Differential Diagnosis for Scrotal Pain and Ureterolithiasis

Single Most Likely Diagnosis

• Ureteral colic: This condition is characterized by severe pain due to a stone obstructing the ureter. The pain often radiates from the flank to the groin and can be associated with scrotal pain, making it the most likely diagnosis given the combination of scrotal pain and ureterolithiasis.

Other Likely Diagnoses

• Epididymitis: Inflammation of the epididymis, which can be caused by infection or other factors, and can present with scrotal pain. The presence of a ureteral stone could potentially lead to urinary tract infection or inflammation that might involve the epididymis.
• Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. Like epididymitis, it could be a secondary effect of an underlying condition related to the ureteral stone.
• Testicular torsion: Although more commonly associated with sudden onset of testicular pain, it could potentially present with radiating pain that might be confused with ureteral colic symptoms.

Do Not Miss Diagnoses

• Testicular rupture: A serious condition that requires immediate surgical intervention. While less common, the combination of scrotal pain and potential trauma or severe inflammation could lead to this condition.
• Appendicitis: Although primarily presenting with abdominal pain, in some cases, especially if the appendix is located near the ureter or testicles, it could radiate pain to the scrotum. Missing this diagnosis could lead to severe consequences.
• Spermatic cord torsion: Similar to testicular torsion, this is a surgical emergency that could present with severe scrotal pain and might be associated with ureteral colic if the pain radiates or is referred.

Rare Diagnoses

• Henoch-Schönlein purpura (HSP): A form of vasculitis that can cause scrotal pain among other symptoms. It's rare but could be considered in the differential diagnosis, especially if other systemic symptoms are present.
• Scrotal cellulitis or abscess: Infection of the scrotal skin or tissues, which could be a complication of an underlying condition or a separate entity altogether.
• Malignancy: Testicular cancer or other malignancies in the pelvic area could cause scrotal pain and might be associated with ureteral obstruction due to metastasis, although this would be a rare and late presentation.