What are Benign (Not Cancerous) Uretheral Lesions in Boys?

Male reproductive system
Male reproductive system
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Irregularities of the urethra in young boys are rare. But they can cause problems with urination.

What Happens under Normal Conditions?

The urethra is a tube-like organ that carries urine from the bladder out of the body. In males, the urethra starts at the bladder and runs through the prostate gland, perineum (the space between the scrotum and the anus), and the entire penis. Normal urine flow is painless and can be controlled. The stream is strong and the urine is clear with no visible blood.

A lesion is a damaged part of an organ or tissue. The defect keeps the organ from working the way it should.



What are Some Types of Benign Urethral Lesions in Boys?

Urethral Polyps

A urethral polyp is a rare, irregular growth that most often appears at birth. It's often made up of fibrous tissue. It may also include some smooth muscle, small cysts, or nerve tissue, all covered with a thin protective layer of tissue.

Meatal Stenosis

Meatal stenosis
Meatal Stenosis

Meatal stenosis is when the hole at the penis tip is very small. This is caused by irritation around the hole. The irritation can lead to tissue growth and scarring across the hole. Meatal stenosis is most common in circumcised males, and seldom occurs in uncircumcised males. For more information on meatal stenosis please visit our comprehensive Urologic Conditons article.

Congenital Urethral Fistula

A urethral fistula is an abnormal passage ("fistula") between the urethra and the outside of the penis. It's called congenital when it occurs during growth before birth. The passage opens under the normal urethral hole at the end of the penis. During urination, two streams of urine may be seen. One will come from the urethral opening at the tip of the penis, and the other from the abnormal hole. The urologist often finds this condition by physical exam and watching the urination. This condition is rare.

Diverticulum of the Anterior Urethra

Diverticula are pouch-like enlargements of the lower urinary tract. They can happen in both the bladder and the urethra. Diverticula in the urethra make it wider.

This type of lesion can appear in 2 forms:

Saccular

This is the less severe condition. The diverticula rise from the floor of the urethra. This causes a weak urine stream, straining, and blocked urine flow. In some cases, the urethra can swell during urination.

Megalourethra

This is a more severe form, where the whole urethra is affected. There are 2 subsets of this condition:

Scaphoid megalourethra

This type of lesion happens when the spongy tissue (corpus spongiosum) around the urethra in the penis is missing.

Fusiform megalourethra

This lesion happens when both the corpus spongiosum and corpora cavernosa (the chambers that support the penis) are missing. In this case, the whole penis swells into a spindle-like form during urination.

The most common cause of urethral diverticulum is surgery that involves the urethra (such as for hypospadias). The urethra narrows downstream from the diverticulum. This raises the pressure in the urethra, causing the weak urethral tissue to balloon.

Cowper's Duct Cyst

Cowper's glands (also known as bulbourethral glands) are found under the prostate gland. These pea-sized glands make a clear, colorless fluid before ejaculation. This fluid cleans the urethra and neutralizes acid to protect sperm. It also provides a small amount of lubrication for sex. Cowper's duct cysts occur due to abnormal narrowing at the opening into the urethra.

Urethral Duplication

Urethral duplication is a rare condition where a person is born with 2 urethras. It can be a complete copy of the organ with 1 or 2 openings, or just an extra urethra with a joined opening.



What are the Signs of Benign Urethral Leisions in Boys?

Symptoms of benign urethral lesions in boys depend on the type of lesion your son may have.

Urethral Polyps

If your son has a urethral polyp, there may be blood in his urine, signs of a urinary tract infection, or problems peeing. These can include:

  • weak or broken urinary stream
  • straining when peeing
  • hesitating before urine flow starts
  • stream stops suddenly
  • dribbling at the end of urination
  • painful urination
  • a sense that the bladder hasn't emptied

Meatal Stenosis

For more information on the symptoms of meatal stenosis please visit our information page on the condition.

