Sudden distention of the ureter, renal pelvis, or bladder may cause flank pain. Any patient with flank pain should be asked the following questions:

''Where did the pain begin? Can you point to the area?''

''Do you feel the pain in any other area of your body?''

''Did the pain start suddenly?''

' 'Have you ever had this type of pain before?''

''What seems to make the pain worse? less?''

''Has the color of your urine changed?''

Is the pain associated with nausea? vomiting? abdominal distention? fever? chills? burning sensation on urination?''

Gradual enlargement of an organ is usually painless. An aching pain in the costovertebral angle may be related to sudden distention of the renal capsule, which results from acute pyelonephritis or obstructive hydronephrosis. The spasmodic, colicky pain from upper ureteral dilatation may cause referred pain to the testis on the same side. Lower ureteral dilatation may cause pain referred to the scrotum. The pain of ureteral distention is severe, and the patient is restless and uncomfortable in any position. Bladder distention causes lower abdominal fullness and suprapubic pain, with an intense desire to urinate. Pain in the groin may result from pathologic processes in the spermatic cord, testicle, or prostate gland; from lymphadenitis of any cause; from hernia; from herpes zoster; or from a disorder that is neurologic in origin.

Testicular pain can result from nearly any disease of the testis or epididymis. Such diseases include epididymitis, orchitis, hydrocele, spermatic cord torsion, and tumor. Referred pain from the ipsilateral ureter must always be considered. Priapism is a painful, persistent erection of the penis that is not a result of sexual excitation. The sustained erection results from thrombosis of veins in the corpora cavernosa. This occurs in patients with sickle cell anemia or leukemia. The exact mechanism is unknown, but it appears to result from a blockage of venous drainage from the penis while the arteries remain patent. Chronic priapism often results in organic ED.

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