BPH or not?

[Susco]

My story start about 6 weeks ago, when I got the feeling that I had developed a UTI. Burning sensation when urinating, and increased frequency, to as often as every 6 hours.

 

Urine had a very foul smell, and on a very few occasions the last drip seemed to contain blood. In the very few cases this happened, it would be in the morning when having stool.

 

I have no problems with urine flow or the amount of urine, I have no pain when urinating only a burning sensation at the end of the cycle, and that I have the urge every 6 hour.

 

As I have experience UTI in the past, I started with a course of Cipro, but as it didn't improve after 2 weeks and had started reading up on BPH, I went to see a urologist in a government hospital.

 

A mistake I think, because the urologist diagnosed me with BPH even before I sat down at his desk. He did no physical examination at all, and the consultation lasted about 5 minutes in total.

 

He booked me for an ultrasound examination, which will happen at the end of this month, and prescribed me 20 tablets of Silodosin, which I didn't take until 2 days ago as i read it was not a cure, and when discontinuing the medicine symptoms might actually worsen.

 

For the following 3 weeks I continued with the Ciprofloxacin only, and the symptoms would remain the same, with the burning sensation at the end some days happen and other days not.

 

The foul smell I don't notice anymore, or at least it is not as overwhelming as a few weeks ago.

 

I kept reading up on my symptoms, and discovered that it actually might be a bladder infection, and that antibiotics may not be effective because of a swollen bladder wand, and that the Silodosin can help for that.

 

So 2 days ago I took one 4mg tablet in the evening, and from that night my urination frequency increased to every 4 hours, quite the opposite of what I would have expected.

 

 

I took another 4mg last evening, but the frequency is still every 4 hours.

 

So now I'm actually in doubt if I should increase the intake to 8mg, or stop it right away, and my problems are actually not BPH related at all

 

Edited November 10, 2020 by Susco

[scubascuba3]

Definitely not an STI or UTI? 

 

If above possible  I would have gone with Azithromycin and Ceftriaxone, both less than 1,000 baht total

Edited November 10, 2020 by scubascuba3

[Sheryl]

What you describe does not sound at all like BPH (though you could also have that to some extent, mist men do past a certain age...but your symptoms are not likely due to it).

 

It sounds like an infection. Could be prostatitis, could be bladder. In both cases with inflammation of the urethra.

 

Do not mess around with Silodosin.

 

See a better urologist. You need to have cultures done. Do that before adding any more anitbiotics as that just makes it harder to identify the organism responsible.

 

Where in Thailand are you?

[Susco]

17 minutes ago, Sheryl said:

What you describe does not sound at all like BPH (though you could also have that to some extent, mist men do past a certain age...but your symptoms are not likely due to it).

 

It sounds like an infection. Could be prostatitis, could be bladder. In both cases with inflammation of the urethra.

 

Do not mess around with Silodosin.

 

See a better urologist. You need to have cultures done. Do that before adding any more anitbiotics as that just makes it harder to identify the organism responsible.

 

Where in Thailand are you?

 

Thanks for your reply, I also suspected an infection, rather than a BPH.

 

What is a culture? PSA - Urinalysis? Could i do this at a lab?

 

You mean stop taking the antibiotics right away?

 

Should I proceed with the ultrasound, or is this a waste of time and money?

 

Would Queen Sirikit hospital be a good place to see urologist, as I don't wanna sell my car to pay the fees at Pattaya Bangkok hospital

[Sheryl]

3 minutes ago, Susco said:

 

Thanks for your reply, I also suspected an infection, rather than a BPH.

 

What is a culture? PSA - Urinalysis? Could i do this at a lab?

 

You mean stop taking the antibiotics right away?

 

Should I proceed with the ultrasound, or is this a waste of time and money?

 

Would Queen Sirikit hospital be a good place to see urologist, as I don't wanna sell my car to pay the fees at Pattaya Bangkok hospital

A culture is a bacteriologic test that grows any organisms present in culture media (takes about 48-72 hours) and then tests for antibiotic sensitivity. Some labs might be able ot do it but most not, and there are special considerations in how the specimen should be collected.

 

Do not start any new antibiotics but continue what you are on until you get a second opinion. I would also hold off on the ultrasound till then, hard to see why it would be indicated.

