s some damage to a nerve in the pelvis. That can lead to genital and rectal pain. Some things that can affect the pudendal nerve are injury, diabetes, and multiple sclerosis (MS).

6. Prostate cancer

Though often asymptomatic, prostate cancer can cause painful ejaculation.

7. Trichomoniasis( type of STD)

8. Radiation therapy

Radiation therapy to the pelvis can result in erectile dysfunction, including pain on ejaculation. These side effects are usually temporary.

9. Psychological issues

Bladder Cancer

What are the causes of bladder cancer

  • Cigarette smoking
  • Family history of bladder cancer
  • Men are more vulnerable to developing bladder cancer possibly due to a greater incidence of cigarette smoking and exposure to toxic chemicals.
  • Exposure to dangerous chemicals such as arsenic, phenols, aniline dyes
  • Radiation therapy for prostate or cervical cancer and chemotherapy with cyclophosphamide (Cytoxan)
  • Chronic infections of the bladder due to stones or other foreign substances
  • Infections caused by  certain fluke

What are the symptoms of bladder cancer?


Blood in the urine or hematuria is the most common symptoms, other symptoms include Frequency, urgency, dysuria, pain in the flanks, bone pain.

How to diagnose a bladder cancer?

Majority patient diagnosed while evaluation for blood in urine. Always to be considered in a person with hematuria with more than 50 years of age. Tests used to diagnose are

  1. Urinalysis- will confirm hematuria
  2. Urine cytology- usually done in a centrifuged sample of urine. If positive high grade bladder tumor to be considered
  3. Ultrasound- it helps to detect presence of bladder tumor
  4. CT/MRI- it can also detect small tumor in the urinary system
  5. Cystoscopy/Biopsy- most important test to detect bladder tumor. It usually associated with TURBT. Resected tissue and Deep biopsy sent for Histopathological exam.

What are the treatment of bladder cancer?

The first surgical procedure is Transurethral Resection of Bladder Tumor or “TURBT.” This procedure is performed with the help of special instruments connected to a cystoscope and involves removing the tumor from the bladder with the help of electrical cautery equipment. This surgery is done through the normal urinary passage and does not involve an external incision on the body.

Next treatment depends on Grade and stage of diseases( TNM classification)

Diseases is mainly divided into superficial and muscle-invasive bladder cancer


What is the treatment of superficial bladder cancer?

  1. Intravesical therapy- BCG, Mitomycin, Gemcitabin etc
  2. Regular check up- by imaging , urinalysis, urine cytology, cystoscopy. Per se it is the most important part of treatment of bladder tumor treatment.


What is the treatment of muscle invasive bladder tumor?

Muscle invasive bladder cancer normally requires an aggressive treatment plan compared to superficial bladder cancer. Main treatment options are radical surgery or Radiotherapy

The most effective treatment for muscle-invasive bladder cancer is Radical Cystectomy. This process involves the surgical removal of the bladder and diverting the urinary stream using intestinal segments.

The procedure involves removal of the bladder, prostate, seminal vesicles, and the fatty tissue surrounding the bladder through an incision created in the abdomen. The lymph nodes in the pelvis are also removed in order to detect the presence of cancerous cells. This also helps in deciding further management measures post- surgery including the requirement for chemotherapy.

Radical cystectomy could be performed either through open surgery, laparoscopy, or with robotic assistance.After the removal of the bladder, the urine has to be diverted. This is done using any of the three urinary diversion methods namely; Ileal conduit, Orthotopic neobladder (where the patient passes urine from the normal passage) or Continent catheterizable pouch. All these methods use intestinal segments which are still attached to their blood supply but have been separated from the gastrointestinal tract

Radical cystectomy in combination with one of the three urinary diversion methods is the accepted and most effective treatment of muscle invasive bladder cancer and certain cases of high-grade superficial bladder cancer.

In certain cases Radiotherapy with or without chemotherapy is also considered as an options.

What is the role of chemotherapy?

Patients who have been diagnosed with metastatic bladder cancer are generally treated with chemotherapy. Chemotherapy may also be recommended for “locally advanced” bladder cancer in order to reduce the chances of recurrence of cancer after radical cystectomy. This process is called “Adjuvant chemotherapy.” “Neoadjuvant chemotherapy” is sometimes administered before radical cystectomy so as to improve the results of surgery and to reduce the size of the tumor.

Prostate Cancer

How to diagnose prostate cancer?

Digital rectal examination- The rectum is located close to the prostate gland. The doctor will examine the through the rectum. If your prostate gland is cancerous, it may feel very hard and nodular. However, very often, the prostate may feel quite normal, even though cancer cells are present. This is major disadvantage of DRE

PSA test- A sample of blood is taken for prostate-specific antigen (PSA). A small amount of PSA is generally found in blood. Men who have Prostate cancer tend to have more amount of PSA in their blood. However, the PSA test cannot be always relied upon and sometimes, men who have prostate cancer will have normal PSA. The increase in the PSA level could be also due to several other factors such as urine infections, recent prostate biopsies, having a urinary catheter, prostate or bladder surgery or a prostatic massage etc. PSA levels higher than normal may be due to prostate cancer or other causes. A biopsy often recommended by doctor if PSA is persistently elevated.

