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Urinary Disorders

Urethra symptoms

09/17/2007

Question:

Since July 16th 2007 I started having weird a sensation in my genital area like I feel a swollen/full feeling at/around the openening of my urethra. I notice it more when I`m up and walking. It makes me feel like I have to pee or like there is a bubble covering the openeing of my urethra (a feeling of having to pee in my urethra not my bladder). I have no pain or burning with urination and all urinalysis and cultures have been negative for any bacteria or infection.

I looked at my genital area with mirror and my urethra openening looks very open/dialated and the anterior wall of my vagina on the right side under the urethral opening is bulging/swollen looking. This all started the day after I had a pelvic exam from my gyno and during the exam he let go of the speculum to hand his nurse a culturette after he swabbed my cervix and when he let go it felt like the speculum was digging/jabbing into me like it slipped or something (was very painful). Could this incident have caused some kind of trauma to my urethra or vagina? Have you ever heard of such a thing? Trauma from a pelvic exam? I thought this could have caused a urethra diverticulum or trauma of skenes/periurethral glands? 

I went to a urologist and mentioned this theory to him and all of my symptoms I have been having. Ie wanted to do a cystoscopy in the office that day. He said from the cysto that I had trigonitis and I did not have a UD! He wanted to do fulguration of my bladder. He said that my symptoms were defferent from the trigonitis. I think trigonitis was just something he just stumbled upon thru the cysto while trying to find answer from my symptoms I was complaining about b/c what I`m feeling is not a feeling from within my bladder. I`m not having any bladder symptoms. This is all low urinary (urethra) complaints. I went ahead and let him do the fulguration trusting that is what was wrong b/c i have been miserable with this for too long now and was desperate to feel better.

It has been a week after the procedure and I began to bleed with urination and have extreme pain at the end of my stream each time. I`m passing small pieces of tissue. I`m still having the same symptoms I was having prior to this procedure plus these since then. I now feel pressure and burning when my bladder fills that I did not have before. What are normal post op symptoms from this procedure? Have I caused more permanent problems/symptoms taking the advice to do this procedure? Is bleeding from urethra and pain normal almost two weeks post op? I still think possible UD! I`ve read that ud is normally found thru VCUG and not just a cysto. I have never had any urinary/bladder problems in the past.

Answer:

It appears that you are well educated about your problem. Based on the information you provided I think symptoms are more related to outside the urethra than inside. Urethral diverticulum usually presents with recurrent urinary tract infections or symptoms of urethritis, which you do not have. Skene gland inflammation and or a cyst is more likely the cause. Diagnosis of trigonitis is difficult to make and fulguration of the trigone can lead to sensation of urge. Bleeding should stop and symptoms of urgency should improve. You need to check back with your GYN to discuss the possibility having had your Skene gland cyst being unmasked by his examination, not the cause of its occurrence.

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Response by:

Ahmad  Hamidinia, MD Ahmad Hamidinia, MD
Formerly, Professor of Clinical Surgery
College of Medicine
University of Cincinnati