 

 BPH has a urologist  who TVF members have reported very favorably on:

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=205&depid=28

 

Consultation will be around 2000 baht and culture maybe a couple thousand more.  Don't buy any meds at the hospital , get yourself at an outside pharmacy.

 

If you are determined not to go to BPH then come to Bangkok and see this UK trained doctor Same caveat re not buying medicine at the hospital. (note that inclusive of travel costs, might not be any less expensive. )

 

https://www.bumrungrad.com/en/doctors/Viroj-Chodchoy

 

 

 

[Susco]

@Sheryl Why do you think the silodosin has the exact opposite effect of what it should do?

 

For the past month my frequency is 6 hours, day and night, some times may be able to keep it 30 minutes to an hour longer.

 

With the silodosin ( urief brand) it went straight to 4 hours.

 

Should I try 8mg this evening, as that is the most common dose prescribed, or stop with it right away.

 

The burning sensation, which was at the tip of my penis,  has disappeared since I started the silodosin, but that may be coincidence

[smutcakes]

If i was you i would stop reading google and go to a proper doctor at a proper hospital and listen to their advice, not trying to second guess them and not taking the medicine they prescribe. Whats the point in going to the doctor at all if you are not going to believe them?

[Sheryl]

10 minutes ago, Susco said:

@Sheryl Why do you think the silodosin has the exact opposite effect of what it should do?

 

For the past month my frequency is 6 hours, day and night, some times may be able to keep it 30 minutes to an hour longer.

 

With the silodosin ( urief brand) it went straight to 4 hours.

 

Should I try 8mg this evening, as that is the most common dose prescribed, or stop with it right away.

 

The burning sensation, which was at the tip of my penis,  has disappeared since I started the silodosin, but that may be coincidence

 

I think silodosin effects are irrelevant to your primary problem.

 

As I said before - you should nto increase silodosin  nor start any other new meds, you should get a second opinion from a good urologist

[xylophone]

2 hours ago, Sheryl said:

See a better urologist. You need to have cultures done. Do that before adding any more anitbiotics as that just makes it harder to identify the organism responsible.

 

1 hour ago, Susco said:

Thanks for your reply, I also suspected an infection, rather than a BPH.

 

What is a culture? PSA - Urinalysis? Could i do this at a lab?

Agree as I went down that road with a supposedly top urologist who kept on prescribing different antibiotics week after week after week until I became very ill with what was a UTI of the rarer variety.

 

Get a culture done ASAP go from there.

[rumak]

5 hours ago, Susco said:

Ciprofloxacin

 

this antibiotic is among this group :  

Types of fluoroquinolones

• ciprofloxacin (Cipro)
• levofloxacin (Levaquin/Quixin)
• gatifloxacin (Tequin)
• moxifloxacin (Avelox)
• ofloxacin (Ocuflox/Floxin/Floxacin)
• norfloxacin (Noroxin)

Many people including myself have had very serious side effects from these "floxins".

 

If you are so inclined you can google about it and make up your own decision.   I think they are very dangerous ( and some carry the strongest caution from the FDA.    )

[Susco]

2 hours ago, rumak said:

 

this antibiotic is among this group :  

Types of fluoroquinolones

• ciprofloxacin (Cipro)
• levofloxacin (Levaquin/Quixin)
• gatifloxacin (Tequin)
• moxifloxacin (Avelox)
• ofloxacin (Ocuflox/Floxin/Floxacin)
• norfloxacin (Noroxin)

Many people including myself have had very serious side effects from these "floxins".

 

If you are so inclined you can google about it and make up your own decision.   I think they are very dangerous ( and some carry the strongest caution from the FDA.    )

 

I have seen similar posts from you regarding other antibiotics, and where several others including Sheryl have proven you wrong, so I think I better don't pay attention to your post.

 

Those medicines have proven to be the most effective against UTI, and I googled that very long ago, and have them been prescribed by doctors in the past.

 

I assume you recommend warm compresses to treat UTI.

[RotBenz8888]

10 hours ago, Susco said:

 

and on a very few occasions the last drip seemed to contain blood

Recommended investigation for visual blood in urine (macroscopic hematuria) is cystoscopy and CT urography.  

