Yes. Kidney stones can cause pain in the testicles, and this is a well-recognized pattern rather than a coincidence. The connection is referred pain: the ureter and the testicle share the same nerve supply from spinal segments T10 through L1. When a stone blocks the upper ureter, the resulting pressure and spasm send signals along those shared nerves, and the brain misattributes the pain to the testicle on the same side. Roughly 20 to 30 percent of men with a symptomatic ureteral stone report groin or scrotal pain. Crucially, testicular pain from a stone never means the testicle itself is damaged, but it can mimic torsion, which is a surgical emergency.
The Shared Nerve Supply Behind Referred Testicular Pain
The mechanism starts with embryology. During fetal development, the testicles descend from the upper abdomen into the scrotum, dragging their nerve and blood supply with them. The testis therefore reports sensation through the genitofemoral nerve and the ilioinguinal nerve, both rooted in T10 to L1. The upper ureter, the renal pelvis, and the kidney capsule draw their sensory fibers from the same spinal segments.
When a stone lodges in the ureter, urine backs up and the ureter stretches and spasms. That stretch generates a barrage of nociceptive signals up the T10-L1 pathway. The spinal cord and brain cannot easily distinguish which downstream structure the signal came from, so the sensation gets referred along the same dermatome. Because the testicle sits on that same segmental map, the man feels it in the scrotum.
The laterality is telling. A stone in the left ureter typically produces left testicular pain, and a right-sided stone produces right-sided pain. Bilateral testicular pain from a single stone is uncommon and should raise suspicion for something else. In plain terms: the stone is in the urinary tract, but the nerve wiring makes the brain point to the testicle.
Why the Pain Feels Like It Moves
Ureteral stones produce migrating pain, and the testicular component is one stop on that journey. As the stone travels from the kidney down the ureter, the pain pattern shifts with the level of obstruction.
A stone high in the upper ureter often causes flank pain radiating to the groin and testicle. As it descends toward the ureterovesical junction, the pain concentrates in the lower abdomen, bladder area, and scrotum. This is why a man may describe pain that "started in my back and ended up in my balls," a classic history that points strongly to a ureteral stone rather than a primary testicular problem.
The pain is typically colicky, meaning it comes in waves that build to a peak over 20 to 60 minutes and then ease. It is often described as severe, rated 7 to 10 out of 10 at peak in acute renal colic. Nausea and vomiting accompany roughly 50 percent of colic episodes because the shared nerve pathways also connect to the gut. Restlessness is characteristic; patients with renal colic cannot sit still, unlike patients with peritonitis who lie motionless.
How Common Is Testicular Pain With a Stone?
Testicular or scrotal radiation is more common than many clinicians expect. Estimates vary because studies define "groin pain" differently, but the literature consistently places scrotal or testicular involvement at roughly 20 to 30 percent of symptomatic male stone cases. In one often-cited series of men with distal ureteral stones, genital pain was reported in about 1 in 4 patients.
For context, kidney stones affect about 1 in 11 people in the United States at some point, and men are roughly twice as likely as women to form them. Peak incidence falls between ages 30 and 50. That means a large population of men will at some point present with scrotal pain that is actually urolithiasis. Emergency departments see this regularly; renal colic accounts for roughly 1 in 500 emergency visits.
The number that matters clinically is this: testicular torsion, the condition that must never be missed, has an incidence of about 1 in 4,000 males under 25 per year. It is far rarer than stone-related referred pain, but it is time-critical, which is why the distinction is drilled into every clinician.
Kidney Stone vs Testicular Torsion: A Comparison
The single most important clinical task when a man presents with testicular pain is separating a benign referred pain from torsion. The table below compares the two using features a patient or clinician can assess.
| Feature | Kidney stone (referred pain) | Testicular torsion |
|---|---|---|
| Onset | Gradual to sudden, colicky waves | Sudden, often awakening from sleep |
| Pain pattern | Waves peaking over 20 to 60 minutes | Constant, severe, unrelenting |
| Location shift | Flank to groin to scrotum | Scrotum only, may radiate to abdomen |
| Testicular position | Normal, high-riding or horizontal | High-riding, horizontal "bell-clapper" |
| Cremasteric reflex | Present | Absent in most cases |
| Nausea/vomiting | Common (about 50 percent) | Common |
| Urinary symptoms | Blood in urine, urgency in many | Usually absent |
| Fever | Possible if infected | Absent early |
| Time window for treatment | Hours to days, urgent but not emergent | 4 to 6 hours before testicular loss |
| Best next step | Urinalysis, imaging (CT or ultrasound) | Immediate surgical exploration |
The 4-to-6-hour window for torsion is the number to remember. Testicular salvage rates exceed 90 percent when detorsion happens within 6 hours, fall to roughly 50 percent by 12 hours, and drop below 10 percent after 24 hours. A stone will not cost a man his testicle; a missed torsion will.
