Distal Ureteric Stone Presenting Solely As Testicular Pain: Diagnostic Lessons From a Primary-Care Setting

Ureteric stones are a common cause of acute flank pain, but their presentation can vary widely depending on the stone's size and location. Pain may radiate to the groin or testis because of shared sensory innervation between the ureter and the genitofemoral and ilioinguinal nerves. However, isolated testicular pain without urinary or flank symptoms is a rare presentation and can easily lead to misdiagnosis in primary-care settings. We report the case of a 23-year-old man who came to a small primary-care clinic with sudden right-sided testicular pain. Examination and scrotal ultrasound were both normal, ruling out torsion and infection. Because the pain persisted, a quick abdominal ultrasound was arranged, which showed mild right-sided hydroureteronephrosis and about 5 mm echogenic focus near the vesico-ureteric junction, suggesting a distal ureteric stone. The patient was managed conservatively with oral fluids, analgesics, and tamsulosin 0.4 mg once daily. Within three days, he passed the stone and became symptom-free. A repeat scan a week later confirmed complete resolution. This case highlights the importance of considering distal ureteric stones as a differential diagnosis for unexplained testicular pain, especially in primary-care and resource-limited environments where early imaging can prevent misdiagnosis and unnecessary interventions.