 

A positive urine culture and mitigation by antibiotics might mask and delay underlying diagnosis. Moreover, upper urinary tract issues can cause lower symptoms, hence full investigation. 

[Susco]

6 minutes ago, RotBenz8888 said:

Recommended investigation for visual blood in urine (macroscopic hematuria) is cystoscopy and CT urography.  

 

A positive urine culture and mitigation by antibiotics might mask and delay underlying diagnosis. Moreover, upper urinary tract issues can cause lower symptoms, hence full investigation. 

 

My guess is that it is a blood vein somewhere that has a "wound" and got infected.

 

If it is a vein in the upper tract, would I feel the burning sensation in the tip of the penis, and only at the end of the urination?

Edited November 10, 2020 by Susco

[RotBenz8888]

2 minutes ago, Susco said:

 

My guess is that it is a blood vein somewhere that has a "wound" and got infected.

 

If it is a vein in the upper tract, would I feel the burning sensation in the tip of the penis, and only at the end of the urination?

I don't think a blood vessel could explain your problem. The most common thing is after all some kind of bacterial infection, but to be safe, it's best to rule out other causes. Of course, best to see an urologist. 

 

I had similar symptoms as you describe, many antibiotic courses with ambiguous and different result. It turned out to be smal passing stones, probably due to low water intake in hot climate. Since I started to drink plenty of water on a daily basis, my problems vanished. 

 

 

[Dumbastheycome]

5 minutes ago, Susco said:

 

My guess is that it is a blood vein somewhere that has a "wound" and got infected.

 

If it is a vein in the upper tract, would I feel the burning sensation in the tip of the penis, and only at the end of the urination?

Be aware that  BPH over a  certain age is most probably  existent  but  not necessarily  related  to  your  symptoms.

Even an inflamed  prostate  is  not always  specific  to  BPH  nor any specific  infection. " Non infectious  Prostatitis".

At times  sexual activity  can actually  create some post event side  effects  without specific  cause.

As  recommended above  get a proper lab test  done to establish any better diagnosis.

I personally suffer similar  symptoms  as  you have  described on an intermittent  basis. Twice tests  have  shown no prostate  or  UTI and symptoms have subsided after  short term anti-inflammatory use.  I have a "very " enlarged  prostate  but as  yet have declined resorting to pharmaceutical intervention. (  As  yet ! )

Worst  episode I have had was after a  long  uncomfortable  journey as a  pillion  passenger on a  small  motorcycle. My anatomy  objected  "bigly" .

[xylophone]

4 hours ago, Susco said:

 

I have seen similar posts from you regarding other antibiotics, and where several others including Sheryl have proven you wrong, so I think I better don't pay attention to your post.

 

Those medicines have proven to be the most effective against UTI, and I googled that very long ago, and have them been prescribed by doctors in the past.

 

I assume you recommend warm compresses to treat UTI.

With respect Susco, the fluoroquinolones are known to have some pretty bad side effects (which I have personally experienced) with one of the more prevalent ones being tendon damage. Minor tendon damage most of us can manage, but something like an Achilles tendon can be very painful and take some time to heal. In addition there were reports of aortic dilation in animal studies and that is something you don't want!

 

The original warnings put out by the drug company regarding tendon damage as being rare were later on found to be much more common after feedback from users and doctors, and Ciprofloxacin does have black box warnings, as mandated by the U.S. Food and Drug Administration (FDA). A black box warning means that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects. 

 

I would stay away from that antibiotic all together as there are others that can do the job just as well.

 

As has been suggested, a culture is needed to establish what type of bacteria is causing your problem, if indeed it is a bacteria, but at least you will know/can rule it out or treat it..

 

 

[rumak]

10 hours ago, xylophone said:

A black box warning means that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects. 

  

 

I believe a word of caution to the wise should be sufficient.    "black box"  warning is as strong as it

gets.     

 

instead he chose to take a shot at me.    up to him   

[Sheryl]

14 hours ago, Susco said:

 

My guess is that it is a blood vein somewhere that has a "wound" and got infected.

 

If it is a vein in the upper tract, would I feel the burning sensation in the tip of the penis, and only at the end of the urination?

No, it would not be an infected vein.

