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Urology (Expert Forum)
Benign Prostate Enlargement, Prostatitis, or what?
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.
Benign Prostate Enlargement, Prostatitis, or what?
by Ray__0, Jul 30, 1998 12:00AM
Hello,
Thank you very much for your response to my previous question.
It was very informative. Please consider my follow-up concern.
I am a 50 year old male. For the past month I have been treated
with Cipro for my second UTI (in a month), which caused
epididymitus and seminal blood. Although those symptoms have
gone away I have another related concern. After urination it
feels like some urine is trapped just outside the bladder and at
times I can actually feel it reflux back up into the bladder.
I feel that this trapped urine probably caused the UTIs in
the first place and that I will probably get another one as
soon as I get off the Cipro. Although for about the past 10
years I have had this trapped feeling to a much lesser degree,
the urine always came out within a few minutes after urinating,
the feeling was gone, and it caused absolutely no problems.
My urologist says it's prostatitis and that's part of the reason
I'm on Cipro. However, after 1 month that aspect of the problem
has not improved and, if anything, has gotten worse. My stream
pressure has decreased significantly. I'm due for a cysto on
Aug. 27 so maybe that will reveal something.
My question is this: If the prostate is constricting the
urethera, how can it be determined whether the cause is
prostatitis, benign prostate enlargement, or something else.
I have never had any soreness during any prostate exam. If
it is prostatitis, do you have any idea when it should stop
going downhill and start to improve? I'm kind of thinking
that may be due to BPE. If so, what is the treatment? Do
they ever perform a TURP on someone my age? Two doctors
in the past have commented that my prostate was large.
Thank you very much,
Ray
==========================================================
Dear Ray
To answer your question, cystoscopy will help provide the information needed. It is possible that you have developed a stricture in the penile urethra and are having these sensations due to the fact that the opening or diameter in the urethra is significantly decreased. A stricture may occur secondary to past urologic instrumentation, trauma, or history of sexually transmitted disease. The cysto will also evaluate the size of the prostate lobes to determine if you may be obstructed. There is another test called a pressure-flow study which will answer this question directly to determine if you have an obstructed flow. A uroflow test, where you urinate into a collection bin and it is related to time a similar but more simple way to examine this issue.
If your problems stem from an obstructing prostate a Transurethral resection of the prostate would be a good solution to your problem. You may however want to try an alpha blocker such as Flomax, Cardura, or Hytrin. The fact that two doctors have commented on your prostate does not mean that you are obstructed secondary to a large gland. People with small glands can also have obstruction just like people with large glands, that is why urologists perform pressure-flow studies and uroflows.
I think you should wait and reevaluate your situation after the cysto because this may provide you with the information or cause to explain your infections and sensations. If you continue to have urinary tract infections you may also need an upper tract radiologic study such as an IVP.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:BPH
Thank you very much for your response to my previous question.
It was very informative. Please consider my follow-up concern.
I am a 50 year old male. For the past month I have been treated
with Cipro for my second UTI (in a month), which caused
epididymitus and seminal blood. Although those symptoms have
gone away I have another related concern. After urination it
feels like some urine is trapped just outside the bladder and at
times I can actually feel it reflux back up into the bladder.
I feel that this trapped urine probably caused the UTIs in
the first place and that I will probably get another one as
soon as I get off the Cipro. Although for about the past 10
years I have had this trapped feeling to a much lesser degree,
the urine always came out within a few minutes after urinating,
the feeling was gone, and it caused absolutely no problems.
My urologist says it's prostatitis and that's part of the reason
I'm on Cipro. However, after 1 month that aspect of the problem
has not improved and, if anything, has gotten worse. My stream
pressure has decreased significantly. I'm due for a cysto on
Aug. 27 so maybe that will reveal something.
My question is this: If the prostate is constricting the
urethera, how can it be determined whether the cause is
prostatitis, benign prostate enlargement, or something else.
I have never had any soreness during any prostate exam. If
it is prostatitis, do you have any idea when it should stop
going downhill and start to improve? I'm kind of thinking
that may be due to BPE. If so, what is the treatment? Do
they ever perform a TURP on someone my age? Two doctors
in the past have commented that my prostate was large.
Thank you very much,
Ray
==========================================================
Dear Ray
To answer your question, cystoscopy will help provide the information needed. It is possible that you have developed a stricture in the penile urethra and are having these sensations due to the fact that the opening or diameter in the urethra is significantly decreased. A stricture may occur secondary to past urologic instrumentation, trauma, or history of sexually transmitted disease. The cysto will also evaluate the size of the prostate lobes to determine if you may be obstructed. There is another test called a pressure-flow study which will answer this question directly to determine if you have an obstructed flow. A uroflow test, where you urinate into a collection bin and it is related to time a similar but more simple way to examine this issue.
If your problems stem from an obstructing prostate a Transurethral resection of the prostate would be a good solution to your problem. You may however want to try an alpha blocker such as Flomax, Cardura, or Hytrin. The fact that two doctors have commented on your prostate does not mean that you are obstructed secondary to a large gland. People with small glands can also have obstruction just like people with large glands, that is why urologists perform pressure-flow studies and uroflows.
I think you should wait and reevaluate your situation after the cysto because this may provide you with the information or cause to explain your infections and sensations. If you continue to have urinary tract infections you may also need an upper tract radiologic study such as an IVP.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:BPH
