41, urinary symptoms, BHP?

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i have been having urinary symptoms for about 1 year now. it all started after very cold mountain bike ride. i needed to pee after the ride and when i finished i still had feeling i need o go. i tried but could jest squeeze a tiny bit more. after a week of this i got worried and got seen by doc. after urine test and her telling me that my urine looks pristine she gave me some pills for overactive bladder. i got all side affect listed but didnt do a thing for my symptoms. she gave me different meds, again for overactive bladder, but same story. meanwhile i got checked for std, my psa was done, post residual ultrasound, all came back normal. she sent me to uro. he checks prostate and said it seemed enlarged. when he touched it with finger it felt pretty painful, even though i kept reading prostate exams are no painful. i asked if it the enlargement is because it is inflamed / swollen o is it bhp. he couldnt tell for sure. he came up with prostatitis diagnosis and prescribed cypro, which i turned down, so he gave me bactrim. course of bactrim did nothing, then he put me on flomax, that i used for a couple of weeks getting no relief but all side effects. i also started taking several supplements daily but they dont seem to do any good either. so with all this said, i am wandering what is going on. is it bhp (i am 41, seems a bit early if so), is my prostate irritated somehow, is my urethra irritated? from my research , my symptoms are not in line with any urinary issue i can find? i found some threads with people having similar symptoms, but never a actual diagnosis or treatment.

my symptoms right now are:

-constant sensation of needing to pee, it is not urgent, but its there. it presents itself at the tip of my penis in form of itching or wet feeling, sometimes mild burning or stinging (not painful, 1 or 2 on the scale of 10)

-the sensation is there pretty much all the time, sometimes it goes away after i dont pee for couple of hours, then it feels like i am back to normal, but as soon as i pee it starts again, like something gets irritated and resets the whole cycle

-there is some dribble at the end, few drops, i dont think i had that before

-stream varies, sometimes it seems normal, other times it looks thinner

-i dont have to make effort to start or stop, the stream is continuous, at the end i have to push a few times to get everything out good.

-sometimes, maybe once a week i get this feeling of stinging in urethra between my scrotum and anus, it lasts for a few hours and then goes away

-sex or ejeaculation is not painful

-peeing is not painful unless my urine is concentrated, then its little burning

-i dont need to get up at night

-i dont have pain

the docs are pretty much clueless.appreciate any shared experience.

thanks

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  • Posted

    prosatitis caused by some undefined bacteria is my guess. seems that is the issue for young people with some of the symptoms you listed

    id get the rectal ultrasound to confirm or not BPH. in parallel id get blood workup to confirm or rule out infection.

    most young guys with this have an infection they treat with long term, low dose AB. but there us no cure that im aware of

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    • Posted

      thanks, what kind of blood work should i have done?

      i believe they did some to test for psa and then something called lipid panel at different occasion.

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    • Posted

      Blood work probably won't show infection in your prostate. Urine test might not either. My understanding is you need to test semen if you think you have prostatitis

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    • Posted

      I'd tell your primary care you want full blood workup looking for anything abnormal. urine culture too. the culture will ID specific bacteria if present.

      I'm not aware of semen culture but it can't hurt

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  • Posted

    Not a doc, but sounds like BPH to me. I guess the question is how much it's bothering you and consequently how drastic a remedy (if any) you'll consider. The fact that you don't have to get up at night sounds pretty good to me! Might want to ask your doc about prescribing 10mg daily Alfuzosin (fewer side effects - esp. sexual - than other alphablockers). I found finasteride and dutasteride to have really nasty (and systemic) side effects. CIC is another, nonsurgical option.

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  • Posted

    few things i forgot to note:

    i do have enlarged prostate according to uro and his finger, he said 40g, not sure how he came up with this figure. he said enlargement can be from inflammation as well as BHP, that the symptoms overlap and that it is notoriously difficult to treat, but he has not yet treated someone that has this constant sensation. he also offered cytoscopy at the time, but i turned it down at the time. maybe its good idea to have it done?

    one thing, i found out helps to get rid of itching, is when i get erection. the sensation of needing to pee goes , but it does return after. also, ejaculating similar to peeing, jump starts my symptoms.

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    • Posted

      Don't trust the estimate from a DRE (digital rectal exam). For years my uro told me 40 grams based on DRE. When I finally got a transabdominal ultrasound it was 145 grams. Subsequent transrectal ultrasound showed 100 grams and then MRI also showed 100 grams.

      At 41, it would be unusual if your prostate was as large as mine (62 years), but there is some chance. If you can get a TRUS, it's probably worth it as it might eliminate a potential thing as the problem. Most likely you have prostatitis or some other infection in that area. Just a guess on my part of course. You would probably benefit from a cystoscopy, but be aware that you might get a UTI (uro will probably prescribe antibiotics). In my opinion you were correct to decline cipro. I would only use it if nothing else works and with prostatitis there still isn't any guarantee.

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    • Posted

      yeah, i have read to take this with grain of salt. i will probably ask for cysto and turp at my next visit, just to shed more light, as i am still not sure if bhp is the culprit or something else. but from what i understand turp will only give me more accurate prostate size? or will they be able to determine if larger prostate is causing the symptoms or if there actually is some sort of infection? from what i understand, largely enlarged prostate dont have to cause any symptoms while just small enlargement can cause several symptoms.

      i also wander at what point (size) they start to call prostate enlarged for given age. we are all different builds, have different size organs, probably different "normal" size prostates too.

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    • Posted

      Hi Cavo:

      You mean TRUS not TURP. TURP would be an operation to reduce the size of your prostate. You aren't there yet. TRUS is transrectal ultrasound used to image the prostate.

      TRUS will give you a good size estimate of the prostate. With regards to what else they might be able to read from an ultrasound, I don't know. Cystoscopy will probably give you more information regarding possible culprits. The uro will be able to see if your urethra is being squeezed and that would probably indicate BPH. They'll also look inside the bladder for possible issues there. I think, but I'm not sure that cystoscopy can also diagnose a large median lobe of the prostate. A large median lobe generally directly pushes on the bladder neck, which is basically a valve that opens and closes to let urine out of the bladder. The large median lobe pushing on it makes it difficult to open so that can cause obstructed flow. I'm no expert and hopefully others will chime in, but a cystoscopy and TRUS should get you moving in the right direction in terms of trying to figure out the issues.

      Best of luck.

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  • Posted

    Presumably you told them it started right after the bike ride. He did not suggest that you have a cystoscopy or that it might be chronic nonbacterial prostatitis ? Do you have pain when ejaculating ?

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    • Posted

      i did mention biking a lot and that it started after the ride every office visit. he offered cystoscopy but i turned it down, he said anytime if i change my mind. he mentioned possible pelvic floor issue too and possible therapy. i was just too busy past year traveling that i was not able to follow on all these. i am back in us now and trying to pursue this and get it resolved.

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