I am male 37. I have seen many GPs and Urologists and they all seem stumped in doing a differential diagnosis of Prostatitis vs. Cystitis. I also wonder if it is neither! Can anyone more knowledgeable suggest something? Here is a brief history -- the primary symptom is that many a times, my end stream urine is turbid (sometimes pink, and occasionally red). The rest of the urine is just fine; only the last few drops are problematic. No significant pain or burning is experienced.
- April 2005: Visible end stream hameturia; diagnosed (correctly?) as UTI and treated with antibiotics (don't recall the family)
- August 2005: Visible end stream hameturia; IVP came clear. Cystoscopy was performed and was diagnosed (i have suspicions of this diagnosis!) with prostatitis. At that time urine culture indicated growth of staphylococcus Aeurus. Took various antibiotics for a month and was declared clear.
- September 2005: trace of blood in stool -- just once. Colonoscopy showed small amount of fresh blood under Ileum (I now suspect it could be from month-long antibiotics but who knows?). Gastro/Endoscopy showed clear stomach. Meckel's scan showed normal outlining. Capsule endoscopy was suggested but could not get it performed (there were no symptoms). Went undiagnosed, whatever it was!
- 11 Jan 2007: stomach discomfort and diarrhea. Had ciproflaxocin for a week.
- 23 Jan 2007: severe body aches, chills, especially in lower back and hips and weakness; had to rush to emergency; urgency to urinate and frequently; end stream urine visibly cloudy or turbid. culture showed growth of E.coli. Treated with heavy doses of third generation cephalosporin for 15 days. PSA was 6.81 ng/ml (normal is up to 4) but I was told that during infection PSA may get raised. After antibiotics, urine tests showed no infection. Drs. said you have cystitis and you can't have prostatitis since there is no pelvic pain.
- 12 Feb 2007: body aches and shivering/chills came back but to a lesser extent. irregular gut movement experienced. end stream urine is still turbid (sometimes pinkish). I am consuming gallons of water just to keep it washed out.
- 17 Feb 2007: transrectal ultrasound showed calcification in lateral walls of prostate and the radiologist told me that there is increased blood circulation. He diagnosed periurethral chronic prostatitis. My GP told me to take antibiotics for couple of months at least.
- 18 Feb 2007: I went to a urologist for a second opinion. He did digital rectal exam and found no tenderness in prostate (Prostate size has always came out normal). I was told to forget about prostatitis. I argued about end stream being turbid and was told that end stream turbidity mean the infection is way back there (somewhere in bladder -- cystitis). He was concerned about the raised PSA though and asked me to repeat PSA after subsiding the current infection with some antibiotics.
Is it prostatitis? I have no tenderness in prostate, no pelvic pain but transrectal exam does show calcification. Except for the end stream drops, all my urine is as clean and clear as anything. The last few turbid drops also don't show up every time. The culture is slowing E.coli growth but I don't want to start antibiotics until the cause is figured out.
If not prostatitis, is it systitis? A recent cystogram (during infection) did show irregular outlining of bladder with small residual urine seen in post void film (whatever that means :))...
Any help and pointers will be greatly appreciated.