Difficulty urinating a symptom of prostatitis? I'm being treated, so when will it subside?

[SonOfZeus]

I have a dull pain in either my testes, penis, or base of my penis.  It intensifies sometimes when I’m about to have a bowel movement, but subsides again after.  It’s most intense after masturbating and ejaculation – my penis immediately throbs but that goes away quickly.  Within a couple days, that subtle pain becomes most intense before gradually dying down again.  

I also have difficulty with urination over the past few months.  My stream isn’t as forceful as before.  Often it comes in pulses.  And when I’m “90% empty”, it tapers down but then cuts off abruptly to a dribble and completely stops.  I know there’s more waiting to come out, and if I relax and push again, I can usually get some more (but rarely all of it) - frustrating, since the final drops often end up on my clothes.

My primary-care doctor and urologist both diagnosed prostatitis via digital-rectal exams.  I’ve been on Ciprofloxacin (antibiotic), followed by Sulfamethoxyzole (antibiotic) plus Naproxen (anti-inflammatory).  Currently I’m on Uroxatral, to help relax my bladder muscles to ease emptying, and further aid my prostate healing.  These medications may be helping, but to be thorough I also had ultrasounds of my bladder and testes and doppler (vascular study) of my penis.  From these they found a small benign cyst on one teste (supposedly inconsequential); that my bladder was indeed emptying when I urinated (contrary to my own observations and physical sensations); and that my penis had only a slow blood leak and hence minor difficulty maintaining an erection.  

I need a reliable second opinion: Do these sound like prostatitis symptoms, and considering these treatments, should I consider myself on the way "out of the woods"?  Is it normal to still have discomfort after ejaculation and difficulty urinating?  How long does prostatitis take to heal?  Might I have some other problem?  I’d like some peace of mind… Thanks.

[David A Burks, MD]

HI,  I agree that you have the classic symptoms of chronic prostatitis and have been treated with standard therapy. It's difficult to diagnose the different forms of prostatitis.  We always start with a 30 day course of an antibiotic like Cipro or Bactrim to treat a possible acute or chronic bacterial prostatitis.  Many patients get relief and are fine with a few patients developing relapses requiring retreatment.  Unfortunately, there is a group of patients with chronic nonbacterial prostatitis-chronic pelvic pain symdrome.  There patients have no bacteria in the prostate but have pain, often in the area between the testicles and rectum, plus the pain with ejaculation and sometines urinating symptoms. We don't know what triggers this problem and there is no cure.  Uroxatral is an excellent option and you have gotten at least a partial response-- good. There is no risk of cancer or other serious impairment or long term damage to your pelvic organs. Symptomatic relief with Uroxatral, and possibly antiinflammatory agents give many men some relief.  Good Luck,      

[SonOfZeus]

Thank you for both the response and the advice, doctor.  I’ve been prompted to at least start some web-based research of my own on the subject of CP/CPPS, and it is somewhat encouraging to learn that the combination of symptoms I’m experiencing is not entirely unique.  As for the prospect of getting the proper treatment and possibly even experiencing some relief, what I’ve read thus far doesn’t sound particularly promising, but I shall continue to keep my fingers crossed.  Thank you once again for planting these ‘seeds’ of thought in my head, and I now feel prepared to discuss some new avenues with my urologist at my next scheduled visit.

[dither77]

Dear SonOfZeus,

I have exactly the same symptoms like you - penile and testicular pain, especially after ejaculation, terminal dribbling after voiding. I've been to a dozen doctors and they say very different things. I hope it's the CP/CPPS condition and not urethral stricture (the latter being impossible to remedy). Please tell me the outcome of your condition because I'm really confused and not sure what to do.