Confused about BPH......

[George__0__0]

    Hi, I am a 33 year old male who has suffered from frequent urination since I was a teen. I also experience a feeling of always having a full bladder and difficulty begining urination when I need to go. I have always asssumed that this was "normal" but over the years my wife has made many comments on my need to urinate frequently.
    Recently I went to a Urologist to arrange for a vasectomy, and durring routine questioning the Dr. felt that I had a problem and needed further examination. I went through a series of tests...blood workup, ultrasound, Xrays and a painfull proceedure where a tube was inserted into my penis (I don't know the medical terminology)  At any rate, I was put on Flomax and told that I would need to be on this for the rest of my life! I was also placed on antibiotics for 6 weeks.......My problems are:
  1. This Dr is very vague and does not welcome any of my questions. He said my prostate is enlarged, but also mentioned a (congenital) narrow bladder neck. Are these two problems related?
  2. Since taking the Flomax, my ejaculation was initially very watery in consistancy and is now "dry". That is, almost no fluid at all. I also feel a decreice in sexual desire. My Dr. had told me that I kwould not have any sexual dysfuntion due to the Flomax.
  HELP!!!! I am a young man, and I don't knopw what to do.....I need to find a better Dr. but I am confused!!!!!!!!!

[hfhs M.D.-AK]

_
Dear George,
It sounds like your doctor has diagnosed you with a primary bladder neck(congenital narrowed or high bladder neck) and an enlarged prostate.  These to conditions are not related but there symptoms are similar.  The test you are referring to is called cystoscopy where the doctor is able to see through a little telescope into the bladder and urethra..  It is difficult to say that the prostate at your age is causing obstruction unless you have another test known as urodynamics.  This test utilizes a catheter placed into the bladder that can measure pressure.  The bladder is filled and you are asked to urinate into a collection device.  The pressures are recorded and associated with a flow rate.  This correlation can then be analyzed by your doctor and only then can someone determine if you are truly obstructed.
If you are obstructed, Flomax is a good drug to help relax the prostate and increase flow.  One of the side-effects of Flomax is retrograde ejaculation which it sounds like you have experienced.  Due to the extreme relaxation of the bladder neck, the semen is forced into the bladder and not antegrade out the penis which is the norm.  You may notice a thick frothy substance in your urine, this is your semen.  This in an of itself is not a problem, unless psychologically you wish to see the semen or if you are trying to conceive.  The Flomax however should have little effect on your desire an sexual relations.
I think your doctor is treating you properly and if the Flomax is helping you, you may want to continue.  There are several other medications that affect blood pressure, which can achieve the same result as the Flomax if the retrograde ejaculation is a problem(Cardura,Hytrin).  If your doctor has time, you may want to discuss these issues with him.
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