Urinary Issues: Potential Urethral Injury and Treatment Options

Urinary problems

I previously asked a doctor about an injury to my urethra caused by squeezing the glans during masturbation in middle school.
It feels like there is a small pouch near the base of the penis close to the scrotum, which led me to suspect it might be a urethral diverticulum.
After urinating, I have to squeeze near the base of the penis to expel residual urine; otherwise, my underwear gets wet when I walk.
Could you please tell me which part of the urinary system I might have injured? Is it possible to address this with surgical intervention? If so, what would the approximate cost of the surgery be?

liù, 30~39 year old female. Ask Date: 2010/01/06

Dr. Xu Weikai reply Urology

Hello, urethral diverticula are very rare and usually occur due to external objects causing injury to the urethra, chronic urethritis, or congenital factors.
In your case, if it has only happened a few times, it is unlikely to cause a urethral diverticulum.
Some individuals may apply pressure to the urethra while urinating, which can retain urine in the urethra; this pressure is significantly greater than that of ejaculation, and there have been no reports of diverticula occurring in such cases.

As for the feeling of incomplete bladder emptying, there are several possibilities: 1.
Cold weather may make it difficult for the urethra to completely expel urine.
2.
During urination, if the zipper or hand slightly compresses the urethra, some urine may not be expelled properly, leading to leakage when putting on pants.

I recommend that when you urinate, you pull your pants down to your knees and avoid holding the penis.
This method of urination should help improve the situation.
Personally, I do not believe you have sustained an injury.
If symptoms persist, you may want to visit a urologist and request a urethrogram to determine if there are any diverticula or other sequelae from trauma to the urethra.
Additionally, a cystoscopy can be arranged for a thorough examination of the urethra.
If there are any unclear points, feel free to ask again for further discussion and research.

Sincerely,
Dr.
Hsu Wei-Kai
Department of Urology
Taitung Hospital, Ministry of Health and Welfare

Reply Date: 2010/01/06

More Info

It sounds like you are experiencing a complex issue related to potential urethral injury, possibly resulting from the incident you described during masturbation. The symptoms you are experiencing, such as the need to manually express residual urine from the base of the penis, suggest that there may be some form of obstruction or abnormality in the urinary tract, possibly a urethral diverticulum or a stricture.

Understanding the Anatomy and Potential Injury
The urinary system consists of several key components: the kidneys, ureters, bladder, and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. Any injury to this area can lead to complications such as urinary retention, infection, or in your case, the sensation of needing to manually express urine.

Given your description, it is plausible that the injury could have affected the urethra, particularly if there was significant pressure applied during the incident. A urethral diverticulum is a condition where a pouch forms in the urethra, which can trap urine and lead to residual urine after voiding. This could explain the need to squeeze the base of the penis to fully empty the bladder.

Diagnosis and Treatment Options
To accurately diagnose the issue, a thorough evaluation by a urologist is essential. This may include:
1. Physical Examination: A urologist will assess the area for any visible signs of injury or abnormalities.

2. Ultrasound or MRI: Imaging studies can help visualize the urinary tract and identify any structural abnormalities.

3. Urethroscopy: This procedure involves inserting a small camera into the urethra to directly visualize the internal structures and identify any strictures or diverticula.

If a urethral diverticulum or stricture is confirmed, treatment options may include:
- Surgical Repair: If the diverticulum is significant or causing recurrent urinary issues, surgical intervention may be necessary. This could involve excising the diverticulum and repairing the urethra.

- Dilation: For strictures, a urologist may perform dilation, which involves widening the narrowed area of the urethra.

- Catheterization: In some cases, intermittent catheterization may be recommended to help fully empty the bladder.

Surgical Considerations and Costs
The cost of surgery can vary widely based on several factors, including the complexity of the procedure, the facility where it is performed, and your insurance coverage. Generally, surgical costs can range from a few thousand to tens of thousands of dollars. It is advisable to consult with your healthcare provider and insurance company to get a more accurate estimate based on your specific situation.

Conclusion
In summary, your symptoms suggest a potential urethral injury that may require further evaluation and possibly surgical intervention. It is crucial to seek a consultation with a urologist who can provide a comprehensive assessment and discuss the most appropriate treatment options for your condition. Early intervention can help prevent complications and improve your quality of life. Remember, it is essential to communicate openly with your healthcare provider about all your symptoms and concerns to ensure you receive the best possible care.

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