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Bph

All discussions relating to bladder cancer symptoms, diagnosis, treatment and prognosis

Bph

Postby Field » Mon Jul 25, 2016 11:20 pm

I am a 54 year old male who has had difficulty urinating for the past decade or so. I went on Flomax and Avodart five years ago when the BPH became disabling with moderate improvement. I have been on Allegra for the past fifteen years for year round allergies. I stopped the antihistamine for several days. On the fifth day I had such bad burning that I could not sleep and considered going to the ED. On a chance, I took an over the counter antihistamine and within an hour the pain was gone. Was this a coincidence or could I have some kind of an "allergic urethra"? and are there any treatments. If not, what could have caused the burning and what can I do in the future. Thank you.

ANSWER: Byron, in individuals with BPH, most antihistamines are contraindicated because they decrease the ability of the bladder muscle to contract properly.  This may lead to urinary retention.  However, Allegra is one of the rare anti-histamines that does not interfere with bladder function so your physician made an excellent choice.

Allergies have, on occasion, been considered a possible cause for non-specific urethritis(meaning no infectious cause was found).  Most of these papers were in the 1960's but I do not believe a histamine related allergic reaction has ever been proven.  In many disorders of unknown etiology, viral infections, allergic reactions, & auto-antibodies are typically theorized.  Therefore, it is possible, but unlikely, that your burning was due to histamine release from being off of your Allegra for a few days.  However, in spite of my skepticism, if your reaction can be periodically reproduced in the future, this certainly would suggest a cause and effect relationship.  I have also checked the medical literature to see if there was any information regarding such symptoms due to suddenly discontinuing the Allegra.  I was unable to find such reports.

The most common cause for urethral burning is an inflammation of the lower urinary tract.  This is usually due to inflammation of the prostate gland so called prostatitis which may or may not be due to a bacterial infection.  I have written extensively about this on this web site.  If you want, let me know and I will send you a copy of my "macro" on this disorder.  Other causes for burning would be a typical bacterial infection of the bladder or urethra and occasionally a urinary stone.  With any of these, the symptom might last just a few hours initially but often recur.  Because of this, I would suggest that you check with your urologist for re-evaluation and at the very least get a urinalysis performed.  Only after a correct diagnosis is made can a rational treatment plan be recommended.  Good luck.

---------- FOLLOW-UP ----------

Dr Goldstein:

Again, Thank you for your very informative reply. I have been unable to get to see my GP because of the weather. It has now been a week since I had the burning.  If it was due to prostatitis or a UTI, in what time frame would a reaccurance be most likely, if this is possible to predict? Also, if you encounter a similar episode where allergies may possible be involved anytime in the future, please let me know at .
Field
 
Posts: 39
Joined: Fri Apr 18, 2014 1:08 am

Bph

Postby Timmy » Tue Jul 26, 2016 2:19 am

Byron, there is no specific time frame for recurrence of symptoms of a UTI or prostatitis.  These conditions may  cure spontaneously without treatment.  More often, the inflammation persists but the person, although asymptomatic, can expect this to flare up again in the future.   I suggest you see your urologist for this and not your family doctor.  I am attaching my "macro" on prostatitis to this note.   This will give you insight into the condition and clues as to what may cause it to flare up.  I will also attach my "macro" on BPH so you will understand the difference between this and prostatitis.  I hope these help you understand your symptoms.

PROSTATITIS:  Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, urethral discharge, sexual dysfunction(such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum(the area between the scrotum and rectum – between the “wind and the rain”) and constipation. The passage of blood at the initiation or termination of urination or in the semen can also be noted. During sexual arousal the prostate gland & seminal vesicles manufacture fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement.  Sperm from the testicles(which account for only 1-2 % of the semen) travel up a series of tubes(epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts.  These structures empty into the prostatic portion of the urethra.  At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra(urinary canal) forming the semen.  The average semen volume is 2-6 cc.  With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles.  It is not uncommon for inflammation and/or infection to spread in a retrograde manner into the vas and epididymis.  Even without such spread, prostatic discomfort is often referred into the testicle.  Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this.  Sitting for long periods of time, especially in an automotive vehicle, can put undo pressure on the prostate and aggravate the condition.  For the latter, it is best not to sit more than 2-3 hours at a time.  Stop the vehicle periodically, take a short walk and go to the bathroom to urinate.  A thick pad or piece of sponge rubber on your seat will also help to cushion the prostate.  One should avoid any of the above that apply.  Eliminating all of these factors that apply to you are just as important, if not more so, than taking medication!  Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort.  Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms.  For most men, ejaculation in moderation, perhaps 1-2 times a week, is reasonable.  A daily warm bath for 10-15 minutes 1-2 times daily also lessens the discomfort.  Attention to sexual activity and warm bathes should be utilized regardless of the type of prostatitis and whether or not medications are prescribed. There are several types of prostatitis.  Sometimes prostatitis can be due to an infection of the gland with bacteria.  Typically, pus cells and bacteria are found in the prostatic fluid. The infection usually requires an initial 4 week course of an appropriate antibiotic(the commonest prescribed are the fluoroquinolones, but tetracyclines, sulfas and other agents can also work).  

Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria.  In the other, there are neither pus cells nor bacteria in the fluid, just the symptoms.  In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder.  Abacterial prostatitis is an elusive entity that has been called by a variety of names including nonbacterial prostatitis, prostadynia, pelvic congestion syndrome and most recently pelvic myoneuropathy.  The latter name was coined by Dr. David Wise of Stanford.  He believes that this may represent up to 95% of all cases of prostatitis.  This variant may be an expression of interstitial cystitis and possibly is due to autoimmune or neurogenic factors. Dr. Wise suggests that  the primary cause of the symptoms involves pelvic muscle spasm, nerve trigger points and some degree of anxiety(either the cause or result of the symptoms).  His therapy involves the use of anti-depressents(we have used Elavil for years in refractory patients), relaxation techniques, trigger point physiotherapy, and biofeedback.  Some others recommend Yoga & meditation as being useful.  Although he may well prove to be correct,  I generally recommend an initial course of antibacterial therapy for patients who clinically have symptomatic prostatitis of any variety.  The majority of patients(even those with nonbacterial prostatitis) seem to respond favorably.  It has been know for decades that many patients with the abacterial variety of prostatitis do well with antibiotics but the reason has been vague.  Some theorized that they may harbor bacteria in the tissues of the prostate that are not being picked up in cultures(possibly walled off loci of infection).  For more information on Dr. Wise's studies check out:http://www.pelvicpainhelp.com/

In my experience, symptoms usually responds to the general measures mentioned in the initial paragraph.  Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha-blockers(such as Flomax, Hytrin, Cardura & Uroxatral).  The latter require a prescription from you physician if he thinks it is indicated.  More recently, a naturally occurring flavinoid with anti-oxidant and anti-inflammatory properties(such as quercetin) has been used in prostatitis.  It's success is yet to be confirmed.  

Prostatitis may also be classified as acute(severe), subacute(mild), or asymptomatic.  It may also occur as a single episode, be recurrent or chronic.  In chronic bacterial prostatitis, long term low dose antibacterial therapy often works well in suppressing symptoms.  In refractory cases, culture of the prostatic fluid or semen often will disclose the offending bacteria.  If found, sensitivity studies can identify which antibiotics are most likely to eliminate that particular germ.  One should be off of all antibiotics for 7-10 days before the culture is taken.  Otherwise, if there is residual antibiotics in your system, this may prevent bacteria from growing in culture.  

In other cases refractory to treatment, there is another condition that can produce similar symptoms. This disorder is ejaculatory duct obstruction. Usually the doctor will find the seminal vesicles to be very swollen on rectal examination. The patient will notice either absence or a markedly diminished semen volume. The diagnosis is made by doing a transrectal ultrasound of the prostate and seminal vesicles. Therefore, if symptoms persist, consultation with a urologist should be scheduled.  In cases with recurrent prostatitis or hematuria, it often is necessary to study the urinary tract more completely.  Predisposing factors to prostatitis such as a urethral stricture(narrowing) and other disorders can then be evaluated.  A man should learn to listen to his body. BPH:  Benign enlargement of the prostate gland(benign prostatic hyperplasia or BPH) occurs to varying degrees in all men as they age.  The prostate surrounds the urinary canal(urethra) just after its connection to the urinary bladder.  Inward growth of the prostate either into the bladder neck(opening) or into the urethra itself can cause difficulty with urinating.  The prostate is checked by digital examination through the rectum.  This gives the doctor an idea as to the size and benignity of the gland.  However, it does not always correlate to symptoms as a small gland may have significant inward growth and a large glands enlargement may be entirely peripheral.   The ability to urinate involves the urinary bladder muscle actually becoming stronger as it works against increasing resistance from the prostate.  This delicate balance can be upset by any factor that decreases?the bladder muscles ability to contract with sufficient force to open the?prostate(such as medications, anesthesia, too much alcohol, ignoring the desire?to urinate, etc.) or those factors that might cause the prostate to?suddenly swell(ie acute prostatitis, sitting  for extended periods of time, biking,?horseback riding, etc.). The typical symptoms that occur include diurnal frequency(daytime), nocturia(night-time frequency), urgency, hesitancy, slow stream and dribbling after voiding.  This complex of symptoms is termed “prostatism”.  If the obstruction to flow progressively worsens, the bladder eventually may not be able to empty completely.  This leads to the accumulation of “residual urine” which may predispose to urinary infections and  kidney damage from back pressure.  However, relatively asymptomatic men with BPH do NOT necessarily require therapy.  Treatment is indicated to relieve symptoms and prevent complications.  In many cases medications can be used.  Alpha - blockers(ie Hytrin, Cardura, Flomax, Uroxatral etc.) work by relaxing the bladder neck and urethra so the pressure generated by a bladder contraction has less resistance to work against.  Natural herbal products such a saw palmetto and pygeum often provide symptomatic relief but the exact mechanism of action has not yet been defined.  The prescription drugs Proscar and Avodart actually shrink the prostate.  They work best in the larger glands and improvement may not be noted for up to 6 months.   In cases refractory to medication, interventional measures are indicated.  The “gold standard” for treatment is the time honored transurethral resection(TUR) of the prostate.  For huge glands, open surgery may be necessary.  In the past decade a number of other less invasive interventional therapies have been developed to reduce the obstructing prostate tissue utilizing various forms of energy.   These include laser prostatectomy, microwave(TUMP or transurethral microwave of the prostate), and radiofrequency(TUNA or transurethral needle ablation of the prostate).  TUMP is actually a minimally invasive, out-patient treatment that can be tried initially if the patient's gland size is appropriate.  

