[Guest]

I am a 34 year old male who recently saw a urologist for painful ejaculation and painful urination which has persisted for about a year. The pain lasts for 10-15 minutes after each event.

My urologist diagnosed me with a urethral stricture by cystoscopy and recommended what I have found to be the standard treatments ... urethrotomy, self-dilation with catheters, or stent placement. However he was very noncommital in recommending one treatment over the other. He seemed more interested in my "preferences" rather than recommending an evidence-based approach.

When I pressed him for his professional opinion, he favored urethrotomy stating it has the best chance of long-term success. Granted I am not the professional here, but my review of the MEDLINE-cited literature has yielded a 5-year failure rate of up to 58% ... certainly not a rigorous meta-analysis, but alarming nonetheless. My current pain can be excruciating and I greatly desire relief, but a failure rate like that seems a bit too high for me to realistically consider the procedure when weighed against possible complications noted below.

I have a small degree of erectile dysfunction which I mostly attribute to pain avoidance related to painful ejaculation. However it rarely has hindered any sexual activity with my primary partner. I am, however, very concerned about urethrotomy worsening the problem.

I am also very concerned about post-surgical incontinence for social & professional reasons.

Can anyone share your experiences or opinions on these issues?

Many thanks!

[Guest]

Painful ejaculation can be due to inflammation or infection of any part of the lower urinary tract such as the prostate or urethra. Scar tissue or cysts involving the semen ducts in the prostate can also do this as can urethral strictures as your urologist pointed out.

As far as post-surgery incontinence, this appears to be quite rare unless the stricture is located exactly at the sphinter muscle in which case the urethrotomy is NOT recommended.

Bottom line: urethrotomy is a good choice when none are perfect. Have it done with a laser if possible as that seems to give a slightly better success rate. Get a second opinion on your situation from another urologist.
[quote] I am a 34 year old male who recently saw a urologist for painful ejaculation and painful urination which has persisted for about a year. The pain lasts for 10-15 minutes after each event... [/quote]