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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3566
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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Hello, I am a 25 year old male (negative for any stds) who

Customer Question

Hello, I am a 25 year old male (negative for any stds) who had an in-office urodynamics and flexible cystoscopy 9 days ago for frequency/urgency. I must say it was quite painful. The results came back normal except a possible spasm of pelvic floor. After a day, the burning during urination diminished. 3 days later, I had a painful ejaculation. 5 days later, I felt burning during urination, which lasted only that day (Started an ineffective 3-day course of Cipro). Now, the past 3 days I've had a nearly constant sensation to urinate--though, as if it were signaling from my urethra, not my bladder--as well as some burning after urination, in my urethra. I've also had hesitancy and sometimes the feeling that there is urine at the tip of my urethra. I am very worried that the procedure could have caused a stricture or scarring. Is this unlikely during a very typical cystoscopy, and something that general happens for more advanced procedures? Could this just be still from inflammation after 9 days; how long could inflammation last?
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
Hi

How is the flow of the urine ?

Is there any blood in the urine ?

Do you have fever?

Have you done an urine test recently ?

Please let me know

Dr.Tharun
Customer: replied 1 year ago.

The flow of the urine is okay when I have a lot of fluid in me and it is hesitant and intermittent when there is less fluid in me.


 


There has been no blood in my urine, except for my very first urination after my cystoscopy, in which is was a light pink for about the first second of the urination.


 


I do not have a fever.


 


I have not had a urine test since the cystoscopy. Prior to the cystoscopy, urinalysis and culture came back negative.

Expert:  Dr. Tharun replied 1 year ago.
Hi

It is very unusual to develop stricture or scarring so fast(9 days).It is seen after a period of 4-8 weeks when healing is complete.

The flexible cystoscope is very thin and flexible as the name suggests and rarely causes injury so severe to cause stricture.The first symptom of stricture is poor urine flow which you don't have.So chances of stricture are really less at this stage.

The possibilities are inflammation or infection.Cystoscopy and urodynamic study both are risk factors for urinary infection.So you should get an urine test and culture done as soon as possible. If there is evidence of infection then you should take a course of antibiotics according to the urine culture.

Drink plenty of water and crane berry juice in the meantime.It will help in such cases.

I hope this helps you.

Please let me know if you have any doubts.

Regards

Dr.Tharun
Customer: replied 1 year ago.

How long could inflammation from the procedure last? It seems like 9 days would be a long time.

Customer: replied 1 year ago.
Relist: Incomplete answer.
Expert:  Dr. Tharun replied 1 year ago.
HI

Inflammation from the procedure should be resolve in 3-4 days.Only if there is infection, inflammation persists for longer duration such as in your case.

Dr.Tharun
Customer: replied 1 year ago.

Thank you. My final question is: Would the doctor have seen on the scope if he did manage to create a small cut or trauma in the urethra? Is that checked for before the cystoscopy is finished?

Expert:  Dr. Tharun replied 1 year ago.
Hi

Yes, the urethra is checked while withdrawing the scope.So any injury would be recognized before completion of the cystoscopy.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3566
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Dr. Tharun and other Urology Specialists are ready to help you
Customer: replied 1 year ago.
Is imflammation or UTI in urethra in males likely to result in scarring enough to create stricture?
Customer: replied 1 year ago.
Relist: Answer came too late.
Expert:  Dr. Tharun replied 1 year ago.
Hi

Inflammation and infection has to be severe and long enough to cause stricture.

Small injuries and mild inflammation cannot produce strictures.


Dr.Tharun
Customer: replied 1 year ago.
Infection has been ruled out, but I am still getting the sensation of urine in my penile urethra along with irritation. Can there be other causes of this besides scarring? How unlikely would it be for scarring to have occured only 6 days later?
Expert:  Dr. Tharun replied 1 year ago.
HI

Urethral irritation can be a part of prostatic inflammation which can be non bacterial, meaning not due to infection.
Apart from that there are rarely any conditions which can cause urethral inflammation.

It is very unlikely to have scarring in only 6 days.

Regards

Dr.Tharun
Customer: replied 1 year ago.
And what about sensation of urine trapped in penile urethra? Besides scarring or stones, can inflammation cause that sensation? Or something else? Can it be psychosomatic?
Expert:  Dr. Tharun replied 1 year ago.
HI

Yes, psychosomatic element has been discussed as a cause for such symptoms.This thought encouraged the use of neuro -modulators and psychotropic drugs in the treatment of this condition.This has proved effective too in many cases.

Regards

Dr.Tharun
Customer: replied 1 year ago.

Thank you.



This is my final 2 question for you:


 


1. If you have scarring/stricture, can you produce a good flow at any point, or will the flow always be slow? I ask this because I have a strong flow when I have to urinate a lot, but a weak flow when there is not too much urine. Can stricture be ruled out by those means?


 


2. Would the catheters and scope instrumentation WITHOUT producing blood still be a possibility of scarring? Or would blood have came out if I was significantly damaged enough to receive a scar?

Expert:  Dr. Tharun replied 1 year ago.
Hi

If you have a good flow at any point of time , stricture is ruled out.Stricture is a fixed obstruction which reduces the flow all the time and hence there will never be good flow once stricture has happened.The flow plateaus off after few seconds and cannot increase beyond that how much ever we strain.