TRUS guided Prostate Biopsy- Biopsy is recommended if PSA is persistently elevated or DRE shows abnormal features. Numerous samples of tissue (usually 12 from all the sites of prostate) are taken  by biopsy from the prostate for pathological examination. The biopsy is generally performed under Transrectal ultrasound scan.

If the biopsy shows the presence of prostate cancer, several other tests performed to determine the stages of diseases

  • Radio-Isotope bone scan
  • MRI scan
  • PSMA PET Scan
  • Abdomino Pelvic CT Scan

What are the staging of prostate cancer?

Grossly there are three stages of diseases, localised or early prostate cancer , locally advanced, advanced or metastatic prostate cancer

What are the treatment options for localised or early prostate cancer

The major treatment options for early prostate cancer include:

  • Watchful waiting
  • Active surveillance
  • Surgery or removal of the prostate gland
  • Radiotherapy

Low grade disease, elderly patient often advised for watchful waiting. Treatment started once the symptoms develops. Young people who have low-grade early prostate cancer may be recommended active surveillance. If the cancer starts to progress, they will be asked to undergo surgery or radiotherapy. People who have moderate- to high-grade cancer are often recommended Radical Prostatectomy or surgery to completely remove the prostate gland or radiotherapy of the prostate. These treatments help to eliminate all the cancer cells and thus cure the cancer. The radiotherapy can be given to the patient using an external machine or even directly into the prostate gland.

What are the treatment options for locally advanced prostate cancer?

The treatment options for locally-advanced prostate cancer mainly include Radiotherapy, Hormonal therapy, Watchful waiting and Surgery. Sometimes in combination of treatment. There are certain factors which are taken into account prior to deciding the best treatment options. This includes physical health, grade and stage of diseases, PSA level, potential risk of treatment etc.

What are the treatment option of advanced Cancer prostate?

The treatment options for advanced prostate cancer mainly include Hormonal therapy (Medical or surgical castration)  Chemotherapy, Radiotherapy and controlling symptoms. Radical surgery is not recommended. However TURP may be performed to alleviate the symptoms. Treatment is mailnly directed to improve the quality of life



Benign Prostatic Hyperplasia- Benign Prostatic Hyperplasia (BPH) is a condition which involves non-malignant enlargement of the prostate gland. The enlargement of the Prostrate gland causes compression of urethra, resulting in obstruction of flow of urine from the bladder to the outside of the body. It further may cause somre complication like Acute Urine Retection, recurrent UTI, recurrent hematuria, backpressure changes in the kidneys

What are the sign and symptoms?

  • Frequent daytime and/or night time urination
  • Urgency
  • Hesitancy
  • Sense of incomplete urination
  • Blood in urine
  • Post void dribbling
  • Painful urination

What are the treatments of BPH?

Medical treatment- alpha bloker like tamsulosin, 5 alpha rqeductase inhibitor like finasteride or combination most commonly prescribed medicine

Surgical treatment- TURP, LASER Procedure, Open Prostatectomy

What is TURP?

In this procedure, after administering anesthesia. the doctor inserts a unique instrument into the urethra through the penis. With the help of this instrument, the doctor cut  the inner obstructing  prostate to enable the easy and smooth flow of urine from the bladder. Nowadays a modification of this procedure using Normal Saline and Bipolar current has made this a very safe operation.

What is LASER Surgery of prostate?

Different kind of LASER available for prostate surgey like Holmium Laser, Green light Laser , Diode Laser. There are various procedure available for Laser surgery like HOLEP, Laser ablation of prostate

Kidney Stones

Who are at risk for kidney stones?

  • Male : female =3:1
  • Peak at 20 -40 years
  • Prevalence higher in mountain, desert, tropical areas and more in summer season
  • 7-12% lifetime risk of stone formation
  • Recurrence rate is very high .. approx. 10 @1 year and 50 % @10 years

Causes of stone formations?

  • Hereditary disorder: RTA, Cystinuria, xanthinuria, hypercalciuria, hyperoxaluria etc
  • Dietary excess: like oxalates, purine, Vit C, Calcium etc
  • Reduction of water intake/ dehydration
  • Sedentary lifestyles/ immobilisation
  • UTI with urea splitting organism
  • Severe urinary obstruction
  • Gi disorders eg- IBD
  • Myeloproliferative disorders
  • Hypercalcaemic disorders
  • Drug induced

Symptoms and sign?

  • Sudden severe colicky pain in the flanks/ groins
  • Sometimes accompanied with nausea and/or vomiting
  • Gross or microscopic haematuria
  • Fever if associated with infections
  • Rarely with symptoms of renal failure


  • Noncontrast CT scan is diagnostic method of choice

Others – Xray, USG, IVU etc