Prostate or Underactive bladder? At my whits end

I had been told for the past several years I had BPH - which was assumed based upon age and symptoms. When I had a 3T MRI as part of my active surveillance protocol for prostate cancer, the radiologist told me I had no signs of BPH but instead I had chronic inflammation.

Earlier, I had tried 3 of the common alpha blockers (Flomax, Rapaflo, etc) - with minimal effect. Finasteride helped greatly with the inflammation but did not help much with the basic urinary issues (slow start, low flow) and after 6 months, the side effects were worse than the symptoms.

By cutting out caffiene and alcohol I have been able to reduce the frequency and urgency issues to the lowest they have been in a decade, but the slow start/flow issues remain. Had a cystoscopy recently which shows some minor obstruction in the lower urethra near the external sphincter and am considering Rezu to treat that.

My suggestion would be to keep looking for a urologist that will take an interest in your issues and work with you to help find the cause and a solution for you vs simply treat the generic symptoms which most seem to do. I am currently on my 5th uro in 3 years. On your own you may want to consider trying to identify things in your diet that may contribute to your issues, including medications. I went on a very simple and bland diet for two weeks - no dairy, eggs, nuts, shellfish, caffiene, alcohol, etc - none of the top common allergens. The only ones that had a noticeable impact for me were caffiene and alcohol. Both will double both my frequency and urgency for approx 24hrs after consumption, as well as make my flow worse. 

It can be very frustrating seeing multiple doctors, getting the same generic answers with nothing more to show for it than a different perscription. Do your own research, keep notes of what you eat/how you feel, the specifics of your urination and it may help you, help the doctors identify what is plaguing you.

Good luck!

Yeah I can't figure this out. I have had a UTI in the past but the doc took a urine sample this past Thursday and didn't mention any sign of infection. I took two flomax last night (usually take one) and woke up at 4am to go. When I woke up at 9am to get ready for work I was able to pee out 150cc. I cath'd immediately thereafter and an additional 250cc came out.

Hardly had any urge to go all day and only had a cup of coffee and a 20oz bottle of water. When I did have a slight urge hardly any came out. Got home just now and cath'd out 550cc. Have a slight pain now too (maybe because bladder is empty?).

I used to be a heavy Diet Coke drinker (six 16oz bottles a day) but gave that up last year. Now I'll have one bottle every other day or so.

Some mornings I'll have a crazy strong flow but also quite a bit of pressure.

I've been on seroquel since '07 (250mg:night) but uro didn't say anything about that.

While you do your research, go back & check your first MRI and see if it does cover the prostate & pelvis area. If it does, the radiologist who read the MRI slide can roughly estimate the size of your prostate. If he missed it, request a second read or take your MRI to a second opinion. The MRI will tell the doc if you have a BPH or not. Other problems like inflamation or infection could not be seen from MRI. But at least you need to go thru a process of elimination first with your old MRI for BPH.

I agree with 2Tim In Most cases. But in detail every one has somewhat different outcome. Good luck.

The only time all day long that I have a remotely decent stream is first thing in the morning, or if I've had a few diet cokes throughout the day.

I'm just having a hard time believing the hypothesis that it's underactive bladder. I don't fit the age profile, I've never had a neurological disease like MS or back disc problems. No reason for my bladder to just up and stop working.

If I had underactive bladder one would think flomax wouldn't work - but when it does it's like the flood gates have opened in the morning.

I am keeping a bladder diary as of this morning and will take that to my urodynamic session on Thursday. I'm also going to ask my primary doctor for a MRI script and rectal ultrasound to determine size. Perhaps another urine culture too.

You're young for enlargement. I'm 66 and I've had slightly similar experience where one urologist assumed I had enlargement from my symptoms and scheduled me for a TURP whereas my usual consultant said he didn't want to do it because my prostate isn't very enlarged. He recommended I try cutting out caffeine drinks and minimise decaf tea and coffee and it might take a year to see improvement. In fact I'm peeing again without Tamsulosin after a few weeks of cutting out caffeine and tea and coffee. I think bladder neck irritation is my main issue, but I had a series of UTIs last year and that threw out the whole system and the theories of causes. Now that that's cleared by low dose Nitrofurantoin over 3 months, the picture seems a bit clearer.

It just gets weirder and weirder. I saw the nurse at the uro office today (doc does surgeries on Tuesday). I gave a small urine sample and by no means emptied my bladder. Nothing unusual on the dip stick, so the nurse has me cath myself and out comes nearly 600cc of urine and visible blood.

She is sending the sample off for culture. Since the doctor wasn't in I wasn't able to get an antibiotic (if I even need one who knows). When I got home I tried to go on my own and a couple drops of blood came out but nothing more. A few minutes ago I cath'd out 350cc of bloody urine and at one point the urine got stuck I think a clot got caught in the tip. And it smells weird now...

I made an appointment with my family doc on Thursday to have a abdominal MRI and a transrectual prostate ultrasound ordered. And maybe a round of cipro if he thinks I have prostatitis.

Tim, I'm going to give this doctor a chance. He seems interested in trying to figure out what's going on. This morning I cath'd out 500cc and had zero urge to go on my own. Still had some blood.

Maybe it is my bladder giving up on life. I'm not sure what can be done to fix that.