The Time Course: When Pain Peaks and When It Resolves
Stone-related testicular pain follows the natural history of the stone itself. The timeline below maps what a typical patient experiences, from first symptom to resolution.
| Phase | Typical timing | What happens |
|---|---|---|
| Stone begins to obstruct | Hour 0 | Flank pain starts, may radiate to groin |
| Peak colic | 30 minutes to 2 hours | Pain builds in waves, nausea, restlessness |
| Testicular component emerges | 1 to 6 hours | Pain shifts toward scrotum as stone descends |
| Spontaneous passage (if small) | 1 to 4 weeks | Stones under 5 mm pass in about 80 percent of cases |
| Passage of stone | Variable | Sharp pain at urethra, then relief |
| Post-passage | Immediate | Pain resolves once obstruction clears |
| Intervention (if large) | Days to weeks | Lithotripsy or ureteroscopy if stone does not pass |
Stones smaller than 5 mm pass spontaneously in roughly 80 percent of cases. Stones of 5 to 10 mm pass in about 50 percent. Stones larger than 10 mm rarely pass without intervention. This is why a man with testicular pain from a small stone is often managed with pain control and observation, while a large stone prompts urology referral.
Red Flags That Mean It Is Not Just a Stone
Referred testicular pain from a stone is benign, but several presentations are not. Any of the following should trigger immediate emergency evaluation rather than watchful waiting.
- Sudden severe testicular pain, especially in a male under 25, with a high-riding or horizontally lying testicle and absent cremasteric reflex.
- Testicular pain accompanied by swelling, redness, or exquisite tenderness of the testicle itself.
- Fever above 100.4 Fahrenheit with scrotal pain, suggesting epididymitis or infection.
- Anuria (no urine output) with flank pain, suggesting complete obstruction or a solitary kidney.
- Pain that persists unchanged for more than 24 hours without colicky pattern.
- A palpable mass in the testicle or scrotum.
The counterintuitive point: a stone that causes scrotal pain is usually a small stone in the lower ureter, and the pain is a sign the stone is moving, not that the testicle is in danger. The dangerous scenario is the reverse, where a torsion is mistaken for a stone.
What to Actually Do
If you are a man with flank pain radiating to the groin or scrotum, the practical steps are straightforward.
First, drink water and try to pass urine to see if a stone emerges. Strain your urine through a filter or a coffee filter to catch the stone for analysis; knowing its composition guides prevention.
Second, take an NSAID if you have no contraindication. NSAIDs are more effective than opioids for renal colic, per the 2019 American Urological Association guideline, and reduce the need for narcotics. A typical approach is ibuprofen with food.
Third, seek care if the pain is severe, you have a fever, you are vomiting and cannot keep fluids down, or you have only one kidney. Imaging with a noncontrast CT or ultrasound confirms the stone's size and location.
Fourth, if pain is sudden and severe in the testicle alone, go to an emergency department immediately and say "rule out torsion." Do not wait to see if it settles.
Finally, after a stone passes, follow up for metabolic evaluation if you are a recurrent stone former. Roughly 50 percent of men who form one stone form another within 5 to 10 years, and dietary changes reduce that risk measurably.
Limitations of the Referred-Pain Model
Referred pain explains most stone-related scrotal discomfort, but it is not a complete account. A stone lodged very close to the bladder can irritate the lower ureter and bladder trigone, producing urgency, frequency, and a burning sensation that men may describe as scrotal or penile discomfort through a different pathway. Some patients with distal stones report penile tip pain rather than testicular pain, which follows the same segmental logic but maps to a different structure.
Imaging does not always find the stone, especially small ones or those obscured by bowel gas on plain film. A normal scan in a patient with classic colic is common and does not exclude a stone that has already passed. And the percentages cited here come from clinical series with varying definitions, so the true rate of purely testicular pain may be somewhat lower than 30 percent. No large prospective series has isolated testicular pain as the sole presenting symptom, which is a genuine gap in the literature.
The practical takeaway remains firm. Testicular pain with a stone is a nerve-mapping artifact, usually signals a moving or obstructing stone in the lower ureter, and is benign in itself. The one thing it must never be confused with is torsion, which shares the scrotal location but not the time window. When in doubt, err toward emergency evaluation; the cost of a negative torsion workup is far lower than the cost of a missed one.