 

The pain at the tip of the penis, assuming there is no visible sore, would be due to inflammation of the urethra.

[Sheryl]

13 hours ago, xylophone said:

.... A black box warning means that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects. 

 

I would stay away from that antibiotic all together as there are others that can do the job just as well.

 

 

 

 

It does mean this, but it does not mean that the serious adverse effects occur in most people.  Various studies have put the incidence of adverse effects (any type, not just the most serious) between 2 - 8%. And there are not always alternative drugs that are any safer, especially given the prevalence of antibiotic resistance in many parts of the world.  Depends on the patient.

 

OP has already been taking this for a while without adverse effects (as indeed the majority of people can). It is quite possible that when he gets a second opinion (as he should) the urologist will discontinue it in favor of a different drug or even advise stopping antibiotics  altogether for a while. But to avoid confusing matters further I think he should continue it until he sees the doctor, which he hopefully will do soon. 

 

Stopping and starting antibiotics on ones own just makes it all the harder for a doctor to identify what is causing the infection.

[lopburi3]

18 hours ago, Susco said:

I have seen similar posts from you regarding other antibiotics, and where several others including Sheryl have proven you wrong, so I think I better don't pay attention to your post.

He is not the only person with severe allergy or issues with the way CIPO is handed out here.  I have also posted my experience - my BIL has had the same issues in USA within the last two months and nearly died - but in his case was in hospital and due to no response to other medications (and had to be stopped).  CIPO is not a benign drug.  But yes it is cheap (making it even more of a danger).   A quick Google should make it clear this is not a drug to take on your own and even in the hands of many doctors I would call it the lazy approach and a real risk to many patients to be handed out as it is here.  You do not recover from some of the side effects and yet it is being given to those without infections as a preventive measure. 

[Chainsaw]

Before you do anything else drug-wise or test-wise I suggest you double your daily intake of water for a few days and see what happens. I had the same symptoms in the past which disappeared when I started drinking more water. Worth a try?

[Susco]

14 minutes ago, Chainsaw said:

Before you do anything else drug-wise or test-wise I suggest you double your daily intake of water for a few days and see what happens. I had the same symptoms in the past which disappeared when I started drinking more water. Worth a try?

 

Did your symptoms also include an increased frequency of urinating, with sufficient urine flow?

 

I would think that if dehydration, the frequency would decrease significantly, or there would be no urine when you get the urge

[xylophone]

3 hours ago, lopburi3 said:

He is not the only person with severe allergy or issues with the way CIPO is handed out here.  I have also posted my experience - my BIL has had the same issues in USA within the last two months and nearly died - but in his case was in hospital and due to no response to other medications (and had to be stopped).  CIPO is not a benign drug.  But yes it is cheap (making it even more of a danger).   A quick Google should make it clear this is not a drug to take on your own and even in the hands of many doctors I would call it the lazy approach and a real risk to many patients to be handed out as it is here.  You do not recover from some of the side effects and yet it is being given to those without infections as a preventive measure. 

Agree with you and despite some research showing that up to 10% of people can be affected by side effects, there is/are some lawsuits going on in the USA at the moment which put this figure much higher.

 

Unfortunately I took ciprofloxacin in NZ for two three-month periods, and did experience some muscle/tendon soreness in my lower right leg, then stopped it, but did not connect the two issues.

 

A couple of years ago here I was put on it again for a UTI (which the urologist here would not culture!!!!) and within the two week period, my Achilles tendon had become very sore and swollen and I couldn't walk properly, so I asked him to stop it and he got VERY angry with me.

 

About a year ago I went for a full medical and was most surprised when the doctor called me in to his room afterwards and told me that I had a problem with my aorta, which surprised me, because nothing like that had been picked up before, and it turns out I have a dilated aorta, which can be the cause of a quick death, or I could undergo some major and invasive heart surgery to correct it, and then it's not always that successful.

 

So I'm on a "watch and wait" regime at the moment, and try not to worry about it, but the thought of just sitting there and suddenly keeling over and dying within a few minutes because of a major aorta bleed is unnerving – – that's why try not to think about it.

