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 What are your experiences with doctors and imaging? 
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Joined: Mon Oct 30, 2017 8:20 pm
Posts: 21
Post What are your experiences with doctors and imaging?
So I'm seeing another urologist; I'm ready to get scoped. But I went to a prominent teaching university health facility in my region (SE Houston area). That + the location made it convenient. However, this time I went in with a lot of questions.

I still have really aggravating urinary symptoms; persistent feeling that I need to void which I assume precursors incomplete voiding (even though most recent PVR was 12 ml), inconsistent streams, ejaculatory dysfunction (not powerful at all and I believe there's even a degree of retrograde ejaculation. I'm not on alpha blockers). I either have a stricture, detrusor underactivity, or asymptomatic prostatitis (asymptomatic in all of the common ways).

I don't believe I have 'traditional' prostatitis. I've had 3 professionals tell me the prostate feels fine, I've never had pain in that region, never had any fevers or infection-like symptoms, practically zero identified bacteria across multiple semen and urine cultures with 1 PCR of urine.

However it seems like there has to be a better way to determine if the prostate is causing a blockage for sure or not. I went in and asked all sorts of questions like

- could a transrectal ultrasound be used to somewhat identify if a possible urethral obstruction due to enlarged prostate is the culprit
- can CT or MRI show the prostate size and if it's obstructing
- could constipation press into the bladder or urethra causing my symptoms that are similar to BPH

And other questions such as if they ever do bacteria testing of prostatic fluid. Most of these questions were met with answers like:

- TRUS doesn't show much and is 'more invasive than a cysto due to the size of the probe' (honestly the rectal probe is not that big and I would heavily argue that point)
- MRI doesn't show much
- if the prostate was enlarged or inflamed and causing obstruction it would be obvious from a cysto (is this true?)
- if other anatomy was causing obstruction due to auxiliary pressures it would be obvious from a cysto (I also wonder if this is true)
- testing of EPS doesn't seem like a worthwhile venture due to me not having infection symptoms and all other tests yielding negative growths

I had a CT scan of the abdomen and pelvis today with and w/o contrast. Really the doc was just looking to make sure there weren't any other glaring issues. I'm scheduled for a cystoscope in January. Can CT scan show anything significant re: the prostate?

Anyway, just wondering what have your guys experiences been with docs/urologists and advanced imaging or diagnostic techniques. Were they reluctant or did you find that imaging helped to actually pinpoint a definite cause? (Such as enlarged/inflamed prostate or other issues causing LUTS).


Tue Dec 11, 2018 6:48 am
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Joined: Fri Apr 13, 2018 1:53 pm
Posts: 59
Post Re: What are your experiences with doctors and imaging?
This sounds more muscular. You may be better off asking for a Urodynamics test, rather than cysto. It tests muscle functionality while you are urinating, still have to stick stuff up your urethra though.


Tue Dec 11, 2018 1:55 pm
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Joined: Tue Apr 12, 2016 11:55 am
Posts: 429
Post Re: What are your experiences with doctors and imaging?
I've only had a PCR urine and basic urine tests. I've read a number of posts and articles that say an EPS and the PSA are capable of detecting specific pathogens (not only bacteria) and calcification. I don't know about cystoscopy, but it is often noteworthy of being a cause or precursor to worse problems (including prostatitis). IMO, it's more invasive than a TRUS because of the greater risk of worsening or causing problems. I may be wrong though, and it could easily be a more case by case basis that claims are made. I consider lower gut problems to be a cause of inflammation in adjacent organs / tissues. It's well-known that even changes in blood pressure and thickness are causes of inflammation. Bone density and platelet count, as well as WBC, when not at normal levels, also result in inflammation and other problems. So I think this view of requiring a cysto to reveal whether it's the case that "auxiliary" pressures are causing the problem(s) is a sales pitch more than strictly a reliable test. Why would there be other forms of diagnostic imaging? If a CT or an MRI can show tiny tumorous growths and other things like holes and gaps, it can also show those things. One question to ask is, and not directly of the doctor or technician: is there sufficient evidence in a scan to infer "auxiliary" pressures as one viable hypothesis or conclusion?

If so, then I would ask the doctor what is there to change or correct it? It may be they're trying to arrange to avoid sending you down a particular route of being treated, whether at that clinic or to a surgeon or elsewhere. If it can be identified as a simpler problem, then it is less likely to reflect on them than if the suggested approach or method involves a higher risk of complications. That's my thinking. It's partly why I try to get well-informed before stepping into an office and asking for them to provide me with the final solution. I'm not saying a problem organ pressures is more complicated because I don't know. It seems it has the greater potential to be in contrast to a bacterial infection that can be treated with antibiotics, or even a routine surgical procedure. However, there is probably information I'm missing about correcting such a problem, which I think is a problem I've had or possibly have now. Even the physical therapist I was seeing thought it was a probable issue.

