Urethral Disorders

What the urethra does

The urethra is the final part of the urinary tract. In women it is short, about 4 cm (1.5 inches), and opens just above the vagina. In men it is about 20 cm (8 inches) long, running through the prostate and the length of the penis, and it also carries semen. The urethra is lined with delicate tissue and surrounded by sphincter muscles that keep urine in until you choose to release it.

Because the female urethra is short, bladder infections are much more common in women. Because the male urethra is long and passes through the prostate, strictures, prostate problems and injuries are more common in men.

Types of urethral disorders

Causes and risk factors

Infections

Gonorrhea and chlamydia are the classic causes of urethritis. Mycoplasma genitalium and Trichomonas cause many of the rest. Unprotected sex and new or multiple partners increase the risk. In women, urethral and bladder infections are usually caused by bowel bacteria such as E. coli.

Scarring

A stricture forms after anything that damages the lining: catheters, cystoscopy or prostate surgery, untreated or repeated infections, straddle injuries, pelvic fractures, radiation, and the skin condition lichen sclerosus. Many strictures have no identifiable cause.

Injury

A fall astride a bar or bicycle crushes the urethra against the pelvic bone. Pelvic fractures in car crashes can tear the urethra near the prostate. Rough catheter insertion is another cause.

Hormonal changes

After menopause, falling estrogen thins the urethral lining, making caruncles, prolapse and recurrent infections more likely.

Symptoms of urethral problems

• Burning or stinging when you pass urine (painful urination)
• Discharge from the penis or a change in vaginal discharge
• Itching or irritation at the opening
• A weak, slow, spraying or split stream
• Straining, hesitancy, or a feeling of incomplete emptying
• Dribbling after you finish
• Needing to pass urine often or urgently
• Blood in the urine or on underwear
• Pain during sex
• Repeated urinary tract infections

Diagnosis

1. History and examination, including sexual history and an examination of the genitals.
2. Urine tests: dipstick and culture for infection, and nucleic acid amplification tests (NAATs) on a first-catch urine sample or swab for gonorrhea, chlamydia, trichomonas and M. genitalium.
3. Uroflowmetry: you pass urine into a machine that measures the flow rate. A low, flat curve suggests a stricture.
4. Bladder scan after you pass urine to measure what is left behind.
5. Cystoscopy: a thin camera looks directly inside the urethra.
6. Urethrogram: X-ray with contrast dye to show the length and location of a stricture or tear.
7. MRI for suspected urethral diverticulum.

Treatment

Infections

Urethritis is treated with antibiotics chosen according to CDC guidance, and partners need testing and treatment too. Avoid sex until 7 days after both you and your partners finish treatment. Urinary tract infections are treated with a short course of antibiotics.

Strictures

• Dilation or urethrotomy (cutting the scar through a scope) can work for short, first-time strictures, but they often recur.
• Urethroplasty, an open reconstruction sometimes using a graft from inside the cheek, has the highest long-term success rate and is preferred for recurrent or longer strictures.
• Some people manage with regular self-dilation.

Injuries

Tears are drained with a suprapubic catheter (through the lower belly) and repaired, either early or after a few months of healing.

Other disorders

• Prolapse and caruncle: estrogen cream, sitz baths, and surgical removal if symptoms persist.
• Diverticulum: surgical excision when it causes symptoms.
• Hypospadias and posterior urethral valves: surgery in infancy.
• Urethral cancer: surgery, radiation and chemotherapy.

Complications

• Urinary retention and bladder damage
• Kidney infection and, with long-standing obstruction, kidney damage
• Epididymitis and infertility after untreated gonorrhea or chlamydia
• Pelvic inflammatory disease in women with untreated STIs
• Fistulas or abscesses around a severe stricture

Prevention

• Use condoms and get tested regularly if you have new partners.
• Drink enough fluid and pass urine after sex.
• Get burning or discharge treated promptly rather than waiting.
• Avoid unnecessary catheterization, and make sure catheters are removed as soon as possible.

Frequently asked questions

What is a urethral disorder?

A urethral disorder is any condition affecting the urethra, the tube that carries urine out of the body. Common examples are urethritis, urinary tract infections, urethral strictures, injuries, prolapse and diverticulum. Symptoms include burning, discharge, a weak stream and blood in the urine.

What are the symptoms of urethral problems?

Common symptoms are burning when passing urine, discharge, itching at the opening, a weak or spraying stream, straining, dribbling, frequent urination and blood in the urine. Pain during sex and repeated infections can also occur.

What is the most common urethral disorder?

Infections are the most common. In men, urethritis from sexually transmitted infections such as chlamydia and gonorrhea is frequent. In women, urinary tract infections involving the urethra and bladder are very common because the urethra is short.

Can a urethral stricture go away on its own?

No. Scar tissue does not disappear by itself, and strictures usually worsen slowly. Dilation or urethrotomy can help short strictures, but urethroplasty gives the best long-term results for most people.

How is urethritis treated?

Urethritis is treated with antibiotics targeted at the likely infection, usually chlamydia, gonorrhea or Mycoplasma genitalium. Sexual partners should also be tested and treated, and you should avoid sex until 7 days after everyone has finished treatment.