 

Now folks can say what they want about there being "no connection between the two" however they are not the ones sitting here with the problem, and if you want further information, then please read the attached items and I urge you, @Susco to read this information, especially the fact that this antibiotic can be even more dangerous to people over 60, and if you search even further people who are on sildenafil (Viagra) should be very careful when they take this drug.
 

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Diarrhea, nausea, abnormal liver function tests, vomiting, and rash.
• Tendonitis and tendon rupture, peripheral neuropathy (nerve pain in fingers and toes) and central nervous system effects (side effects that affect the brain including psychosis, convulsions, hallucinations) have been associated with ciprofloxacin and other fluoroquinolones. These side effects may be irreversible and they can all occur together in some patients. They may occur at any time after starting ciprofloxacin and in any patient. If any of these very severe side effects happen, ciprofloxacin should be discontinued immediately and all fluoroquinolones avoided in the future. The risk of tendonitis and tendon rupture is increased in people over the age of 60, in those taking corticosteroids, or with a history of organ transplant. Previous tendon disorders or strenuous activity may also increase risk.
• May also cause anxiety, insomnia, psychotic reactions, nerve pain or a loss of feeling in the limbs, ECG abnormalities, increased sensitivity to light and other effects.
• Should not be given to children under the age of 18 years unless they have certain serious infections that cannot be treated with other antibiotics. Children are more susceptible to the adverse effects of ciprofloxacin.
• May exacerbate muscle weakness in people with myasthenia gravis.
• Serious, sometimes life-threatening, adverse reactions such as liver damage and allergic reactions have been occasionally reported.
• May trigger seizures or increase the risk of having a seizure.
• May disturb blood glucose levels in people with diabetes; careful monitoring of blood glucose is required.
• May cause photosensitivity reactions and severe sunburn on exposed areas of skin.
• Not suitable for people with myasthenia gravis, certain heart rhythm disturbances, or pediatric patients (unless being given to prevent inhalation anthrax or plague). Dosage may need reducing in people with poor kidney function. May cause liver damage or heart rhythm disturbances.

Also check this out: https://eurekalert.org/pub_releases/2018-07/bcom-tds072518.php

 

As I and Sheryl have said, there are other antibiotics out there that can do the trick for you, but before you go switching antibiotics GET A CULTURE DONE.

Edited November 11, 2020 by xylophone

[Sheryl]

6 hours ago, Susco said:

 

Did your symptoms also include an increased frequency of urinating, with sufficient urine flow?

 

I would think that if dehydration, the frequency would decrease significantly, or there would be no urine when you get the urge

Your symptoms do not in the least sound like dehydration.

 

They sound like an inflammation probably due to an infection.  Could be chlamydia (very common here and the antibiotic you are taking would not be ideal choice) or it might be another organism. The infection might be only in the urethra or also in the bladder and/or prostate.

 

Again, see a better urologist for proper diagnosis and treatment.

[Susco]

3 minutes ago, Sheryl said:

Your symptoms do not in the least sound like dehydration.

 

They sound like an inflammation probably due to an infection.  Could be chlamydia (very common here and the antibiotic you are taking would not be ideal choice) or it might be another organism. The infection might be only in the urethra or also in the bladder and/or prostate.

 

Again, see a better urologist for proper diagnosis and treatment.

 

Chlamydia is an STD, and I'm 100% sure it can not be an STD

[Sheryl]

2 minutes ago, Susco said:

 

Chlamydia is an STD, and I'm 100% sure it can not be an STD

 

it is, though you could have been infected long ago and only now be symptiomatic, it happens.

 

Or it could be another organism.

 

In any case what is clear is that:

 

1. The symptoms you report suggest inflammation of the urethra and possibly bladder or prostate

2. This is usually due to an infection (can also sometimes be the result of mechanical irritation, like after a medical procedure but you don't mention history of same).

3. Proper treatment depends on the  organism responsible. And also where the infection is, since if in the prostate a much longer course of treatment is needed.

[Susco]

15 minutes ago, Sheryl said:

Your symptoms do not in the least sound like dehydration.

 

I googled dehydration, and it shows symptoms like frequent urinating and burning sensation, as it can cause irritation of the bladder and even UTI.

 

For the past few weeks have a very dry face skin, which usually disappears if I apply Vaseline for a day. This time it is very hard to get rid of it, and keeps returning every few days.