Severe injury produces enough bleeding to be seen outside the urethra.If there was no blood, then obviously the injury has to be minor one.Minor injuries can produce strictures but mild ones only.They are rarely symptomatic.

I hope this answer your questions.

Regards

Dr.Tharun
Customer: replied 1 year ago.

Hello, while all my symptoms seem to have gone away, one thing remains. It may be something that I just have not noticed before.


 


When I urinate, the stream slants slightly to the left. There is no spraying. There is no double-stream. Just a bit of a slant to the left. I am circumcised.


 


Is this a problem of the urethra? Is having some slant normal or is it a sign of narrowing or stricture of urethra?

Customer: replied 1 year ago.
Relist: Answer came too late.
Expert:  Dr. Tharun replied 1 year ago.
Hi

Glad to hear that your symptoms have improved a lot.

Slight slant in the stream of urine need not be worried up on .
You can just relax about the issue.

Regards

Dr.Tharun
Customer: replied 1 year ago.
Thank you for your answers and help. You have done a great job in helping me!

If I may just ask, besides my urine taking a slight slant sometimes, I noticed the past couples of days that sometimes at the very end of my urination after my normal flow has stopped, I'll squeeze again and I'll squirt a needle-thin stream for about a half-second to second, instead of my normal sized stream to complete the urination. Is this normal occasionally or indicative of anything?

Again, thanks much for the support. This definintely completes my thread. Have a great day. Regards.
Expert:  Dr. Tharun replied 1 year ago.
HI

This holds no significance as long as your normal urinary stream is OK.

Regards

Dr.Tharun
Customer: replied 1 year ago.

Dr. Tharun, My urine stream and flow is normal throughout the day, but once I go to sleep and then wake up, my first urination is a struggle. It is hesitant and intermittent. The following urinations of the morning will be normal, but frequent, and then taper off as the day goes on and become normal. Why would this first urination of the morning hours be very difficult? Any insight?


 


(My digital rectal exam came back fine, as did cysto, and urinalysis, but I was told my bladder is overactive. I can currently hold about 8 ounces before I must urinate, which is an improvement from where this began.)

Expert:  Dr. Tharun replied 1 year ago.
Hi again,

There is no fixed explanation for this.But one theory could be that we always awake from REM sleep which causes sympathetic stimulation.This sympathetic stimulation can cause the urinary sphincter muscles to contract and hence makes it difficult to relax when we want to urinate.This can explain the delay in starting the urine stream.
One more reason is that the bladder is overfull in the morning hours and our sphincter has been working overtime to prevent accidents during night.So when we try to reverse this habit in the morning it takes more time .

Regards

Dr.Tharun
Customer: replied 1 year ago.

Dear Dr.Tharun,


 


Do you have any insights as to why I would have a normal stream of urine, then after completion, sometimes, when I push to get out the remaining bits of urine out, instead of a less powerful stream, it will squirt in a needle-thin stream for a couple of seconds? This doesn't always happen. Can it be a muscle tightening issue that does this? Something else?


 


Kind regards and thank you.

Expert:  Dr. Tharun replied 1 year ago.
HI

Usually what we squirt out at the end of the urination is the remaining urine in the urethra rather than anything in the bladder.We do that by contracting our pelvic muscles which squeezes out the urine in the urethra.So it doesn't have importance whether this squirt is powerful or thread like.

Regards

Dr.Tharun
Customer: replied 1 year ago.

Okay, thanks. And should the urine stream typically be thinner when you have less to go? Or should the thickness always be the same? I find my stream to be thin when there is around 4 ounces in me, but normal when there is 8 or more.


 


 

Expert:  Dr. Tharun replied 1 year ago.
Hi

Less urine means less stretching of the bladder and hence less force is generated unless we use our abdominal muscles to create more pressure which generally is not required.

So less urine means less strong stream.

Dr.Tharun
Customer: replied 1 year ago.
Hello sir--It has been some time since I have had problem with urination. However, now that I am healed, I notice my stream is a bit messy in that besides the normal stream, it spits out a bit to the sides. Sometime, at end of urination, I will notice some shoot out the top of the 'slit' and some drip from the bottom of the 'slit'. I don't recall if this is something new or that has gone unnoticed. Is this a harmless quirk or would you think something is wrong?
Expert:  Dr. Tharun replied 1 year ago.

HI again,

Urine flow decreases towards the end of urination as the bladder pressure decreases. Hence the urine may split towards the end and is a normal phenomenon. If you have to strain to pass urine , then it is abnormal.

As long as straining is not present, it is normal.

Dr.Tharun

Customer: replied 1 year ago.
There is no straining, just a bit messy of a stream.
Expert:  Dr. Tharun replied 1 year ago.
HI

No straining is great. Don't worry about the slight splits in the stream towards the end.Drink plenty of water and this will take care of itself.

Dr.Tharun
Customer: replied 1 year ago.
Ok, thank you. And for the slight "spit" or "spray" during the normal stream is considered fine as well?
Expert:  Dr. Tharun replied 1 year ago.
Hi

Yes, slight spray is ok.You can relax now.

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