Hello doctor, I am a 52-year-old male, married and with a son. My basic complaint is recurrent UTI, poor urine flow and chronic testicular pain. I was down with kidney infection since past five months and had to be treated with Magnex Forte for five days. A CT scan showed mild perinephric stranding. I was put on low dose Niftran for three months. A follow-up CT scan with contrast revealed normal kidneys and function. Since my urine flow has always been poor, I did an ascending urethrogram a month back. The report indicated no obvious abnormality. There was bleeding and excruciating pain for two days post procedure. Four days later, I again developed severe UTI for which I had to take injections of Amikacin 750 mg for five days. I have once again been put on Niftran 100 mg twice daily. The urologist has suggested a bladder neck incision as he feels that my bladder neck is not opening fully and that there is a slight narrowing of the prostatic urethra. My prostate is slightly enlarged at 26 gm. The urologist is planning to widen neck and if required, scoop out prostate tissue that is blocking the passage. I have been on treatment for chronic testicular pain for last 8 to 9 years. I also have grade 2 varicocele, mild burning pain on tip of the penis. Earlier, I used to get burning pain in penis after ejaculation. One doctor suspects that I have chronic non-bacterial prostatitis. I am currently seeking advice that will help prevent upper UTI, increase urine flow and relax the bladder muscles. My average urine flow is only about 5 or 6 ml/sec. My medicines include Saw palmetto and Quercetin, Mildfil 5 mg, Silodosin 8 mg, Tapentadol 75 mg twice daily, Valium 5 mg and Duzela 20 mg. The last three are prescribed by a pain specialist. My urologist is planning to do a BNI including parts of the prostate (laser), varicocelectomy and a cystoscopy. There is a certain improvement in urine flow after I started taking Silodosin. It seems to be more effective than Tamsulosin and Alfuzosin (10 mg). The only drawback is complete retrograde ejaculation. Can I shift to Silodosin 4mg? Is it fine to do varicocelectomy and BNI at the same time? More importantly, will BNI offer excellent outcome as the X-ray does not indicate an obvious abnormality?
Hello. As per my understanding, you are suffering from two things. I want to see your urine flow report (printed graph). Do you have an ultrasound done? (I specifically want pre and post void urine residue if available). Now I think, regarding recurrent UTI, you may have two problems. Either problem in bladder itself or problem in bladder outflow (neck). These two can be differentiated by uroflowmetry and ultrasound. If required, a urodynamic test is the best. If the problem is bladder itself (weak bladder power), then you may improve with BNI (bladder neck incision) but not 100 percent. If the problem is not in the bladder, then you can go ahead with BNI and your UTI should improve. So, if you do not want urodynamic test then you can go ahead with BNI and in rare case, if you have bladder problem (weak bladder), then you may not improve as expected. Regarding varicocelectomy, both surgeries can be done together but again testicular pain has thousands of cause impossible to diagnose everything. If it is due to varicocele, then the pain will go. But, as per my experience, resolution of pain after varicocelectomy is only in 60 to 65 percent of patients. Retrograde ejaculation can occur with 4 mg also. So, you can try with 4 mg provided your urinary symptoms do not get worse. For more information consult a urologist online -->