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Urology/Possible urethral stricture

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QUESTION: 5 days ago, I was having sex, and my penis got bent (there was a bit of pain). During ejaculation, I felt a strong stinging pain and had difficulty ejaculating, then I noticed blood in the ejaculate. I also noticed blood in my urine immediately after when I went to pee, but not after that.

The following day, I noticed that the strong stinging pain didn't go away (in the urethra, area of the glans), unless I held myself back from urinating at ease. I also felt like there was something stuck in the wall of the urethra, but it doesn't seem to impede the flow. I had also ejaculated twice since this incident, there was no difficulty, pain or blood.

Since two days ago, I begin to feel the constant urge to urinate, and it is increasingly annoying. The mild stinging pain also didn't go away.

My questions:
1) Is this a stricture?
2) Did the ejaculations worsen my condition?
3) How long would it take to heal?
4) I plan to get a urine test to rule out possible infections. Do you think this is necessary?

ANSWER: Elbie:

It's impossible to determine the nature of your injury from only your description.  It's a little too soon for a stricture, but there could be some other injury such as a rupture of the tunica and/or urethra.  There may also be a hematoma.  WIthout an examination, the extent of your injury is unclear.

It is possible but unlikely that ejaculation worsened the problem.

Since we don't have a clear diagnosis, its impossible to determine how long healing may take.

You don't need a urine test; at least that's not all you need.  You should consult a urologist as soon as possible just to make sure there is no evidence of a serious injury to the penis.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for the quick answers.

I don't know the approximate cost of 1 visit to the urologist in the US, do you have an estimate? I currently don't have access to insurance, will it be a bad idea to wait for a few days in case it's self-limiting? The symptoms are currently not affecting my daily activities, they are mild except for the urge to urinate, which is not worsening. I noticed that the urge is worse in the past two evenings, but doesn't affect me in the night during sleep.

Is there any other way than cystoscopy to figure out whether or not it's a hematoma? Do small hematomas regress within days?

Answer
Elbie:

Typical cost for a new patient evaluation in a urology office is around $200 or so.  However, this is an urgent situation.  If you can't make the appointment, you may need to consider an ER visit.  Waiting to see if it heals on it's own is taking an unnecessary risk.  If it gets worse, the damage may not be easily fixable.

A hematoma is just a collection of blood.  by itself, these are usually not too dangerous, but where did the blood come from and what other injury may be present?  If the tunica or urethra are ruptured, you may need treatment or surgery to repair it.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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