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Hello Doctor, For almost a year I am having this

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Posted on Tue, 5 Mar 2019
Question: Hello Doctor, For almost a year I am having this problem, The first time I experienced frequent urination and very tiny red dots in penis head... This was going for sometime I took Azithral and other antibiotics and also a cream.. This started in Dec2017. finally in Mar 2018 I took Ultrasound kub abdomen. Report shows mildly enlarged prostate ..PVR of 88 ml.. Doctor gave me some antibiotics and Urimax 0.2 mg.. I went back to him and complained till I cannot urinate fully he gave me urimax 0.4 mg. in between this I had UTI also so took norfloxcin .. still can't urinate properly so doctor asked me to take dutasteride I don't remember how much mg... I have been on urimax for almost 5 and dutasteride for 4 months still when I urinate I feel I have not done completely. I got frustrated and went to another urologits he asked me take all the test blood test ct scan kub with contrast and even urethrogram .all the test was clear uroflow also clear ... Now when I urinate there is dribbling at the end..even after I think I am done I still have the feel to urinate but it's not coming . the need to urinate is always there but not very urgent or uncontrollable .. so when I masturbate with this feeling I feel I am ejaculating quickly but even after that when I urinate I still have the feeling I have not urinated fully .. am really scared as this is going on for sometime . planning to get married this year.. is this curable or something permanent had happened to me ... I also have constipation sometime I find it very difficult to pass stool... I don't understand what is the diagnosis here.. I also have small problem in my leg ever since this urine problem I also had burning and numbness in legs it is somewhat ok now.. I took nerve test and the neurologist says I have peripheral neuropathy ..... can nerve problems or constipation or whatelse can cause this urine problems ...am very scared as I am planning to get married .. if I get married will be able to perform well ? I don't know .
doctor
Answered by Dr. Bhagyesh V. Patel (29 minutes later)
Brief Answer:
possible neurologic disturbances at internal urethral valve.

Detailed Answer:
Hello and welcome to Ask A Doctor service.
I have read your query and here is my advise.

* As per the duration of persistent symptoms of urinary complain and normal CT scan
with urethra evaluation, associated neuropathy assessed by the neurologist suggest
the condition to be most likely from the problem at internal urethral valve via nerve
disturbances.

Kindly provide me further details to proceed more precisely.

1. Any report as Urethrography has been done by urologist ?
2. Do you get normal semen amount with proper flow during ejaculation ?
3. Any problem in getting erection ?

Awaiting for your response.
Regards.

Dr Bhagyesh
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhagyesh V. Patel (15 minutes later)
Doctor, urethrogram x-ray showed no blocks as soon as the urologist saw the xray he said there is no abnormalities . the urethrogram report by radiologist doctor also said the bottom line is no abnormalities seen.. same for ct scan with contrast. before I used to ejacylate with force .. the amount of semen coming out is not a problem but still I feel the sperm come out with little bit less force.. and erection I think it's normal.. i have been on dutasteride and urimax so I lost erection.. but now since I have stopped the drug I think erection is coming back.. doctor please tell me this is curable
doctor
Answered by Dr. Bhagyesh V. Patel (8 minutes later)
Brief Answer:
uroflowmetry test assess capacity of internal urethral valve.

Detailed Answer:
Hi XXXXXXX
Thanks for the details.

* The urethra passage is normal by evaluation, but the assessment of capacity of
internal urethral valve requires uroflowmetry test.

- Uroflowmetry test evaluate the contractility of the urinary bladder muscle, internal
urethral valve and other neurology evaluation in reference to the urinary system.
- So far as cure is concerned, once the root cause is identified one can definitely figure
out the percentage chances of total recovery.

Hope this information will help you further.
Take care.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhagyesh V. Patel (24 minutes later)
Doctor uroflowmetry I did twice on both occasion doctors said flow is normal.. how can not be a possible diagnosis for my problem ? . both the urologist are best doctors who work in top hospitals. bit either of them know about my problems in legs. am really confused ?.. now where do I go now..
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Follow up: Dr. Bhagyesh V. Patel (11 minutes later)
just now I went to toilet..Came back and sat in my place within few minutes I get the need to urinate .. it's almost like urinary incontinence I know incontinence is something uncontrollable urge to pass urine .. mine is not that bad. but still I feel the need to urinate . even if I go now to urinte I won't get that feeling I have completely done. so this continues .. so what is next for me ?.. am sure if I go back to urologist the one which I saw first he will definitely give me some tablets again urimax. he won't send to me urologist . the second urologist which I saw he listens to me and I can tell him. should I see a neurologist ?
doctor
Answered by Dr. Bhagyesh V. Patel (12 minutes later)
Brief Answer:
MRI and neurophysician consultation to proceed from this point.

Detailed Answer:
Hi

* When the uroflowmetry report is showing normal report means that the cause of
urinary incontinence is via nerves which are controlling the bladder and urethra ( as
in the spinal cord level ).

* Complete neurology work up with neurophysician and MRI lower lumbar sacral region
will be of utmost importance from this stage onward.

It`s a gentle suggestion to remain panic free as the situation is nasty but it will be cured once the definite cause is identified.

Would like to discuss further doubts.
Thanks.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Dr. Bhagyesh V. Patel

General Surgeon

Practicing since :1999

Answered : 16233 Questions

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Hello Doctor, For almost a year I am having this

Brief Answer: possible neurologic disturbances at internal urethral valve. Detailed Answer: Hello and welcome to Ask A Doctor service. I have read your query and here is my advise. * As per the duration of persistent symptoms of urinary complain and normal CT scan with urethra evaluation, associated neuropathy assessed by the neurologist suggest the condition to be most likely from the problem at internal urethral valve via nerve disturbances. Kindly provide me further details to proceed more precisely. 1. Any report as Urethrography has been done by urologist ? 2. Do you get normal semen amount with proper flow during ejaculation ? 3. Any problem in getting erection ? Awaiting for your response. Regards. Dr Bhagyesh