 

I don't drink much during the day in normal circumstances, except when I cut the lawn, then I drink 1.5 liter during those 2 hours.

 

I also think to recall that the day after I have cut the lawn, my symptoms are less.

 

By coincidence, I cut the lawn this afternoon, and drank 1.5 liter water, and I haven't urinated since, which is now little over 5 hours.

 

The previous days the frequency was 4 hours maximum.

 

Worth a try?

 

https://www.bladderandbowel.org/news/importance-of-hydration/

Becoming dehydrated can lead to:

 

• Bladder irritation and concentrated urine – not having enough fluid in your body will lead to concentrated urine, which can irritate the bladder and make you feel the urge to pass urine with urgency or more frequently or suffer from incontinence. By drinking more fluids, this will help to flush any irritants through your bladder and out your body
• Increased risk of UTI – concentrated urine can also lead to a risk of a urinary tract infection. Symptoms of a UTI includes a burning sensation when urinating, the feeling of being unable to empty your bladder, pain in your lower abdomen or pelvis and feeling generally under the weather

Edited November 11, 2020 by Susco

[Sheryl]

Dehydration in itself does not cause these symptoms.  But it increases the risk of an infection and that causes it.

 

Hydrating alone will usually not be enough to clear an infection you already have but it definitely helps.

[Susco]

Just now, Sheryl said:

Dehydration in itself does not cause these symptoms.  But it increases the risk of an infection and that causes it.

 

Hydrating alone will usually not be enough to clear an infection you already have but it definitely helps.

 

I'm still taking the Cipro, which should clear an UTI. I also suspect I may be having diabetic issues.

 

Tomorrow I'm gonna take a blood glucose test, and a few days drink a lot of water and no alcohol at all

[polpott]

On 11/10/2020 at 2:18 AM, Susco said:

My story start about 6 weeks ago, when I got the feeling that I had developed a UTI. Burning sensation when urinating, and increased frequency, to as often as every 6 hours.

 

Urine had a very foul smell, and on a very few occasions the last drip seemed to contain blood. In the very few cases this happened, it would be in the morning when having stool.

 

I have no problems with urine flow or the amount of urine, I have no pain when urinating only a burning sensation at the end of the cycle, and that I have the urge every 6 hour.

 

As I have experience UTI in the past, I started with a course of Cipro, but as it didn't improve after 2 weeks and had started reading up on BPH, I went to see a urologist in a government hospital.

 

A mistake I think, because the urologist diagnosed me with BPH even before I sat down at his desk. He did no physical examination at all, and the consultation lasted about 5 minutes in total.

 

He booked me for an ultrasound examination, which will happen at the end of this month, and prescribed me 20 tablets of Silodosin, which I didn't take until 2 days ago as i read it was not a cure, and when discontinuing the medicine symptoms might actually worsen.

 

For the following 3 weeks I continued with the Ciprofloxacin only, and the symptoms would remain the same, with the burning sensation at the end some days happen and other days not.

 

The foul smell I don't notice anymore, or at least it is not as overwhelming as a few weeks ago.

 

I kept reading up on my symptoms, and discovered that it actually might be a bladder infection, and that antibiotics may not be effective because of a swollen bladder wand, and that the Silodosin can help for that.

 

So 2 days ago I took one 4mg tablet in the evening, and from that night my urination frequency increased to every 4 hours, quite the opposite of what I would have expected.

 

 

I took another 4mg last evening, but the frequency is still every 4 hours.

 

So now I'm actually in doubt if I should increase the intake to 8mg, or stop it right away, and my problems are actually not BPH related at all

 

Some years ago I returned to the UK with a UTI caught in Thailand. Very severe and ended up in hospital. Doctors were unable to tie it down to a specific infection hence my diagnosis of non specific UTI. The only thing that relieved it was a high dose of Ciprifloxacin, which I was on for 3 months.Symptoms cleared after a month or so and never returned.

 

One word of warning, 2 years later I suffered a severe case of Achilles tendinitis which is a common side effect of taking Ciprifloxacin for extended periods, particularly in the over 50s.. Very painful for 2-3 years.

 

My advice, stay on the Ciprifloxacin and stay away from mucky women.

 

 

Edited November 11, 2020 by polpott