Difficulty urinating in men is noted in diseases of the urethra and bladder, prostate damage, some other andrological pathologies and oncological processes. Occurs acutely or develops gradually, usually combined with other dysuric disorders. To determine the cause of miction difficulties, a survey, external examination, finger rectal examination are conducted, hardware and laboratory examinations are prescribed. Treatment includes drug therapy, physiotherapy, local techniques, and sometimes surgical interventions.
Causes of difficulty urinating in men
Pathology of the urethra
The cause of the development of the symptom in men with trauma can be a tear of the urethra. There are pains, an admixture of blood in the first portion of urine, bleeding from the urethra outside the miction. Another emergency condition, accompanied by difficulty urinating, are concretions. With a partial overlap of the lumen with a stone, pain, hematuria, weakening and dispersion of the jet are noted.
In patients with benign tumors of the urethra, stranguria appears against the background of neoplasia growth. A man is worried about itching, burning and discomfort during the injection, deviation, splashing or splitting of the jet, imperative urges, partial incontinence. Urethrorrhagia is characteristic. With urethral cancer, there is an increasing difficulty in urinating up to urinary retention, purulent discharge, pain in the perineum and the affected area, an increase in inguinal lymph nodes.
Diseases of the bladder
The symptom accompanies infectious and inflammatory processes. Nonspecific acute cystitis in men is characterized by pollakiuria, nocturia, painful infections, imperative urges, turbidity of urine, terminal hematuria, pain in the external genitals and above the pubis. Bladder tuberculosis is a complication of kidney tuberculosis, manifested by dysuric disorders, periodic macrohematuria, general weakness, subfebrility, weight loss.
Increasing stranguria, turning into complete urinary retention, is the main manifestation of detrusor cervical sclerosis. At first, men are concerned about the sluggishness of the jet, followed by a feeling of incomplete emptying, pain, and increased urges. With a hyperactive type of neurogenic bladder, difficulties are noted when trying to urinate arbitrarily and during miction. In the absence of urges, vegetative disorders (blood pressure rise, hyperhidrosis) indicate the need for emptying.
The symptom is detected in half of men with the initial stage of bladder leukoplakia, combined with aching pains in the lower abdomen, imperative urges, episodes of incontinence. Progression leads to severe pollakiuria and nocturia, which worsen the quality of life. In severe cases, terminal hematuria is possible.
Benign tumors develop slowly, gradually. Stranguria occurs against the background of attached cystitis. Hematuria, frequent urges, pain of the perineum and in the suprapubic zone are observed, increasing at the final stage of mycosis. Bladder cancer is characterized by rapid progression with early hematuria, which is joined by frequent painful urination, imperative urges. Pain in the groin, pubis and sacrum initially bother only with a full detrusor, then become permanent.
An increase in the volume of the prostate gland and compression of the urethra are the cause of difficulty urinating in men with prostate pathologies:
- Acute prostatitis. The symptom occurs with a follicular form, supplemented by intense pain, an increase in body temperature. During the transition to the parenchymal form, dysuria increases, the pain becomes pulsating, pronounced hyperthermia is noted, there is a high probability of acute urinary retention.
- Chronic prostatitis. Stranguria, frequent urges and a feeling of incomplete emptying are detected at the initial stage of the pathological process. Then, due to compensatory hypertrophy of detrusor, the severity of symptoms decreases, and increases again with decompensation.
- Prostate adenoma. There is a delay in the onset of miction, difficulties in the process of emptying the bladder, sluggish intermittent jet, an increase in urination time. Patients are concerned about nocturia, pollakiuria, incontinence, persistent urges.
- Prostate sclerosis. At first, stranguria, resi, a weak jet are noted, and subsequently urine will be released drop by drop. When vesicles are involved, hemospermia is detected. Localization and intensity of painful sensations vary significantly, there may be sharp or aching pains in the lower abdomen, testicles, perineum, rectum.
