Renal Tuberculosis vs UTI vs Autoimune dis vs prostitis

[smile552]

Greetings all,

I'm just wondering what exactly the following case might be: on and off burning in urethra(male) and some times include pubic area. Sometimes vibrating like feeling in scrotum. white string like tissue in the urine all the time and this string like tissue is full of white blood cell. All lab including culture negative, ultrasound and digital prostate negative. Antibiotics doesn't work..it works only sometimes and symptom back again. No other pain or symptom other than this.  What Could this can be and what other test could be recomended? Thanks.

[smile552]

Thank you very very much Dr. again. I don't have any problem in voiding at all. My sream is normal as before and also, I havn't any pain or symptom any where..kidney or bladder area or abdomen. My urination frequency also normal as usual. The urologist checked kidney and bladder in ultrasound--didn't find any thing. Offcourse not x-ray or CT yet. I will propose this in my next visit to get x-ray or CT. So, far..the urologist is almost give up and he said--he don't know what else he can do. He tried urine/swab culture plus urinalysis, cytology, ultrasound, different antibiotics...Azitromycin, metronidazole, Erthromycin, Doxycycline. The symptom/pain wasn't bad at all..just on and off and did not stay long. But, when I have the symptom, I feel like burning both in my urethra and sometime groin area. I have also have some vibrating like feeling in the scrotum skin..but not have pain or any thing in the testicle. However, the sring like tissue in my urine is always there. Every time I go to the Dr., he take urine sample and look in the microscope..in the urine it self, no blood but the sring like tissue have many WBC( he als showed me and I can say >> 500. That is what bothering me and the Dr. too. He also thought that --may be some bacterial cause and may be the right antibiotic is not given..the problem is becouse the culture is negative and difficult to do sensetivity test and use the right antibiotics. The other reason that--in the previous antibiotics, the pain temporarly responding and come back again. Sometime,there is also too much precipitate show up in the urine. when it happen like 1/6 of my urine becomes a precipitate. It was checked in cytology and found amorphous phosphate. The Dr. said, it is not pathological..said come out from the food I eat.. don't know but the quantity is too much and scary. i'm realy appreciate Dr. for your assistance and wondering if you give me any advice..what else I can do and what these issue might be? any specific bacteria/culture, any pathology behind like sricture(but no pain or voiding problem..why WBC if so?), prostate issue? ( look normal in manual exam and ultrasound), kidney/( but no pain..?), viral cause?( no externalsymptom..also why it respond to antibiotics sometime?), TB?, idiopathic inflamation or any autoimmune problem..? what about the vibrating like feeling in the scrotum..does it indicate/associated with any thing?  I'm realy very sorry for too much writing and may take your time to read all this. I'm realy than you very very much for your time and support, not only for me but for every one. Thank you.

[Stephen Liroff, MD]

The string like tissue is not a frequent finding and its cause is certainly not clear at this point. Are you truly emptying your bladder when you urinate? Is there some cause for inflammation in your kidneys or ureters (you’d need a kidney x-ray or CT scan to answer this)? Any reason to believe that there is a foreign body/substance in your bladder
The symptoms of Tuberculosis of the bladder are the same as any bladder infection: burning, frequent urination, urgent urination.
Hope that this helps.
S.A.Liroff, M.D.

[smile552]

Thank you very much Dr. for your attention. Yes, I was evaluated by Urologist for different time and urine culture plus emprical treatment done. However, the culture was negative. Also cytology was done and negative. All lab test shows many(~500 or more) white blood cells in the string like tissue comeout in the urine, not in the urine it self. This string like tissue comeout in the urine all the time, but the burning pain was just on and off. The burning pain ( not the string tissue in the urine) responding for antibiotics and it come back again. I don't think Acid fast done yet but I'm wondering Dr. what would be the possible symptom for TB in the urithra? Also, as you said, is the string like tissue with these many white blood cell can happen without infection? like by another cause of mechanical erritation? is renal TB normally common?
What other possible cause could like this..string tissue with this high WBC.

Thank you very much Dr.

[Stephen Liroff, MD]

Sounds as though you have been evaluated to some extent, but was this by a urologist? Have you had a urine culture for acid fast bacteria (Tuberculosis)? Have you been cystoscoped and have you had an intravenous urogram or CT urogram?
These are tests that can be done but do not necessarily need to be done.
The cause for intermittent burning as you describe is seldom found. Active manipulation of your penis may cause some local minor trauma and result in some discomfort with urinating.
S.A.Liroff, M.D