Presumptive Prostatitis?

Hi Doctor, I am a 33 yo male. I've been experiencing symptoms "down there" that have become very frustrating to deal with, not only physically, but mentally as well.  It's definitely become a source of depression for me, and my mental well being is getting worse each day.

Anyway, since the beginning of June I've been experiencing the following (some days are better than others, and some symptoms are worse than others (especially the feeling of urine trapped in the urethra):

- Feeling / Sensation of constant dribbling, however, I am dry but I do seem to experience significant dribbling after urination
- Feeling of urine trapped in the urethra
- Discomfort (not necessarily pain) at the tip of the penis
- Excessive dribbling of either urine or prostate fluid many minutes after ejaculation and "flushing" the urethra by urinating

Sometimes I also have lower back pain, but this could be from poor posture.

Unfortunately, I don't have the means of going to any urologist that I please, as I am part of the VA Health Care System. Around the middle of June I went to my primary care doctor.  She ordered a urine test, and treated me with antibiotics for 2 weeks, in case I had a UTI. However, the test results came back negative for any issues, and she said that everything seemed normal.  She prescribed sulfamethoxazole 800 / trimeth 160 and the symptoms didn't improve.

She then referred me to the clinic urologist.

I saw the urol around the middle of July. He ordered a kidney & bladder ultrasound and said everything was normal.  He did the finger rectal exam for a BRIEF second, said that was normal, too.  He said he would treat it as presumptive Prostatitis, and prescribed me Cipro for 2 weeks.  Still no improvement.  I felt he rushed me and wasn't the most caring...  All I want is a better understanding of what I'm going through and how it may be treated, and for how long could this last?  Uro said next step is cytoscopy...  For me, that's too invasive. Please help!

[David A Burks, MD]

Hi, you have a complex set of problems.  Basically your complaint boils down to an abnormal sensation in the urethra after voiding, post void dribbling and penile sensations and discomfort. It is apparently not an infection as your urine tests are normal and treatment with multiple antibiotics have been ineffective.  At this point I agree that you need a cystoscopy to rule out a structural problem in the urethra causing these symptoms.  The most common cause of your symptoms is a urethral stricture.  It cause the dribbling, discomfort and pain radiating to the tip of your penis.  The cystoscopy is a minimally invasive office procedure using local anesthetic jelly.  In light of your persistent symptoms, the stress and depression it's causing, I highly recommend you have the cystoscopy which could possibly diagnose an easily fixable problem. If the cystoscopy is normal an x-ray study of your urethra while voiding (voiding cystourethrogram)  may be needed.  Good  Luck.