American Medical Association Family Medical Guide - American Medical Association [560]
Urethral stricture
Injury or chronic inflammation can cause scar tissue (dark areas) to form in the walls of the urethra and narrow the channel inside the urethra. Narrowing of the channel can block the flow of urine, causing problems in the urinary tract.
Symptoms
Urethral stricture may make it increasingly difficult and painful to urinate. Other possible symptoms include a frequent urge to urinate with a small output of urine, dribbling urine after urination, pain in the lower abdomen or pelvis, blood in the urine, blood in semen, and a discharge from the penis. Urethral stricture can lead to recurring urinary tract infections.
Diagnosis
A diagnosis of urethral stricture is based on the symptoms and a physical examination. A doctor may also order urine tests to check for infection. If the urethral stricture continues to narrow the urethra, the doctor may refer you to a urologist (a doctor who specializes in treating disorders of the urinary tract). The urologist may perform a postvoid residual (PVR) urine test, which measures the amount of urine left in the bladder after urination. To confirm the diagnosis, he or she may perform cystoscopy (see page 805), an examination of the urethra with a cystoscope (viewing tube).
Treatment
To treat a urethral stricture, a urologist may first try to widen the urethra with a long, thin, flexible instrument called a dilator. In this procedure, the penis is numbed with a local anesthetic and the dilator is inserted through the urethral opening in the tip of the penis. You may need follow-up treatments to keep the channel open.
If treatment with a dilator is not effective, the urologist may recommend surgery using a cystoscope. The scar tissue may be removed through the cystoscope using tiny surgical instruments or a laser (a highly concentrated beam of light). In some cases, surgery is performed through an incision to remove the tissue that contains the stricture and replace it with tissue taken from another part of the body. After surgery, a urethral stent (a small plastic tube) is sometimes placed in the channel to keep it open.
Urethral dilation
To stretch the urethra, the doctor numbs the penis with a local anesthetic and inserts a long, thin, flexible instrument called a dilator through the urethral opening in the tip of the penis. You may need follow-up treatments to keep the channel open.
Balanitis
Balanitis (also called balanoposthitis) refers to several common types of inflammation of the foreskin and the head of the penis (glans). The inflammation can result from infection, poor hygiene under the foreskin, friction from damp clothing, or irritation from chemicals in soap, clothing, condoms, or spermicides. Balanitis occurs more frequently in uncircumcised men than in men who are circumcised.
Symptoms
Balanitis causes redness, soreness, and swelling in the foreskin and head of the penis that make the foreskin difficult to retract (pull back). If it is painful or difficult to pull back your foreskin, see your doctor right away.
Diagnosis
A diagnosis of balanitis is based on the symptoms and a physical examination. In some cases, a doctor may recommend blood and urine tests to determine if a yeast infection or a sexually transmitted disease such as gonorrhea (see page 480), genital herpes (see page 482), or syphilis (see page 483) is causing the problem.
Treatment
Balanitis usually clears up on its own after successful treatment of the underlying cause. If the condition is caused by poor hygiene, your doctor will recommend keeping the area clean to prevent recurrences. You should also avoid using strong soaps, detergents, or shampoos, which could irritate the skin. If the condition results from an infection, your doctor will prescribe an antifungal or antibiotic lotion or an oral medication to clear up the infection and help relieve inflammation. For persistent cases of balanitis, a doctor may recommend circumcision (surgical removal of the foreskin).
Phimosis
Phimosis refers to tightening of the foreskin around the head