Can Benign Prostatic Hyperplasia (BPH) cause testicular pain?

BPH Does Not Typically Cause Testicular Pain

Benign Prostatic Hyperplasia (BPH) does not directly cause testicular pain, as the condition primarily affects urinary symptoms through obstruction of the bladder outlet and urethra. 1, 2

Understanding BPH and Its Symptoms

BPH is characterized by the proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic transition zone. This enlargement primarily causes lower urinary tract symptoms (LUTS) that can be categorized as:

• Storage symptoms: Frequency, urgency, nocturia
• Voiding symptoms: Hesitancy, weak stream, intermittency, straining
• Post-micturition symptoms: Sensation of incomplete emptying, post-void dribbling

The American Urological Association guidelines clearly outline that BPH symptoms are focused on urinary function rather than testicular pain 1, 2.

Diagnostic Approach for Testicular Pain When BPH Is Present

When a patient with BPH presents with testicular pain, clinicians should consider alternative diagnoses:

1. Urological causes:

   • Epididymitis
   • Orchitis
   • Testicular torsion
   • Varicocele
   • Hydrocele
   • Prostatitis (not BPH)
   • Urinary tract infection

2. Non-urological causes:

   • Inguinal hernia
   • Referred pain from kidney stones
   • Nerve entrapment
   • Musculoskeletal issues

BPH Assessment and Management

The standard BPH evaluation includes:

• Medical history
• Physical examination including digital rectal examination
• International Prostate Symptom Score (IPSS)
• Urinalysis 1, 2

Optional tests may include:

• Post-void residual measurement
• Uroflowmetry
• Prostate volume assessment 2

Treatment options for BPH include:

1. Medical therapy:

   • Alpha-blockers (first-line for most patients)
   • 5-alpha reductase inhibitors (for prostate size >30cc)
   • Combination therapy
   • PDE5 inhibitors (if erectile dysfunction is also present)

2. Surgical interventions (for severe symptoms or treatment failures):

   • Transurethral resection of the prostate (TURP)
   • Minimally invasive procedures

Clinical Pearls

• If a patient with BPH complains of testicular pain, this should prompt investigation for other conditions rather than attributing it to BPH
• Prostatitis, which can cause perineal or testicular pain, should be distinguished from BPH
• When evaluating testicular pain in men with BPH, consider obtaining a urinalysis to rule out infection
• Referred pain from other urological conditions may coexist with BPH

Common Pitfalls

• Attributing testicular pain directly to BPH without investigating other causes
• Focusing solely on BPH management when testicular pain is the primary complaint
• Failing to perform a thorough physical examination of the testicles, epididymis, and inguinal region in men with testicular pain
• Overlooking the possibility of prostatitis, which can cause pain and may coexist with BPH

In conclusion, while BPH is a common condition in aging men that causes urinary symptoms, it does not directly cause testicular pain. When testicular pain is present in a patient with BPH, other etiologies should be investigated.