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What causes difficulty and pain during urination?

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Posted on Wed, 9 Jul 2014
Question: I have difficulty and pain in urination and after urine and blood tests urologist put me in CONTIFLOW-D since XXXXXXX 2014 and ALEVO(500) for 10 days.Urine tests show few bacteria.Even after taking medicene for more than 3 months there is no sign of pain receding nor improvement in the flow of urine.And also ultra sound done;nothing abnormalities except enlargement of porstate ie about 33.25 gm and that too after the operation of prostate in XXXXXXX 2012. Mild diffuse in UB and and wall thickening, no calculi was shown .My sugar was 131(fasting)and 178(pp) .Why pain is not getting alright after so much of medication and antibiotics.Pl advise .Should i need to be hospitalised.I am 66 years old.my PSA was 2.25 and creatinine 1.PVR 152.ureter not diated.Frequency at night sometimes 2 times and sometimes 3 to 4 times.Watever it is but difficulty and pain persist in urination.Looks like the medicene was not helping.I am avoiding all sugary food items although my dr.tells me not necessary.I can eat all with due care for sugar.
doctor
Answered by Dr. P. T. Patil (19 minutes later)
Brief Answer:
Could be dueto Stricture Urethra.

Detailed Answer:
Hello
Thanks for your query,based on the facts that you have posted it appears that you have undergone surgery mostly (TURP) in 2012 for enlarged prostate and now have difficulty in passing urine and dysuria.

Your ultrasound scanning revealed a post void residue of urine to be 152 ml with which is significantly high and enlarged prostate with volume of 33 .25 cc .

Your symptoms could be either due to recurrence of enlarged prostate or post operative stricture of urethra which is known complication of endoscopic surgery .

Please consult qualified Urologist for clinical and digital rectal examination and get following basic investigations done to confirm the diagnosis .
1) Endoscopic examination of urethra and bladder ,(Cysto-Urethroscopy)
2) Retrograde Urethrogram.

Further treatment will depend upon the results of thse test and final diagnosis,

In the mean while continue taking antibiotics to prevent infection.

Hope I have answered your query ,please feel free to ask if you have more questions ,
I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (2 hours later)
1. When I press just below the navel i feel the immediate urge for pee and i feel disturbed and in fact just three months back i had experienced quite a pain but that is all as no pain ever since but yes when i press i feel the urge and it is quite disturbing when i am in the midst of watching FIFA world cup to go to the loo. What could it be?
2.Do i ned to be hospitalised for undergoing the two above investigations ? Dear Dr. I need relief.Do i get the relief or is it the end of the world ?
3.Do i need to go for one more surgery ? Or is there medicene which can give me relief.
4. How serious is this ?
doctor
Answered by Dr. P. T. Patil (38 minutes later)
Brief Answer:
Not to be worried .

Detailed Answer:
Hello
Thanks for follow up.Please read answers to your queries
1) You have post void residue of 152 ml meaning thereby that 152 ml of urine remains in bladder after passing urine (which in normal circumstances should be 5-10 ml.) so your bladder is contains substantial amount of urine that gives rise to sensation of urge on pressing over lower abdomen.

2)You will need to get hospitalised for 4-6 hours for Cystoscopy .Retrograde Urorthrogram is done as a out patient procedure in radiology department.

3)If positive you may need to undergo endoscopic surgery either of Visual Internal Urethrotomy for stricture urethra or revision TURP for enlarged prostate depending upon the findings of these tests.Do not worry ,you will definitely get relief from symptoms.Unfortunately medicines will not help as this is due to mechanical obstruction in urethral passage which has to be cleared off by surgery only.

4) This is not a serious issue at all .One has to accept and face it boldly.

Thanks and Regards.
Dr.Patil.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (43 minutes later)
Thank you for detail explanation.One request: pl suggest one anti-biotic until i get to the qualified urologist for temporary relief. Meanwhile,where are you based?If u are near calcutta i would definitely ome to you.
doctor
Answered by Dr. P. T. Patil (3 hours later)
Brief Answer:
Take antibiotics twice daly twice daily.

Detailed Answer:
Hello
Thanks for follow up.
You need to take broad spectrum antibiotic like Cefexine and urinary antiseptic like Nitrofurantoin along with anti inflammatory drug like Diclofenac twice daily.I am based in XXXXXXX you can write me again after getting test reports I shall be glad to guide you ..

Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. P. T. Patil

Urologist

Practicing since :1971

Answered : 10389 Questions

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What causes difficulty and pain during urination?

Brief Answer: Could be dueto Stricture Urethra. Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that you have undergone surgery mostly (TURP) in 2012 for enlarged prostate and now have difficulty in passing urine and dysuria. Your ultrasound scanning revealed a post void residue of urine to be 152 ml with which is significantly high and enlarged prostate with volume of 33 .25 cc . Your symptoms could be either due to recurrence of enlarged prostate or post operative stricture of urethra which is known complication of endoscopic surgery . Please consult qualified Urologist for clinical and digital rectal examination and get following basic investigations done to confirm the diagnosis . 1) Endoscopic examination of urethra and bladder ,(Cysto-Urethroscopy) 2) Retrograde Urethrogram. Further treatment will depend upon the results of thse test and final diagnosis, In the mean while continue taking antibiotics to prevent infection. Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you Thanks and Regards. Dr.Patil.