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Urology (Expert Forum)
Questions to ask abut irritated/inflamed urethra
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Questions to ask abut irritated/inflamed urethra
by Irribop, Oct 17, 2004 12:00AM
In July I started having some pain in the urethral area, what feels like about a quarter of an inch inside the opening. It started after a somewhat painful sexual encounter.
It did not feel like a UTI, which I've had a lot of. It just hurt and still does. There is no urgency or burning when I urinate. But the pain does get worse after I go. It also hurts to sit too long. Sex is impossible. The pain is not external but close enought to the opening that any friction or banging would hurt.
Anyway, when I first got it, the sticks you can buy at the drugstore did not detect a UTI, but sometimes high white blood cells.
A doc-in-the box diagnosed a UTI and gave me 3 days of levaquin, which didn't help. My regular doctor tested my urine after that. I had white cells to some extent but little bacteria. I got another 7 days of levaquin, which didn't help.
A urologist did cysoscopy (major ouch!) and saw what he called "classic urethritis," but no probem with the bladder. I got 10 days of doxycycline, which did not help. I had an MRI--no diverticula. The gynecologist did not think I had any form of vulvar disorder, and I have no pan there.
When I went back the urologist he said there was nothing that would cause me the kind of pain I am having, though he had seen inflammation at the opening of the urethra--which he did describe as "posterior." He referred me on to a female specialist.
I use scent free detegent, and no perfumes, etc. I am taking prescription stength alleve, but to little or no avail.
What can I ask the female urologist to look for when I see her? In other words, what could nonbacterial causes of urethritis be? What can I do to reduce the pain and inflammation?
Thanks for the help.
It did not feel like a UTI, which I've had a lot of. It just hurt and still does. There is no urgency or burning when I urinate. But the pain does get worse after I go. It also hurts to sit too long. Sex is impossible. The pain is not external but close enought to the opening that any friction or banging would hurt.
Anyway, when I first got it, the sticks you can buy at the drugstore did not detect a UTI, but sometimes high white blood cells.
A doc-in-the box diagnosed a UTI and gave me 3 days of levaquin, which didn't help. My regular doctor tested my urine after that. I had white cells to some extent but little bacteria. I got another 7 days of levaquin, which didn't help.
A urologist did cysoscopy (major ouch!) and saw what he called "classic urethritis," but no probem with the bladder. I got 10 days of doxycycline, which did not help. I had an MRI--no diverticula. The gynecologist did not think I had any form of vulvar disorder, and I have no pan there.
When I went back the urologist he said there was nothing that would cause me the kind of pain I am having, though he had seen inflammation at the opening of the urethra--which he did describe as "posterior." He referred me on to a female specialist.
I use scent free detegent, and no perfumes, etc. I am taking prescription stength alleve, but to little or no avail.
What can I ask the female urologist to look for when I see her? In other words, what could nonbacterial causes of urethritis be? What can I do to reduce the pain and inflammation?
Thanks for the help.
Doctor's Answer
by Kevin Pho, MD, Oct 19, 2004 12:00AM
, Oct 19, 2004 12:00AM
The doxycycline and levaquin would have treated for most infections - including STDs like gonorrhea and chlamydia. However, to be sure, you may want to be tested regardless.
The other thing would be to test the prostate for any infection. Prostatitis can be difficult to treat. A thorough digital rectal exam, and culture of any prostatic fluid should be considered. You can also discuss whether a transrectal ultrasound, evaluating for abscesses, would be helpful.
A cystoscopy would rule out any masses or strictures - so these possibilities are less likely.
There are some inflammatory or rheumatological disorders (i.e. Reiter's disease) that can also cause urethritis. If every test for infection is negative, you may want to pursue these causes.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The other thing would be to test the prostate for any infection. Prostatitis can be difficult to treat. A thorough digital rectal exam, and culture of any prostatic fluid should be considered. You can also discuss whether a transrectal ultrasound, evaluating for abscesses, would be helpful.
A cystoscopy would rule out any masses or strictures - so these possibilities are less likely.
There are some inflammatory or rheumatological disorders (i.e. Reiter's disease) that can also cause urethritis. If every test for infection is negative, you may want to pursue these causes.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
