Urologic causes of gynecomastia: approach to diagnosis and management.

A 27-year-old man presented with bilateral painful breast enlargement and recent onset right testicular swelling. After appropriate evaluation, a radical orchiectomy was performed, and a Leydig cell tumor was found. The various urologic etiologies for gynecomastia are presented, as are the potential interventions. A rational approach to the patient with new onset breast swelling is presented.