Urethra

Sexually transmitted infections can be examined and treated both by urologists and by dermatovenereologists. Like the boundary between nephrology and urology, or between urology and gynecology, this is an area where specialties “overlap.”

A urologist can use additional examination methods — for example, changes such as condylomas (genital warts) that have spread inside the urethra can only be seen during an endoscopic examination.

Urination problems, painful intercourse, frequent and painful urination, sometimes fever, pain in the perineum and above the pubic bone, pelvic pain, discomfort in the rectum, testicles and lower back, sexual dysfunction, and burning during urination.

These symptoms can overlap with those of a urethral stricture or infection; only an examination can tell them apart. More information is available on the prostate page.

Once a urinary tract infection has developed, it is unlikely to clear up on its own. Without treatment, the infection can spread: the kidneys can be affected and permanent damage can occur. That is why you should not wait for the infection to go away by itself.

In pregnant women, an untreated urinary tract infection is associated with a risk of preterm birth. In people with chronic illnesses, the infection can take a more severe course. If the infection has progressed, long-term antibiotic treatment may be needed.

The type and duration of antibiotic treatment are prescribed by a doctor only on the basis of an examination and test results. An infection accompanied by a high fever and pain in the kidney area requires urgent medical attention.

Venereal diseases always call for a proper examination. The patient’s symptoms and history are very important: the examination is guided by the symptoms, the diagnosis is made from the examination results, and treatment is given according to the diagnosis.

Discharge, pus and an odor from the urethra are among the main complaints, and they give reason to suspect that the patient may have gonorrhea or another infection.

Among sexually transmitted diseases, gonorrhea is widespread — colloquially it is also called “the clap.” In this case, both a dermatovenereologist and a urologist can provide their own treatment.

Gonorrhea deserves particular attention because such diseases can later lead to narrowing of the urethra — and that falls within urology. To prevent this, appropriate treatment must be given in time.

If a narrowing has already formed — whether short or long — the urethra has to be opened with a urological procedure, that is, surgically. Such cases do occur in practice: patients who developed a narrowing of the urethra after gonorrhea because they did not receive proper treatment in time.

The method for treating the narrowing (endoscopic or open) is chosen individually based on the location and length of the stricture; each method has its own risks and limitations.

Condylomas are sexually transmitted, and in men they can sometimes spread inside the urethra. In such cases the urethra needs to be examined endoscopically and the condylomas removed with a laser; sometimes medication is also instilled into the urethra. This is an endoscopic procedure that usually falls within the urologist’s scope.

Although the laser has a limited effect on the surrounding tissue, like any endoscopic or laser procedure this one also carries risks; the decision is made individually after an endoscopic examination.

Trichomoniasis causes symptoms not only in the urethra; later on, it can also cause symptoms in the epididymis. Such patients often say they have “testicular pain,” but the examination shows that it is an infection and hardening of the epididymis.

The infection does not reach the epididymis through the skin — it travels from the urethra to the prostate, and from the prostate along the ducts to the seminal vesicles and on to the epididymis, causing chronic symptoms. In such cases, combined treatment is prescribed for the infection of both the prostate and the epididymis; which antibiotics and other medications to use is decided individually.

Chronic testicular pain is a debilitating condition that affects daily life; although it is chronic, treatment is available. In the most difficult cases, removal of the epididymis may be considered — this is usually not done in young patients and is discussed only in older patients with persistent pain.

Removal of the epididymis is a last resort and is not suitable for everyone; every surgical procedure has its own risks. More information on testicular pain is available on the testes page.

If Ureaplasma and Gardnerella are not causing symptoms in the urethra, there is no need to treat them — they are considered common microorganisms.

If a man who is being evaluated for infertility has been given this diagnosis and treated for it, this is not considered the cause of the infertility; the cause is something else entirely, and it is important not to be misled by this.

In every case, the decision to treat is made individually based on symptoms and examination results. If infertility is suspected, its cause is investigated separately.

Prostate diseases, infections and injuries are among the factors that can cause blood to appear in the semen. Although this sign frightens patients, the cause is often not malignant.

If the necessary examinations and tests reveal a problem such as an infection or impaired patency (obstruction), it is treated. In any case, if this sign appears, you should see a specialist.

Do not confuse blood in the semen with blood in the urine: visible blood in the urine always needs to be investigated — even without pain, and even if it happened only once. Even if an ultrasound is normal, cystoscopy and imaging of the upper urinary tract may be needed.