Really strange irriation problem

Hello,
I would be much obliged if you could share your opinion with me on my problem. I will explain in as much detail is possible. I am a 21 year old male. I started to experience some mild penis pain, a prickly sensation that was most noticeable when the penis was actually touched. I've had this before and it's always gone away quickly, and this case was no exception, it went away after a couple of days. However, it seemed to lead into something else. I started to feel the need to urinate more often and quite frequently it would feel as if my bladder would not completely empty. This became progressively worse over the course of a week to the point where I had a constant sensation of needing to urinate, even though my bladder was empty. The sensation is very similar to that of a full bladder, but is concentrated more around the base of the bladder and the base of the penis, but it is different enough that I am aware when I really do need to urinate and when I do not. This is the only symptom I have. The problem became so bad that I was unable to sleep due to the discomfort. At one point I was at almost 4 consecutive days of no sleep. I visited my GP and took 2 urine tests, 2 days apart. Both showed absoloutely nothing abornormal (no signs of infection, no blood present, etc etc). None the less, the GP put me on a 5 day course of Ciproxin just to rule out an infection anyway, gave me some Buscopin and a small course of Diazepam to help me sleep. He also checked my prostate, which was not enlarged or sore. My urine was not cloudy at all and did not possess a strange odor. Sexual functions do not seem to be effected in any way. Currently the problem seems to be slowly abating. My GP seems to be at a complete loss as to what would cause my problem. He seems to think it could be anxiety related. Some things to note:

-I have had this problem before a few times to a very mild degree (it always went away after a night's sleep).
-If I take a hot bath, the irriation seems to almost abate, but returns as soon as I get out (this seems to indicate to me a problem with the muscles not properly relaxing when unaided by the hot water?)
-The problem seems to be irritated by lack of sleep and anxiety (I have a very anxious persona)
-The problem is usually not present upon waking and makes itself worse over the course of the day.

It is my belief that it may be something like an allergy causing me irritation in that area, and it is worsened by lack of sleep and anxiety. My GP seems to have ruled out every condition he can think of in that whole area. I would be interested to hear your opinion if you have one, I understand this is a strange and hard to explain problem. Thank you.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There are several causes that may cause your symptoms.  These include a urethral stricture, urethritis (either chlamydia or gonorrhea), a lumbar disk problem, a urethral polyp, or peripheral neuropathy.  

If all the urine tests and prostate exam were normal, I would obtain chlamydia and gonorrhea cultures to evaluate for urethritis.  

A urethral polyp or stricture is also a possibility.  Tests for these conditions include the following:
- Urinary flow rate may be measured
- Post-void residual (PVR) measurement
- Tests for chlamydia and gonorrhea
- Cystoscopy to confirm diagnosis
- A retrograde urethrogram to confirm diagnosis

A cystoscopy or retrograde urethrogram would be the most comprehensive tests to evaluate your symptoms.  I would suggest followup with a urologist.

If every test I mentioned is negative, then referral to a neurologist for evaluation of neuropathy may be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[ukchap]

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