Pain in the genitourinary tract is usually associated with distention of a hollow viscus (ureteral obstruction, urinary retention) or the capsule of an organ (acute prostatitis, acute pyelonephritis). Pain may be local or referred. Pain associated with malignancy is usually a late manifestation and indicative of advanced disease.
Pain of renal origin is usually located in the ipsilateral costovertebral angle. It may radiate to the umbilicus. With infection, the pain is typically constant, whereas with obstruction it may come and go. Nausea and vomiting may result from reflex stimulation of the celiac ganglion. Patients with intraperitoneal pathology will typically lie motionless to avoid pain, while patients with renal obstruction will move about to try to find a more comfortable position.
Ureteral pain is typically acute and a result of obstruction. Distention of the ureter along with hyperperistalsis and spasm of the smooth muscle of the ureter may result in two different pain patterns. The site of obstruction is often predicted by the site of pain. Upper ureteral obstruction may result in pain in the flank and side. Midureteral obstruction may cause pain in the lower quadrant or groin and thus may be confused with appendicitis in right-sided ureteral obstruction or diverticulitis in left-sided ureteral obstruction. Lower ureteral obstruction may cause pain referred to the scrotum in males or to the labium in females. Obstruction from a stone in the very distal ureter as it traverses the bladder muscle or ureteral orifice is associated with bladder overactivity (frequency, urgency, dysuria).
Acute urinary retention results in severe suprapubic discomfort. Chronic urinary retention is usually painless despite tremendous bladder distention. Suprapubic pain not related to the act of micturition is rarely bladder in origin. Acute cystitis pain is usually referred to the distal urethra and is associated with micturition.
Prostatic pain is associated with inflammation and is located in the perineum. Pain radiates to the lumbosacral spine, inguinal canals, or lower extremities. Because of its location near the bladder neck, inflammatory processes of the prostate result in irritative voiding complaints.
Pain in the flaccid penis can be caused by sexually transmitted diseases, trauma, or paraphimosis, a condition of the uncircumcised male in which the retracted foreskin is trapped behind the glans penis, resulting in vascular congestion and painful swelling of the glans. Pain in the erect penis may be due to Peyronie disease (fibrous plaque of the tunica albuginea, resulting in painful curvature of the erect penis) or to priapism (prolonged erection).
Acute conditions such as trauma, torsion of the testis ...