It's interesting that the question of whether an MRI shows obstruction was answered with 'it doesn't show much'. An MRI is often regarded as the more comprehensive scan. It's why it is the choice scan for looking at the brain, is it not? It could be a smart idea to do a search for 3D imaging via a different scan than either MRI or CT. I'm looking into it myself, but haven't scheduled something yet. Have you tried alpha blockers?


Tue Dec 11, 2018 8:09 pm
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Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1131
Post Re: What are your experiences with doctors and imaging?
I'm attempting to get an annual 3T MRIs done to keep an eye on my prostate since my psa (2.2 - 2.8) has been somewhat elevated ever since this condition began. So far so good...no lesions, or growths of any kind. PC doctor said it showed signs of inflammation though due to prostatitis...which really doesn't tell me anything.


Wed Dec 12, 2018 11:07 pm
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Joined: Tue Apr 12, 2016 11:55 am
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Post Re: What are your experiences with doctors and imaging?
I consider that a different response than the usual. Have you had other scans than an MRI, CT, cysto, or TRUS? What about a regular x-ray?


Thu Dec 13, 2018 2:05 pm
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Joined: Tue Aug 04, 2015 6:50 pm
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Post Re: What are your experiences with doctors and imaging?
Yeah, I've done a cysto...which resulted in a terrible UTI, so I am avoiding those. I haven't done a CT though for prostatitis, even if I could, I'd have to wait a while as I just had one due to an accident. I have had TRUS, but it's been a while also. All that ever showed was a few stones and inflammation.


Thu Dec 13, 2018 3:54 pm
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Joined: Mon Oct 30, 2017 8:20 pm
Posts: 21
Post Re: What are your experiences with doctors and imaging?
I've tried alpha blockers, they don't seem to help and I can't handle the stuffiness and headache. They make me pelvic floor feel weak AF.

My CT scan results indicated "Enlarged and enhancing seminal vesicles with mild surrounding inflammation is consistent with seminal vesiculitis". Not really a great Dx cause I doubt there's any good treatment.


Thu Dec 13, 2018 10:32 pm
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Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1131
Post Re: What are your experiences with doctors and imaging?
I end up taking .02 (half the standard dose) of flomax / tamsulosin and it minimizes the side effects somewhat. Nose spray helps as well, as it makes my nose stuffy also.


Fri Dec 14, 2018 2:41 am
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Joined: Tue Apr 12, 2016 11:55 am
Posts: 429
Post Re: What are your experiences with doctors and imaging?
Anonacct,

Why don't you try a different blocker? Beta blockers might help. Do you have frequent sex? Or are you having sex without a condom? Whenever the dx has an -itis as the suffix, it denotes inflammation. There's most likely more than one solution to SV. Even if the docs that dx'ed you say otherwise.


Fri Dec 14, 2018 6:21 am
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Joined: Mon Oct 30, 2017 8:20 pm
Posts: 21
Post Re: What are your experiences with doctors and imaging?
presto423 wrote:
Anonacct,

Why don't you try a different blocker? Beta blockers might help. Do you have frequent sex? Or are you having sex without a condom? Whenever the dx has an -itis as the suffix, it denotes inflammation. There's most likely more than one solution to SV. Even if the docs that dx'ed you say otherwise.


Why beta blockers? Afaik my blood pressure is fine. I don't have frequent sex since this whole problem, I get ED cause I am constantly focused on the feeling of my penis.

I have some rapaflo on my desk, I took it a few times but again the sides are just too much. I need to pick up my flonase that I had prescribed by an otolaryngologist a while back to see if I can take that + the alpha blocker and be okay with minimized stuffiness. That's the big killer.

Also the rapaflo is in capsules, it's not a tablet. So I'm unsure of the best way to take it if I want to half it.


Fri Dec 14, 2018 11:26 am
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Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1131
Post Re: What are your experiences with doctors and imaging?
To halve the dose, get some clear empty capsules, they're pretty cheap. Then, open the Rapaflo capsule (usually these aren't clear) and pour the entire contents into one of the clear empty capsules. Open a second clear empty capsule, pour half the contents from the first clear capsule...into the second. I'm doing that with Tamsulosin. Otc decongestant nose sprays like 4Way, and others work well and last for a while.


Sat Dec 15, 2018 3:29 am
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Joined: Tue Apr 12, 2016 11:55 am
Posts: 429
Post Re: What are your experiences with doctors and imaging?
Sorry, I was mistaken about beta blockers. I thought there was a class of beta blockers that were for reducing urinary issues. But, stress raises blood pressure, so something that reduces it normal levels could help... probably not beta blockers though. I see they have serious side effects, including airway constriction and heart arrhythmia.


Sat Dec 15, 2018 6:46 pm
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