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Urethral sharp ticklish discomfort...

  Dear Doctor,
  I am 31 years of age, residing in Japan with my wife, and have Chronic Prostatitis.  SInce last year, I have had prostate massages and IV antibiotic feeds (Maxipime),
  with the peak WBC count at 4-5 (still low, said my former urologist) at March 1997.   Since then, my WBC count has been consistently between 0-1 to 2-3, though last
  week it went up to 3-4 (but my new urologist said this is within normal range).
  I always have had a nervous bladder/urethra, with drops of urine passing through urethra after peeing, and esp. after drinking lots of water.
  The past few months, I have had this occasional sharp ticklish discomfort (on left side of urethra?), lasting for a few seconds, but with the after-effects lasting longer.  This
  usually makes want to "milk" the penis.  At times it feels like a strand of pubic hair is lodged inside, or like a reaction to some irritant.  This discomfot occurs at times after
  drinking much water and peeing a lot (strain on urethra?), after an ejaculation (irritant), and sometimes just out of the blue.
  It happens once every few weeks or even months at times, though my mind/uerthra seems to be expecting it at any moment...
  Other than that, I have no other problems except for an occasional mild urethral burning like sensation which usually disappears after a few
  weeks, esp. when I relax.  My uro doesn't think this is caused by an infection, as my WBC counts in urine tests are always very low.
  (oh, I did have a bloody ejaculation about 8 years ago, which cleared up after about 2 weeks, from red to brownish to clear...)
  I have no real problems when urinating (dysuria, etc.), except for anxiety during relaxing sphincter muslces, and my tests for malignant cells (urine), uroflow, and constant post-massage WBC checks do not reveal any real problem.  Hence, my
  urologist thinks I do not have any stenosis, polyps, cancer, strictures, urethritis, and my even prostate never feels any pain when drained/massaged and is of relatively normal
  size and texture, according to my urologist.
  Instead, he has given me a tranquilizer along with Cerniltion, as he thinks I have a psychosomatic condition too (my gastroenterologist has given Dogmatly and another tranquilizer
  for my "Irritable Bowel Syndrome," saying that I have a nervous/anxiety complex disorder that causes a "nervous colon").
  It's true, at times when I am occupied, my fixation on any urethral discomfort would be lessened, and when I fixate or think about it, some sort of discomfort would return.
  But last week, just a few hours after seeing my uro, I had the same sharp ticklish pain after an ejaculation, and for days since then I "feel" all these sorts of sensitive feelings
  in the urethra... strange isn't it?
  My urologist has not insisted on it, but I am trying to avoid any invasive tests on my urethra like "urethroscopy" due to its traumatizing risks (bleeding, strictures, scarring, infection, and extreme pain!).
  So, Doctor, do you have an opinion as to what may be causing this sudden sharp ticklish like discomfort? If there is nothing really serious I do not want to risk having a urethroscopy worsen my
  sensitive urethra, and also I think this sort of procedure would cause a major psychological trauma to me.
  Can be anterior valves, anxiety-caused muscle spasms in urethra/bladder neck, stones (though my countless urine tests would have confirmed this by now), divierticulum, cycts (in urethra?), etc.?
  I do NOT smoke, take alcohol, eat meat and have abstained from sex for 2 years now.  I take fiber a lot though to improive intestinal health and drink lots of water.
  Thank you for your attention (to this long email).
Dear Felix,

Urethral pain can be caused by a variety of conditions that can be categorized as infectious, inflammatory, cancerous or congenital. Urinalysis to evaluate the urine for red blood cells, white blood cells  and infection is our most useful screening tool. Your doctor has been quite thorough in evaluating your condition.Repeated urinalysis have failed to uncover a significant abnormality. This is encouraging. The likelihood of a serious condition in this setting is very low. As you mentioned the next step in evaluation of your condition is urethroscopy. and cystoscopy to look directly inside at your urethra and bladder. Although this procedure is well tolerated by both men and women, it is not indicated in your condition.
There are several possibilities as to the cause of your condition. An anxiety disorder that is contributing to both your irritable bowel and urethral symptoms is a possibility. Another possibility is a condition called interstitial cystitis. This condition affects both men and women although more women commonly are diagnosed with the condition. It is treated with antidepressant medication as well as other medicines. it may be worthwhile for you to read some of the previous responses to questions regarding this condition already available on the forum. This information is provided for general medical education 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).

*keyword: urethral pain

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