Here is an explanation of a TUR of the prostate gland.  The prostate gland can be thought of as being composed basically of three parts which from inside to out are: the prostatic portion of the urethra(urinary canal), the prostatic glandular tissue causing the obstruction(adenoma) and the compressed capsule of the prostate.  In a TUR, the prostatic urethra and adenoma are removed leaving only the capsule.  This surgery can be likened to coring out an apple from the inside leaving only the skin.  The prostate is resected into many tissue slivers which wash into the bladder and then are removed at the end of the operation by suction.  This leaves a raw bed, which, over a period of 6-8 weeks, regenerates a new urethra!  At the termination of the procedure, one can look from the far end of the prostate into the bladder without residual obstruction.  A catheter is left in for a few days to drain the bladder and to initiate the healing process.   Good luck!

?  
Timmy
 
Posts: 55
Joined: Thu Mar 13, 2014 7:52 am

Bph

Postby Blase » Tue Jul 26, 2016 4:20 pm

I am a 54 year old male who has had difficulty urinating for the past decade or so. I went on Flomax and Avodart five years ago when the BPH became disabling with moderate improvement. I have been on Allegra for the past fifteen years for year round allergies. I stopped the antihistamine for several days. On the fifth day I had such bad burning that I could not sleep and considered going to the ED. On a chance, I took an over the counter antihistamine and within an hour the pain was gone. Was this a coincidence or could I have some kind of an "allergic urethra"? and are there any treatments. If not, what could have caused the burning and what can I do in the future. Thank you.

ANSWER: Byron, in individuals with BPH, most antihistamines are contraindicated because they decrease the ability of the bladder muscle to contract properly.  This may lead to urinary retention.  However, Allegra is one of the rare anti-histamines that does not interfere with bladder function so your physician made an excellent choice.

Allergies have, on occasion, been considered a possible cause for non-specific urethritis(meaning no infectious cause was found).  Most of these papers were in the 1960's but I do not believe a histamine related allergic reaction has ever been proven.  In many disorders of unknown etiology, viral infections, allergic reactions, & auto-antibodies are typically theorized.  Therefore, it is possible, but unlikely, that your burning was due to histamine release from being off of your Allegra for a few days.  However, in spite of my skepticism, if your reaction can be periodically reproduced in the future, this certainly would suggest a cause and effect relationship.  I have also checked the medical literature to see if there was any information regarding such symptoms due to suddenly discontinuing the Allegra.  I was unable to find such reports.

The most common cause for urethral burning is an inflammation of the lower urinary tract.  This is usually due to inflammation of the prostate gland so called prostatitis which may or may not be due to a bacterial infection.  I have written extensively about this on this web site.  If you want, let me know and I will send you a copy of my "macro" on this disorder.  Other causes for burning would be a typical bacterial infection of the bladder or urethra and occasionally a urinary stone.  With any of these, the symptom might last just a few hours initially but often recur.  Because of this, I would suggest that you check with your urologist for re-evaluation and at the very least get a urinalysis performed.  Only after a correct diagnosis is made can a rational treatment plan be recommended.  Good luck.

---------- FOLLOW-UP ----------

Dr Goldstein:

Again, Thank you for your very informative reply. I have been unable to get to see my GP because of the weather. It has now been a week since I had the burning.  If it was due to prostatitis or a UTI, in what time frame would a reaccurance be most likely, if this is possible to predict? Also, if you encounter a similar episode where allergies may possible be involved anytime in the future, please let me know at .
Blase
 
Posts: 51
Joined: Sat Jan 04, 2014 7:36 pm


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