Pain in the urethra is a common condition in men. It can be due to an inflammation of the urethra or to a urethral stenosis. The severity of symptoms varies depending on what’s causing the condition. Treatments also vary according to the type of problem. How do you recognize these diseases? What are the symptoms and possible treatments? Origins, manifestations, diagnosis… Clinique Marois will tell you all about it.

The different types of problems

Pain in the urethra in men can be a sign of urethritis or urethral stricture.

• Urethritis

  Urethritis is an inflammation of the urethra (the pathway that carries urine from the bladder to the urinary meatus) and the peri-urethral glands. In most cases, this inflammation has an infectious origin, so it’s considered a sexually transmitted infection (STI).

  Urethritis is a public health issue worldwide. It’s frequent, highly contagious and increases the risk of contracting human immunodeficiency virus (HIV). It’s the cause of several cases of infertility in women and prostatitis in men and is considered a reportable disease.

• Stenosis

  Urethral stenosis is a rare disease that affects about 0.5 per cent of men. It’s characterized by a narrowing of the urethra. This scarring around or inside the urethra causes a decrease in the pressure of the urine stream.

Causes of urethral pain in men

Depending on the nature of the problem, the causes of urethral pain can vary greatly.

• Causes of urethritis in men

  Urethritis can have both infectious and non-infectious causes.

  In the majority of cases, it’s of infectious origin and is the result of a sexually transmitted and blood-borne infection (STBI). Several bacteria cause it, the three main ones being:

  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Trichomonas vaginalis

  Urethritis is called gonococcal when it’s caused by the gonococcus (Neisseria gonorrhoeae). This is the most common form. It usually appears a few days after contamination, which probably occurred during unprotected sexual intercourse with a person who was already infected.

  Gonorrhea can be associated with the second most common bacterium, Chlamydia (Chlamydia trachomatis). This mixed form is common and accounts for 25 per cent of cases. Trichomoniasis, also transmitted through unprotected sex, is the infection caused by Trichomonas vaginalis.

  Non-infectious urethritis is less common and can be caused by bladder instability or an enlarged prostate. It’s also caused by testicular or prostate cancer, testicular abnormalities or inflammation after surgery.

• Causes of urethral stenosis

  Urethral strictures can have several causes. It may be related to a urinary tract infection such as gonorrhea. Other likely causes of urethral strictures include:

  • infection of the foreskin (glans),
  • tumours in the urethra (quite rare),
  • severe trauma in the pelvic area (e.g., falling on a bicycle with a horizontal bar).

  Technical manipulations (catheterization, endoscopies), as well as certain sexual practices with foreign bodies, can cause trauma that favours scar formation. This can lead to the narrowing of the urethra. Urethral stenosis can also occur following prostate surgery or other types of surgery on the urinary tract.

Symptoms of urethritis

Urethritis has several different symptoms. The patient may experience urinary burning, urethral discomfort and spontaneous urethral discharge outside of urination. This discharge may resemble pus or serum and may be accompanied by blood.

Urethritis may also be manifested by urinary frequency or hematuria (blood in the urine). Other clinical signs may also be present depending on the extent and origin of the infection.

Symptoms of urethral stenosis

Urethral stricture results in very thin or double, interrupted, spiral urinary jets in most cases. Other symptoms include:

• dripping of urine after urination,
• burning sensation when urinating,
• presence of residual urine because of obstruction or urine flow,
• urinary tract infection,
• hematuria (blood in the urine)

In the most severe cases, stenosis can lead to complete obstruction of urine flow.

Possible tests to diagnose infections

Depending on the patient's symptoms, different tests can be performed to diagnose infections that cause male urethral pain.

• Possible tests for urethritis

  If signs of urethritis appear, the physician will first test for an STI. After confirmation, they’ll take specific biological samples to identify STI factors. They may ask for a urine sample or a sample of the urethral discharge to be collected from the urinary meatus. These samples will be analyzed in a medical laboratory.

  The specialist may also perform physical examinations to diagnose urethritis.

• Possible tests for stenosis

  One effective test for diagnosing stenosis is cystoscopy. This involves viewing the inside of the bladder with a cystoscope. A urologist performs this test and provides a clear enough picture of the bladder to detect bladder infection, bleeding or problems.

  Urethrocystography and bladder ultrasound are other tests that can be used to diagnose stenosis.

Treatment of urethral pain in men

The treatments proposed by the doctor are different depending on what’s causing the pain in the urethra.

• Treatment for urethritis

  The medications prescribed vary according to the germ responsible for the pathology. After confirming the diagnosis, the physician may prescribe an antibiotic-based treatment (free of charge at RAMQ). They may also prescribe painkillers and corticosteroids.

  To optimize the effectiveness of the drug treatment, it’s preferable to follow these preventive measures:

  • abstinence for up to 7 days after treatment is completed and symptoms have resolved
  • using a condom during sex if abstinence becomes difficult or if there is any doubt
  • mandatory testing and treatment by the partner(s).

  Infections confirmed by a laboratory test must be reported to the regional Public Health Department (PHD).

• Treatment for stenosis

  To treat stenosis effectively, specialists can dilate the urinary tract. This surgery widens the meatus opening to facilitate the normal passage of urine. This is a minor surgery that’s quite common in cases of stenosis.

  Optilume is an innovative treatment performed in Les Cliniques Marois to treat recurrent stenosis, often after conventional therapies have been ineffective. This new treatment consists of balloon dilatation and taking medication.

  Meatomy is a surgical procedure that also widens the opening of the urinary meatus. It’s widely used to treat stenosis.

  Urethral pain in men can be a manifestation of urethritis or stricture. Treatment for these infections can range from simple medication to surgery, depending on the problem.

  To find out the source of the infection, you need to confirm the diagnosis with a specialist. Cliniques Marois has specialists who can diagnose and treat sexual diseases and urinary disorders. Consult one of our specialists for quality care.

  Urethral pain in men can be a manifestation of urethritis or stricture. Treatment for these infections can range from simple medication to surgery depending on the problem.

  To find out the source of the infection, it is essential to confirm the diagnosis with a specialist. Cliniques Marois has specialists in the diagnosis and treatment of sexual diseases and urinary disorders. Consult one of our specialists for quality care.