Benign Urethral Lesions
Urethra is an important part of the urinary system as it allows passage of urine out of the body. This passage also plays an important role in transporting semen while ejaculating, in men. Normally, the urethra functions without any problems. At times, certain disorders may affect the urethra and cause discomforting and painful symptoms. These need immediate diagnosis and effective treatment.
How does the urethra work normally?
The urethra is mainly responsible for transfer of urine from the bladder and out of the body. In men, the urethra is responsible for transferring semen from the reproductive channel to outside the body during ejaculation.
In men, the urethra starts at the bladder and passes through the prostate gland, the perineum and into the penis (urethral opening). In women, the urethra is comparatively shorter and connected the closely-located bladder to the vaginal urethral opening.
In normal conditions, the passage of urine through the urethra is painless and controllable. The stream of urine being expelled out of the body is also strong and clear.
What causes benign urethral lesions?
Causes of benign urethral lesions include:
What are the types of benign urethral lesions?
These are the different types of benign urethral lesions:
This is suspected to be caused by genital warts developing on the penile shaft. These are mostly caused by HPV (human papilloma virus). A visible lesion on the urethral opening at the tip of the penis, change in the urinary stream and a history of genital warts indicate towards this condition.
Lichen Sclerosis (LS)/Balantis xerotica obliterans (BXO)
Lichen sclerosis (LS) is a type of chronic skin disorder which has unknown causes and affects the tip of the penis. It shows pale, shiny and whitish skin around the urethral opening which eventually forms a scar. Urethral stricture (narrowing) is often seen in case the condition is left untreated which causes urinating problems. It also results in soreness, cracking skin, itching and sometimes bleeding and formation of ulcers.
Urethral stricture disease
This condition is caused due to scar tissue formation at one or more points in the urethra. The symptoms of this type of urethral lesion include frequent urination, slower stream of urine, bleeding, UTI and infection or inflammation of prostate. A retrograde urethrogram or urinalysis test along with cystoscopy helps to diagnose this condition in the best manner.
Urethral polyp is not common. These are abnormal growth seen at birth (congenital) and are more common in females as compared to males. The abnormal growth is made of fibrous tissue that may also have smooth muscles, nerve tissue and small cysts which are covered with a thin membrane of tissue.
Symptoms for this condition include abnormal mass in the vulva, hematuria (blood in urine) or obstruction of the urinary stream. Diagnosis for this condition involves using cystoscopy and VCUG (voiding cystourethrogram) tests.
This occurs in glands called as Skene’s glands. These are located in the urethro-vaginal wall near the opening of the urethra in females. This cyst can be seen as a moist, bulging and tense whitish-yellow mass which narrows the size of the urethral opening. Symptoms of this condition may include urinary leakage, misdirected urinary stream, painful urination and urinary obstruction.
These are polyp-like (stalky) masses which hang down in an area of the urethral opening. These are usually diagnosed when testing for another disorder. Women who avoid hormone replacement therapy (HRT) after menopause are usually more likely to get affected with this.
Symptoms and signs of this condition include painful urination and bleeding, urgency and frequency or urination changes and tenderness can be felt around the urethral opening. These are distinguished from the thin and reddish membrane which protrudes out from part of the urethral opening.
This is a significantly rare yet troublesome urethral condition which affects females mainly. It is most commonly seen in younger girls and may develop at any age.
In this the urethra’s membrane and underlying soft tissue protrudes from the urethral opening. This can cause pain, often urine retention and vaginal bleeding.
A simple but thorough physical evaluation can help to diagnose this condition.
How are benign urethral lesions treated?
The exact treatment for a benign urethral lesion mainly depends on its nature and location. In case of abscesses, infections or urethral injuries it is advised to get immediate medical attention. The urologist will guide you about the best-suited treatment for benign urethral lesions.
Abscesses that are connected to gonococcal urethritis are successfully treated using antibiotics. Apart from this, the urologist may surgically drain the abscess and divert the flow of urine using a catheter (Foley catheter). A suprapubic tube can also be inserted through the abdomen as it helps to drain urine easier.
Treatment of urethral stricture disease mainly depends on accurately identifying individual scars. The main part of this process is the urethrography imaging technique. It uses contrast dye injected into the urinary system to identify the location of the strictures. In cases where the strictures are densely packed together and completely block the channel, the urologist may make an incision above the pubic bone to study the condition in detail.
Urethral stricture treatment focuses on increasing the diameter of the affected channel using either dilation or endoscopic techniques. There are several different methods for performing these procedures. These include mostly advanced and innovative minimally invasive surgical methods which ensure faster recovery and less risk of complications.
A urethroplasty required making an incision in the penis to remove the stricture and then rejoining the tissue ends effectively at the urethra or using a skin graft to restore the damaged urethral opening. A catheter is usually attached for a few weeks following this procedure.
Metal stent implants, which are permanent, are useful for treating bulbar urethral strictures although the procedure is in its experimental stages. It has shown remarkable results when treating short (less than 2 cm-long) scars.
Treatment of non-cancerous urethral growth can be difficult at times. Lesions from genital warts (HPV) are usually treated using advanced laser equipment. At times, topical cream treatment is also advised.
For treatment of LS (Lichen Sclerosis) antibacterial and anti-inflammatory agents are often useful.
Urethral polyps are treated by removing them using cystourethroscopy. This is a minimally invasive procedure which uses miniaturized surgical instruments attached to the end of the cystoscope to perform the surgery.
Paraurethral cysts are not treated unless they exhibit clear symptoms. These normally burst and decompress by themselves. However in case infection or blockage and pain develops from this condition then the urologist may burst the cyst using a scalpel blade and drain the fluid inside it to relive the symptoms.
Urethral caruncle may not require treatment if it is asymptomatic. In other cases, treatment involves using topical estrogen cream or HRT (hormone replacement therapy) to resolve the caruncle. In case the caruncle becomes enlarged and causes significant problems, the urologist removes the growth and cauterized the base.
Urethral prolapse treatment usually involves surgical removal of the prolapsed tissue and repositioning the membrane using sutures to prevent additional protrusion.
How effective are the treatments for benign urethral lesions?
Benign urethral lesions caused by HPV, gonorrhea, etc are significantly difficult to treat despite of the fact that antibiotics help to control the problem to certain extent. Repeat procedures are uncommon after initial treatment for this condition.
Common complications with internal urethrotomy and dilation technique for treating urethral strictures include recurrence of the strictures. The length of the stricture usually decides the risk of recurrence of this condition. Studies have shown that regular infrequent catheterization may help to reduce the chances of recurrence in such cases.
Urethroplasty complications also include recurrence of stricture disease, along with bleeding, infection and other complications in the lower extremities. Before removing the catheter, the doctor may also perform a VCUG to determine the extent of success in healing the damaged area.
Regular follow-up checks are scheduled normally after a stricture procedure. These are helpful to note the rate of urine flow from the urethra. Apart from this, radiographic tests (such as retrograde urethrograms) are performed at intervals of 3 to 12 months to check for recurrence signs.