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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for urethra problem

Hi... ok... here it goes.... When I was 11yrs old, I had a bike accident. From 21yrs old on, I have had multiple procedures to deal with my urethra stricture. 5 yrs ago, I had surgery. From that point on, I have noticed that my perineum tends to get swelling when I get an erection. The swelling begins before the erection begins and lasts longer than the erection does. It does not usually hurt. My last procedure was in 11/13. It was a dilation. This Morning (6:30am), when I ejaculated it was v. painful... after I could not urinate, when I tried it was v. painful (tried 2xs 8am, 10am). The pain lasted a while (usually my painful urination stops when the urination stops, for some reason the pain today lasted between 30mins for the first urination and an hour 30minutes plus for the second). At 10:30am, I took a cab to the emergency room... during the ride, I noted that my perineum was still swollen and I had to hip sit and I also had to walk bow legged into the hospital. (the head of my penis was also hurting). At 12noon, I was able to urinate a little (dribble stream with pain). At 1:30pm, I again urinated but the flow was less, pain was same. I believe that perineum was still swollen but it was not on my radar. I told I would have to get a Suprapubic catheter and had decided to have the procedure the next morning. While I was waiting to get admitted, at 3pm, I urinated and my flow normal (my normal) and with pain (still my normal). I also noticed that the swelling in my perineum was also gone. I decided against the procedure. I have urinated once since being home. It was again my normal flow. Am I crazy to connect the two and any ideas on why it is swelling. I spoke with one of the urologists and he didn t seem to think they were connected. In truth, I have never brought the topic of the swelling up with any of the urologists I have worked with over the last few years because it never occurred to me. We are now talking about a urethra re-construction but if this perineum thing is contributing to my urethra problems and could be fixed with a less intrusive procedure... (and buy me some time)... that would be great... again thanks...
Mon, 24 Feb 2014
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General Surgeon 's  Response
Hi. Thanks for the elucidate self explanatory history.
The perineal swelling along with the erection is suggestive that the part of the penis root has been herniating through the weakness of its covering.
Secondly the other swelling you developed is suggestive of the diverticulum of the urethra, most probably developed due to stricture or the procedures blocked the out flow.
I think the correction of this swelling is also a part of the next procedure.
The easiest way to diagnose this is urethrography to outline the the urethra. This will help plan the nest procedure well.
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