Diverticulum of the Anterior Urethra

Some signs of urethral diverticulum are:

  • urethra bulging during urination
  • weak urinary stream with dribbling afterwards
  • having urinary infections often
  • other linked irregularities (such as prune belly syndrome)

Cowper's Duct Cyst

Signs of a Cowper's Duct cyst include:

  • discomfort during urination
  • bloody spotting
  • a weakened urinary stream
  • dribbling after urination

Urethral Duplication

While most cases of urethral duplication are found by chance, there are signs. Some signs are:

  • 2 urinary streams
  • infection in the extra urethra
  • blocking problems from a buildup of material

Duplication often occurs as a blind ending that doesn't get signals from the bladder. The duplicate urethra will almost always be on top of the normal urethra.



How are Benign Urethral Lesions Diagnosed?

Cystoscopy
Cystoscopy
Image: Cancer Research UK

Urethral polyps are found with a cystoscope. A cystoscope is a long, thin telescope with a light at the end that lets your urologist look inside the body. This is performed under anesthesia in children. However, the key test to diagnose benign urethral lesions is a voiding cystourethrogram (VCUG). VCUG is a type of x-ray test. VCUG uses a special dye infused into the urethra to show the structures.



Treatment

How a benign lesion is treated depends on the type. Your urologist has many methods to choose from to treat your lesions.

Urethral Polyps

Urethral polyps can be removed using cystourethroscopy. Your urologist can peer into the urethra with a small, flexible camera and use miniaturized tools to remove the growth. The base of the polyp is burned off with an electric current.

Meatal Stenosis

Most often, the small urethral hole at the penis tip is cut wider a short ways in to help with urination. This can be performed in the office with topical anesthesia, or in the operating room for more extensive problems. For more information on meatal stenosis please refer to our comprehensive meatal stenosis page.

Congenital Urethral Fistula

Urethral fistula repair is done as an outpatient procedure. Your urologist will:

  • straighten the shaft of the penis
  • close the fistula hole
  • cover the repaired urethra with skin (which may be taken from the foreskin)
  • either circumcise or rebuild the foreskin

Diverticulum of the Anterior Urethra

This problem may be treated with surgery.

Cowper's Duct Cyst

There's a thin wall between the bulbous urethra and Cowper's duct, and its opening. Your urologist can take out part of this wall using a small knife through a tube in the urethra (endoscopic resection). This will ease the symptoms. If the duct can't be reached with an endoscope, open surgery is done.

Urethral Duplication

No treatment is needed if the extra urethra isn't causing debilitating symptoms. If the 2 holes are close together with 2 urinary streams, surgery can connect them into a single one. If the penis is curved as well (chordee), the urologist may choose to straighten it and remove the extra urethra.



What Can We Expect after Treatment for Benign Urethral Lesions?

Urethral Polyps

If your child has surgery it should take care of any symptoms and the problem shouldn't come back.

Meatal Stenosis

The key step to keeping the problem from coming back is to spread the urethral opening and put ointment on the edges 2 or 3 times a day during healing (7 to 10 days). This will prevent painful or difficult urination and spraying of the urinary stream. For more information on what to do after treating your meatal stenosis please visit our comprehensive Urologic Conditions page.

Congenital Urethral Fistula

After the treatment, your son will need to follow up with his urologist.

Diverticulum of the Anterior Urethra

After treatment, boys who had mild forms of this condition should have a penis that works well. Boys who had a penis with a sac-like form will have a penis that will only pass urine. If the diverticulum was caused by other surgery, the penis will work well if the first surgery fixed the original problem.

Cowper's Duct Cyst

Surgery should take care of any symptoms. The problem shouldn't come back.

Urethral Duplication

Surgery should fix the problem so there's a single urinary stream. If it was a success, the problem shouldn't come back.



Frequently Asked Questions

Are urethral polyps life-threatening (malignant)?

No. These are benign growths (not cancer). But all surgically removed polyps are sent for biopsy to make sure.

When should we start treatment for meatal stenosis?

Meatal stenosis isn't an emergency. But you should take care of it as soon as it's found.

Do all urethral duplications need surgery?

Surgery is needed only in certain cases. One case is when there's also a curved penis causing 2 urinary streams. Surgery for this problem is fairly simple.