- Prostate cancer. The disease is latent for a long time, the existing disorders are caused by adenoma or prostatitis. There is an increase in the frequency of infections with difficulty at the beginning of urination, weakness of the jet, episodes of incontinence. Hematuria, pain in the pelvis, above the pubis and in the perineum, erectile dysfunction are possible.
Other andrological pathologies
Stranguria is observed in balanitis. Signs are more pronounced in acute inflammation, include swelling and hyperemia of the head, the appearance of plaque and ulceration, itching, erectile dysfunction, in some cases – inguinal lymphadenitis, urinary retention. Cavernitis is characterized by a bright, rapidly developing clinical picture. Against the background of febrile temperature, a man has acute pain in the penis and a prolonged erection, causing difficulty urinating. Sometimes the symptom is found with a large varicocele.
Paraphimosis develops as a result of infringement of the head by the foreskin, forcibly removed from its base. Due to edema and stagnation of blood, the head and foreskin significantly increase in volume, squeezing the urethra, which causes difficulty urinating. There is a sharp soreness, increasing cyanosis of tissues. In the absence of timely help, gangrene may form against the background of ischemia.
When the testicle is twisted, stranguria, soreness during urination, and sometimes urinary retention are caused by extremely intense pain syndrome, reflex influences. The pain in the scrotum is so acute that it causes collapse, nausea and vomiting. The affected half of the scrotum is pale, cyanotic or hyperemic. The diseased testicle is higher than the healthy one.
Andrological diseases in children
Sometimes stranguria is noted in boys with synechiae of the foreskin. It is considered as an indication for dissection of adhesions. Difficulties in the process of urination are possible with a large volume of fluid in patients with dropsy of the testicle, accompanied by swelling, heaviness in the groin, discomfort when walking. The disorder is also detected in children with prostatitis. Urination becomes frequent, painful, intermittent. There are pains in the lower abdomen.
Along with tumors of the genitourinary organs, the symptom may occur with some other neoplasms. Thus, neoplasia of the ponytail at the initial stage is manifested by pain in the sacrum and lower back. In the future, first unilateral, and then bilateral numbness of the lower extremities develops. The man complains of difficulties with defecation and urination, violations of sexual function. Large chondrosarcomas of the pelvis squeeze the surrounding organs and tissues, including the detrusor neck, which is manifested by stranguria.
Difficulties in the process of miction are possible with the following diseases and pathological conditions:
- Neurological pathologies: spinal dryness.
- Narcological problems: MDMA abuse.
- Hereditary diseases: Wolfram syndrome.
Diagnostics of difficulty urinating in men
Diagnostic measures are carried out by a urologist-andrologist. The man is interviewed to find out the anamnesis of life, clarify the moment of the appearance of difficulties, the dynamics of the development of symptoms over time. During an external examination, signs of inflammation, hematomas, accumulation of fluid in the scrotum, pinching of the head and other changes are revealed. As part of an additional examination , the following procedures are prescribed:
- Finger examination of the prostate. During the manipulation, the specialist determines the size and shape, evaluates the uniformity of the prostate gland. According to the results, it is possible to assume the presence of inflammation or a volumetric process, which makes it possible to clarify further diagnostic tactics.
- Ultrasonography. With stones and injuries of the urethra, ultrasound of the urethra is performed. In case of detrusor pathologies, ultrasound of the bladder is recommended, in some cases – with an assessment of residual urine. Prostate ultrasound is performed for men with suspected prostatitis, adenoma, cancer and prostate sclerosis. In case of cavernitis, an ultrasound of the penis is necessary.
- Radiation techniques. Patients with cervical sclerosis are prescribed retrograde urethrography. In case of tumor lesions of the detrusor, excretory urography and descending cystography are performed. In neurogenic dysfunction, a comprehensive examination is carried out, including conventional and mictional urethrocystography, ascending pyelography and other methods.
- Urodynamic studies. With cervical sclerosis and preserved urination, uroflowmetry is performed. In neurological disorders, along with uroflowmetry, profilometry, sphincterometry, and cystometry are performed.
