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Urology (Expert Forum)
UTI, BPH, or something else?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
UTI, BPH, or something else?
by officemanager, Feb 25, 2006 12:00AM
Basically healthy 59 yr. old husband. In hospital 6/05 for probable TIA's. While there was diagnosed with UTI (asymptomatic) and given 10 day course of antibiotic. In Aug/Sept began having erection problems, as well as continuing burning before, during, and just after urination.
December went to PCP for the burning and dipstick urinalysis positive for infection (no culture). Prescribed Bactrim. Followup visit 2 weeks later: the burning was always still present even though dipstick was now negative. Difficulty still maintaining erection. PSA: 1.7 and all blood work came back negative for diabetes, etc.
Referred to urologist. Again, positive for blood and infection confirmed by culture. Based on post void ultrasound: 10 oz. urine retained in bladder. Diagnosis: enlarged prostate. Given Flomax and amoxicillin. (also, one aspirin 325 mg., Benicar HCT, and zocor) No other tests.
Followup visit 2 weeks later: Dipstick negative for infection (was still sent off for culture. No results yet). Post void: 7 oz. BUT still burning everytime urinating. AND still erection problems. Prescribed Levaquin 500mg ($10/tablet!) for 10 days. No other tests were suggested.
Question: What will the doctor be looking for next? What is going on with the burning when it seems like the infection is cleared up again? Is the burning related to the infection? He has not addressed the erection problems yet. Shouldn't the Flomax be working after 2 weeks? My husband was always "slow" when urinating and he says that nothing has changed as far as he can tell. Any questions we should be asking the doctor?
Thank you for considering this.
December went to PCP for the burning and dipstick urinalysis positive for infection (no culture). Prescribed Bactrim. Followup visit 2 weeks later: the burning was always still present even though dipstick was now negative. Difficulty still maintaining erection. PSA: 1.7 and all blood work came back negative for diabetes, etc.
Referred to urologist. Again, positive for blood and infection confirmed by culture. Based on post void ultrasound: 10 oz. urine retained in bladder. Diagnosis: enlarged prostate. Given Flomax and amoxicillin. (also, one aspirin 325 mg., Benicar HCT, and zocor) No other tests.
Followup visit 2 weeks later: Dipstick negative for infection (was still sent off for culture. No results yet). Post void: 7 oz. BUT still burning everytime urinating. AND still erection problems. Prescribed Levaquin 500mg ($10/tablet!) for 10 days. No other tests were suggested.
Question: What will the doctor be looking for next? What is going on with the burning when it seems like the infection is cleared up again? Is the burning related to the infection? He has not addressed the erection problems yet. Shouldn't the Flomax be working after 2 weeks? My husband was always "slow" when urinating and he says that nothing has changed as far as he can tell. Any questions we should be asking the doctor?
Thank you for considering this.
Doctor's Answer
by Kevin Pho, MD, Feb 26, 2006 12:00AM
, Feb 26, 2006 12:00AM
Prostatitis can certainly be considered. I would consider a thorough digital rectal exam as well as prostatic massage. Any secretions that is obtained should be sent off for analysis and culture. A transrectal ultrasound can be done to image the prostate for abscesses. If present, it would need to be drained as antibiotics would not be helful in these cases.
If the prostate is clear, you can consider a cystoscopy to evaluate for anatomical causes for your symptoms - such as a urethral stricture or polyp.
These options can be discussed with your personal physician, or in conjunction with another urological opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b
If the prostate is clear, you can consider a cystoscopy to evaluate for anatomical causes for your symptoms - such as a urethral stricture or polyp.
These options can be discussed with your personal physician, or in conjunction with another urological opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_b