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BPH vs Prostatitis Help with Diagnosis

Posted , 2 users are following.

jindu18133
jindu18133

Warning: Long ... first post

Hi everyone i've been reading these forums collecting information and am hoping you can offer some insight into my issues.

First some history: I'm 48 yo male, healthy except for prostate issues.  In my 30's I had a few (3-4) episodes of "prostatitis", one time they found bacteria and in all cases they resolved within a couple of weeks.  

Then in Nov/2016 I developed symptoms that resembled UTI, main issue of having a sensation I needed to urgently urinate, right after urinating.  When regoing, nothing comes out, bladder is empty.  They did a ultrasound and said bladder is empty and not retaining urine PVR was 22, no infection.  They gave my a diagnosis of BPH and rx for Flomax.  I took the flomax it didn't seem to help at at all.  After a couple of weeks the urologist did a cystoscopy and said everything looks unremarkable but confirmed its BPH.  Also stated that the prostate was "small" but no size given.  I continued to take the FLomax and eventually after a couple months, I started to feel better and the symptoms went away.  I continued to take the Flomax every other day since it makes me stuffy. From Feb 2017 to Sep 2017 I was pretty normal with minimal symptoms.

Then in October 2017 the symptoms came back again worse.  The main symptom is irrititation : right after peeing, it feels like I have to go again and I feel a "pressure" in the lower abdomen.  If i wear a tight belt it feels much worse.  If I expand my belly outward it feels better. Note that i've emptied the bladder.  I don't have nocturia at all and unless I drink too much frequency isn't really a issue, its mainly urgency (although bladder is empty).  I do have intermittent stream and dribbling and sometimes slow to start up.

I called the urologist again and he chalked it up to BPH again & said Overactive bladder due to BPH & gave me a rx for Trospium (anticholinergic).  I tried it for a couple weeks but it made it even more difficult to pee so I stopped.  

I talked to my IR about PAE and said he has a lot of success so ended up undergoing PAE in Nov 2017.  Symptoms seem to gradually get better.  In the first two weeks after the PAE my stream was strong with no hesitancy.  However then things started getting worse again.

I had another US and PVR was 6ml and no obstructions per the urologist. He is chalking it up to BPH.  My IR said I have an anatomic variant in my pudendal artery that is often the culprit when there is improvement after PAE followed by worsening later.  He thinks redoing the PAE should help.

My URO is very confident that my symptoms are from BPH.  He says that enlargement of prostate can cause obstructive & irritative symptoms and irritative are usually more bothersome.  I just find it unusual since he says the prostate is small and there is no significant obstruction / PVR is good why it's so symptomatic.  I'm wondering if there is some inflammatory prostatitis at play ? I don't have any "pain" but sometimes after urinating there is some very mild burning in penis and abdomen.  

So i guess my question is, is it possible to really know if it is really BPH or prostatits or even possibly both ??

Thanks for your insights in advance.

0 likes, 3 replies

3 Replies

  • j12080
    j12080 jindu18133

    Posted

    GET A 3 T MRI then have an Interventional Radiologist read it. Find an MRI with a pelvic coil if possible. what is it going  to tell you?

    1) do you have a large prostate and exactly how large. 

    2) do you have any signs of any cancerous lesions. 

    3) what is the density of the prostate. 

    4) is the median lobe large and is it pushing up in to the bladder. 

    5) is the urethra being pinched or obstructed by the tissue in the large gland. 

    This reading can be done only by an Interventional radiologist that is specializing in the prostate gland. There are three or four of them in the U.S. If you are in the US, you should find one of them. If you need more information, let me know. Know what you have before you start dealing with it. A 3T MRI will do just that and they are easy to fine if you are in the states.

    Good luck

    • jindu18133
      jindu18133 j12080

      Posted

      Thanks for the advice, I will talk to my IR and see if we can do a 3T MRI
    • j12080
      j12080 jindu18133

      Posted

      If you do not know an IR, you can go to any independent MRI imagining center that has a 3 TMRI. I would bet that Donnie Sartin at Dr. K's office would be able to tell you where in your area you could get the MRI. I like the pelvic coil as it just lays over you lap and you do not even remove any clothing. It is much more comfortable than the rectal coil but that one is not as bad as it sounds. The MRI take about 35 minutes. Usually done with contrast. Siemens Skyra 3T multiparametric MRI offers unparalleled visualization and prostate imaging. If you want to try to find imagining center in your city  with that specific equipment it would be good but any 3TMRI machine would do the job. The Skyra is what Dr. K has and uses during the procedure. It is a $3 million machine from Siemens. You will receive a disk which you can place in a pc and send over the web site with a push of the button. You will then be able to have the discussion of the particulars over the phone and also view what he is tell you about your prostate and your condition. Again, he does not charge you for this. It is very educational and enlightening with regard to you specific body.

      Then you can decide what you want to do. All this is posted on their site to read.

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