Testicular pain: What to know

Written in association with: Mr Nkwam Michael Nkwam
Published: | Updated: 07/09/2023
Edited by: Sophie Kennedy

Testicular pain can be a sign of various issues and requires immediate medical attention. In this informative guide, highly respected consultant urological surgeon Mr Nkwam Micheal Nkwam shares a key case in point of what to do when testicular pain occurs and explains the importance of seeing a doctor promptly.

Can testicular pain be a sign of something serious?

It has always been well-documented that finding cancers earlier improves the likelihood of cure so seeing your doctor quickly if you have blood in your urine for example, is always the right thing to do. But what about testicular pain?

As we say in the trade, "Time is testicle!", so make sure you seek urgent medical attention as soon as possible! Although testicular cancer can present with a painful testicle it is far from the most likely cause. The most important diagnosis to rule out is twisting of the testicle on its cord - this is called testicular torsion.


A case in point: What to do when testicular pain strikes

It is 3pm on Monday afternoon and 14-year-old Johnny is in the middle of his favourite session of double maths at school when all of a sudden, he develops a severe pain in his right testicle (although either testicle can be affected). He is sent to see the school nurse for review. The pain gets worse and the nurse quite sensibly advises he be sent to A&E immediately to review. Johnny’s parents are informed and come to pick him up within the hour to take him to the nearest hospital.

It is now 4:30pm and Johnny is seen straight away by the urology team. There is no history of injury to testicle for example, while playing sport, and Johnny had been totally well all week with nothing to suggest a urine infection either. His testicle was still painful but now also red and swollen so the doctors explained to Johnny and his parents that they are concerned this may be a case of testicular torsion! There is no scan which can tell doctors one hundred per cent that there is no torsion - so the only way to confirm the diagnosis and treat it in one go is with immediate surgical exploration in theatre.


“Time is testicle”

Testicular torsion occurs when the testis rotates on its cord cutting off the blood supply to the testis – this is a medical emergency.

Truth be told, testicular torsion can occur at any age but is most common between the ages of 12 and 18 years. If left twisted, the testicle will eventually die but if it is untwisted, it can be brought back to life and this is time-dependent. Over 80 per cent of testes are saved when the testis is untwisted within 6 hours of the onset of pain. However, the salvage rate falls to about 50 per cent at 10 hours, 10 per cent at 12 hours and a lowly 5 per cent or less at 24 hours. Hence, the saying “time is testicle!”


What about Johnny?

Luckily for Johnny, he got to theatre 2 hours after his pain started and his testicle was twisted. So, the surgeons untwisted it thus saving the testicle and put stitches in as well to stop it from happening again. For good measure his other testicle was also stitched to prevent the same. Both Johnny and his testicles went on to make a full recovery and he was back in double maths again the following week!

The take home message is; in the event of sudden onset testicular pain make sure you seek medical attention immediately.




Mr Nkwam Micheal Nkwam is one of the UK’s leading consultant urological surgeons. To schedule a consultation with Mr Nkwam, visit his Top Doctors profile today.

By Mr Nkwam Michael Nkwam
Urology

Mr Nkwam Michael Nkwam is a highly respected consultant urological surgeon based in London. He is renowned for his expertise in benign prostate hyperplasia (enlargement), prostate cancer diagnostics and Holmium laser (HoLEP). He additionally specialises in kidney stones, haematuria (blood in the urine) and vasectomy. His NHS base is at the Princess Royal University Hospital in Farnborough Common, part of King’s College Hospital NHS Foundation Trust, where he was appointed in 2019.  He holds the position of Chair of the Cancer MDT as well as Cancer Lead for Urology and as such has established good working relationships with Consultants and Clinical Nurse Specialists from other specialties such as General Surgery & Gynaecology.
 
Training

Mr Nkwam completed his medical degree at St George's, University of London in 2007, subsequently completing his core surgical training in the West Midlands in 2011. He was awarded his membership of the Royal College of Surgeons of England in 2010, later completing his higher surgical training in Urology in the East Midlands training programme. During his time in the Midlands he garnered experience in all aspects of urology including bladder, prostate and kidney cancers, as well as andrology and female bladder health.  He became a Urological Fellow of the Royal College of Surgeons of England in 2017 and in 2018 he was awarded admission to the General Medical Council’s Specialist Register for Urology.
 
Subspecialist Fellowship Training

Mr Nkwam completed a year-long fellowship in Holmium Laser Enucleation of the Prostate (HoLEP) surgery and Endourology at Luton & Dunstable Hospital, one of the highest volume centres for HoLEP in the UK performing over 200 cases annually.  Here he developed his expertise in performing the HoLEP – widely regarded as the most effective and durable procedure available for men with benign prostatic enlargement.  Shortly after his appointment to King’s College Hospital, London in November 2019 he successfully performed their first ever HoLEP procedure and to date he has performed over 350 cases.
 
Research

Mr Nkwam has clinical expertise in all areas of endourology, general urology and urological oncology.  He is also a keen academic and has presented his work at several national and international conferences.  His research is well published, with over 20 publications in peer-reviewed journals and seven as first author.
 
Throughout his esteemed career, the excellence of Mr Nkwam’s work has been recognised with numerous awards, including ‘Best Poster in Session’ prizes, awarded by the European Association of Urology (EAU) in 2017 and the British Association of Urological Surgeons (BAUS) in 2018.  As a testament to his academic and clinical expertise, he was also awarded the East Midlands Trainee Medal in 2017 and the Ian McCallum Research Prize in 2018 for his work on superficial bladder cancer, in Nottingham.  He is a member of several key professional bodies, including British Urology Researchers in Surgical Training (BURST) and the British Association of Urological Surgeons (BAUS).
 
Lastly, Mr Nkwam has also been awarded a Master of Philosophy (MPhil) for his research thesis on the development of new biomarkers in prostate cancer.
 
Special interests

Following on from his MPhil research, Mr Nkwam has a specialist interest in prostate cancer diagnosis and treatment.  He is an expert in MRI-guided ultrasound fusion transperineal prostate biopsy – a procedure which can be done simply and quicky under local or general anaesthetic in just a few minutes with the added benefit of targeting potential prostate cancers with the help of an MRI scan.  This transperineal approach has the added advantage of greatly reducing the risk of infection following biopsy compared to the standard transrectal route.

In addition to setting up the HoLEP service at King’s, Mr Nkwam also re-launched the Focal Therapy service at the Trust in November 2024 with the introduction of Nanoknife – focal therapy treatment for prostate cancer.  This has the benefit of treating only the part of the prostate with the cancer in it and crucially sparing the rest of the prostate and surrounding critical structures without the need for any hormonal manipulation.  This means significantly reduced side effects for men, such as erectile dysfunction and urinary incontinence, compared to more standard radical treatment options, such as radical prostatectomy or radiotherapy.
 
Mr Nkwam also offers minimally invasive surgical treatments for benign prostate enlargement including Rezum (steam treatment) and prostatic urethral lift implants (Urolift).
 
Mr Nkwam is an excellent listener and prides himself on his clear oral and written communication with patients, and always does his best to go the extra mile for them whenever he can. 
 
In his spare time he enjoys watching and playing football, as well as rugby and Formula One.  However, his favourite past-time is spending time at home with his wife and three young children in south London.

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