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• Intestinal problems such as diarrhea, blood in the stool, or irritation

• Swelling of the penis, scrotum, or prostate gland

• Bruising of, pain in, or damage to the treated area or nearby tissues

• Breast enlargement or tenderness or hot flashes

• Loss of muscle mass or thinning bones (osteoporosis; see page 989)

• Fatigue, infection, heart disease, hair loss, or sores in the mouth

Disorders of the Bladder, Urethra, and Penis

The bladder is a hollow, elastic organ in the pelvis that acts as a reservoir for urine. The urethra is a narrow, muscular tube that carries urine from the bladder out of the body. In men, the urethra also carries semen out of the body during ejaculation. Ducts leading from the testicles, the seminal vesicles, and the prostate gland join the urethra just below the point where it leaves the bladder.

Location of the bladder, urethra, and penis

Most of the urethra lies inside the penis, which consists of three cylinders. The two cylinders on the upper surface of the penis are made up of spongy tissue that is filled with blood when the penis is erect and empty when the penis is relaxed. The third cylinder surrounds the urethra and does not fill with blood during an erection.

In uncircumcised men, the head of the penis (called the glans) is covered by a loose flap of skin called the foreskin. In the United States, the foreskin is frequently removed at birth in a surgical procedure called circumcision (see page 375).

Disorders of the bladder and urethra that affect both men and women are discussed in the chapter on disorders of the urinary tract (see page 801). Those included here affect men exclusively or affect men differently than women.

Cystitis in Men

Cystitis is inflammation of the bladder. Cystitis is rare in men and usually results from a more serious underlying disorder, such as a blockage or tumor in the urinary tract or an infection that has spread from elsewhere in the urinary tract, such as the urethra or the prostate gland.

Symptoms

The symptoms of cystitis include pressure or pain in the lower abdomen, an itching or burning sensation when urinating, an urgent need to urinate, increased frequency of urination, and reddish or brownish or strong-smelling urine. Other possible symptoms include fatigue, fever, chills, vomiting, pain in the side, or pain in the penis.

Diagnosis

A preliminary diagnosis of cystitis is based on the symptoms. A doctor will order a urine test to check for bacteria or blood in the urine. The urine sample is grown in the laboratory to confirm the presence of an infection, identify the microorganism that is causing the infection, and determine the best treatment. If there is no infection, the doctor will probably recommend tests—such as cystoscopy (see page 805), an ultrasound (see page 111), or a CT scan (see page 112)—to determine if an underlying disorder is causing the problem.

Treatment

If the cystitis is caused by a urinary tract infection, your doctor may prescribe antibiotics or antibacterial drugs, depending on the cause of the infection. He or she will also treat any underlying disorder that is causing the problem. Your doctor will probably recommend that you increase your intake of fluids (to at least eight glasses of water every day), while avoiding fluids (such as alcohol, citrus juices such as orange juice, and beverages that contain caffeine) that could irritate your bladder.

Urethral Stricture

Urethral stricture is a condition in which the urethra gradually narrows because of contracting scar tissue in the walls of the urethra. The scarring may result from long-term use of a catheter, from surgery, or from chronic inflammation of the urethra caused by an injury or an infection such as gonorrhea (see page 480).

Urethral stricture can interfere with urination and ejaculation. In rare cases, the condition results in kidney damage if urine builds up in the urinary tract and flows backward into the kidneys. Urethral stricture can sometimes be a factor in urinary