- Endoscopic methods. Visualization of the affected area during urethrocystoscopy makes it possible to assess the localization, prevalence and severity of sclerotic changes in the cervix. Cystoscopy is the leading diagnostic method for leukoplakia, benign and malignant detrusor tumors. Along with determining the nature of the pathological process, it makes it possible to perform biopsy sampling.
- Laboratory tests. In neoplasms and leukoplakia, morphological examination of the biopsy material is carried out to verify the diagnosis. In infectious processes, STIs are excluded by PCR, ELISA or microscopy of the discharge, the indicators of general urinalysis are evaluated: the presence of leukocyturia, bacteriuria, and other changes.
Treatment of difficulty urinating in men
The list of therapeutic measures is determined depending on the nature of the disease:
- Cystitis. In order to combat infection, antimicrobials from the groups of nitrofurans, cephalosporins and fluoroquinolones, plant uroseptics are prescribed. Antispasmodics and NSAIDs are used to reduce pain. Presacral, intravesical and pre-bubble blockades with local anesthetics, and bladder lavage can be performed. UHF, medicinal electrophoresis, ultrasound, and inductothermy are used as part of physiotherapy treatment.
- Neurogenic MP. Alpha-blockers, calcium antagonists, antidepressants, anticholinergics, succinic acid preparations are recommended to reduce detrusor tone, stimulate blood circulation, and improve local metabolic processes. Botulinum toxin is injected into the wall of the organ. These activities are supplemented with special physical therapy complexes, detrusor training, ultrasound, thermal procedures, laser therapy, electrical stimulation.
- Prostatitis. The basis of treatment is antibacterial agents, which are selected taking into account the sensitivity of the microflora. The duration of the course depends on the form of the disease (acute or chronic). Prostate massage is performed to eliminate stagnation and activate blood flow. Ultrasound, laser therapy, and sometimes medicinal microclysms are prescribed.
- Prostate adenoma. Drug therapy includes alpha-blockers, antibiotics, alpha-reductase inhibitors, phytopreparations, immunocorrectors. In the presence of atherosclerosis, which prevents the flow of medications into the prostate, vasodilators are indicated. After the completion of antibiotic therapy, probiotics are recommended to prevent intestinal dysbiosis.
- Balanit. Men are advised to carry out thorough hygiene of the genitals using herbs with anti-inflammatory action and local antiseptics. Topical corticosteroids, dermatotropic immunosuppressors are prescribed. Depending on the etiology of the inflammatory process, antibacterial or antifungal agents are needed.
- Cavernite. In case of acute inflammation, hospitalization in a hospital is required. At the stage of infiltration formation, antibiotics, NSAIDs, immunostimulants are used. Urethral instillation, electrophoresis, UHF, magnetotherapy, laser therapy are performed. In case of chronic cavernitis, outpatient treatment. It includes immunostimulants, anti-inflammatory drugs and physiotherapy.
If men have difficulty urinating , the following surgical interventions can be performed:
- Urethral concretions: advancement of the stone from the urethra into the detrusor with subsequent lithotripsy, external ureterolithotomy, extraction of the concretion from the posterior urethra through the bladder with the imposition of epicystostomy.
- Tumors of the urinary tract: chemical, radio wave and laser removal of condylomas, surgical excision of benign neoplasia, transurethral or circular resection of the urethra, amputation of the penis in cancer, TUR, bladder resection, laser en-bloc resection, cystectomy.
- Prostate diseases: transurethral resection, thulium or holmium laser enucleation, laser vaporization, adenomectomy, brachytherapy, radical prostatectomy.
- Cavernitis, balanitis: opening of a penis abscess, emergency amputation with the development of gangrene, correction of penile curvature in the long-term period after cavernitis, circumcision with recurrent balanitis with phimosis.
- Emergency conditions: dissection of the infringing ring upon admission and circumcision after the subsiding of inflammatory phenomena with paraphimosis, surgery for twisting of the spermatic cord, orchiectomy for testicular necrosis against the background of twisting.