PENIS/TESTICAL PAIN/

  I HAVE HAD PAIN IN MY TESTICALS AND PENIS FOR A LONG TIME ALSO WHEN I URINATE I GET FLOW THAT SEEMS BLOCKED BECAUSE IT COMES OUT IN TWO STEAMS SPLIT ALSO RIGHT TESTICAL SEEMS ENLARGED AT TIMES THAT WAKING IN VERY UNCOMFORATABLE I HAVE BEEN TO DOCTOR AND ALL I GET IS PROSTATE EXAM WHICH SEEMS OK PUT THEY PUT ME ON ANTIBOTICS THAT DIDN'T SEEM HELP I HAVEN'T BEEN BACK TO MY DOCTOR THIS PROBLEM IS REALLT EMBARRESSING BUT I REALLY HAVE A HARD TIME SITTING ETC ANY HELP WOULD REALLY BE APPRECITAIED THANKS

[hfhs M.D.-AK]

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Dear Russ,
It sounds like  your symptoms are consistent with prostatitis and a possible secondary infection of the  right testicle.  Men with prostatitis syndromes are frequent patients in the urologic office.  Initially, you should have been screened with urine analysis, urine culture, urine cytology, and uroflowmetry.  If no bacterial pathogen is found then a special urine analysis with three samples should be performed.  There are several categories of prostatitis, infectious prostatitis, either acute or chronic.  There is another category that is a little less specified, known as nonbacterial prostatitis or a third category known as prostadynia.  The three part urine sample would put you into a category of which type of prostatitis you have.  I will briefly discuss each type below.  If your prostate becomes enlarged(secondary to prostatitis) you can get reflux of urine back towards the testicle or if can become more difficult for the ejaculatory ducts to empty leading to congestion or infection of the testicles.  It also may be more difficult for you to urinate when the prostate is inflamed giving you this blocked feeling which you describe.
Acute bacterial prostatitis  accounts for less than 5% of cases.  Symptoms would include fever ,chills, malaise, and myalgia.  Local symptoms are frequency, urgency, low back pain and outlet obstruction(difficulty urinating).  Digital rectal exam is exquisitely tender.  The most common pathogens are E. coli, Klebsiella, Proteus mirabilis, Enterobacter, and Staphylococcus aureus.  This disease is treated with a long course of antibiotics which it sounds like you have had.
Chronic Bacterial prostatitis is defined by recurrent Urinary tract infection and persistence of pathogenic bacteria in prostatic fluid.  Primary complaints consist of genitourinary pain(61%),dysuria or painful urination(16%), clear urethral discharge(12%), recurrent UTI(9%), and sexual dysfunction(1%).  Physical exam is usually normal, however the three part urine analysis shows a high number of white cells on one of the three samples.  This may be what your doctors are telling you(>10WBC/HPF in the EPS)  The most common organism found is E.coli in 80% of cases.  Chronic bacterial prostatitis is simply a bacterial infection that recurs and is chiefly due to the ductal structure of the prostate you were born with.
Treatment with Bactrim or one of the Fluoroquinolones for 4-6 weeks is successful 30-50% of the time.
Nonbacterial prostatitis is an inflammatory condition of unknown etiology.  The symptoms are similar to those with chronic prostatitis and this group of patients outnumber all other patients with prostatitis.  Again the physical exam is unremarkable however on the three part urine test there is not only high numbers of white blood cells, but all lipid laden macrophages.  These are cells not characteristically seen in the prostate secretions filled with fat.  There may be a chemical irritation as a basis of this disease.
A trial of antibiotics should be tried but conservative measures such as over the counter anti-inflammatory agents(Motrin, Advil, Aleve), hot sitz bathes and support should be offered.
Prostadynia is a term used to define patients with proststitis type pain without specific findings related to the prostate.  Typically these patients are younger and have variable urinary complaints.  There is no etiology of this disease established and therefore a generalized work-up should be done.  Again conservative measures should be performed in addition to some limited dietary restriction of caffeine,alcohol, and spicy foods.  Other talked about treatments include Zinc  and Saw palmetto however neither of these therapies have been proven.
It is difficult to identify exactly where your pain is from your description however and infection of the prostate could cause all of the symptoms you described.  If your pain is strictly in your testicle and it remains large even after a long course of antibiotics you would be wise to have yourself examined again by your urologist to make sure you don