I am a 37-year-old male, 190 lbs. I have been to two urologists with different diagnosis. I have had trouble starting my urinary stream for as long as I can remember. The stream remains weak during urination and as a result I have a phobia about urinating with others nearby. There is never any pain or blood during urination. I also get up 1-2 times a night to urinate. There is no family history of prostate cancer in my family. I went to a doctor April 2008 because of increased strain while trying to urinate after I get up at night. I do go frequently during the day…especially after the first urination.
The first doctor said that I suffer from BPH due to an enlarged prostate. He performed a cystoscopy…urodynamics and a prostate ultrasound. Nothing significant was found during the cystoscopy. The prostate ultrasound came back with 29 cc or grams…not sure which unit of measurement is correct there. The urinalysis findings led my first doctor to believe that I may have MS possibly resulting in detrusor sphincter dysynergia (DSD). MRI scans of my brain and spinal cord came back negative for MS. The MRI for the cervical spine did find a right posterolateral C5-6 disk herniation that mildly contacts and flattens the ventral cord extending to the proximal right C5-6 foramen. I was on flomax/avodart for 7 months with no change in urinary habits. His recommendation is for a procedure…TUMT/TUIP or TURP.
I recently went to another doctor for a second opinion. The results (history/tests) from the first doctor were forwarded to the second doctor. After an oral examination, he did not feel that my prostate size was the issue. Since, I also have a history of large hemorrhoids/constipation/spastic colon and IBS; he thought there might be a correlation with that. I am an introvert and believe the source of most of my stress goes to my colon. He gave me a PSA test, which came back normal (0.5). Also, he performed a renal/bladder ultrasound. The results showed that I was not emptying completely…especially for someone of my age. After a cystoscopy with him (just last week), he said I have scar tissue in my urethra from a stricture. He thinks I may have suffered some injury as a child. He recommends that I undergo a Direct Visual Internal Urethrotomy (DVIU) to take care of the narrowing as a result of the stricture/scar tissue. He also wants to do an urodynamics test with me to see what he finds. He gave me a month’s sample of uroxatral, which did not help my stream any.
I am set to undergo an endoscopy with my Gastro doctor this upcoming week. Blood results show that I am chronic microcytic anemic due to low MCV/MCH. My hemoglobin is fine. My doctors think I have a Mediterranean gene even though I am mostly northern European. My ferritin levels are also really low and I have begun taking an iron supplement (ferrous sulfate). I underwent a stapled hemorrhoidectomy last October and already have one autoimmune disease (limited scleroderma/CREST syndrome); so he wants to rule out Celiac disease, I suppose due to possible malabsorption. I no longer have a bleeding issue with my hemorrhoids due to the surgery. Also since any effort to bulk up my stool due to increased fiber and laxatives has failed.
My biggest concern is the vast difference in opinion between both urologists in what my issue may be. Any suggestions? Are there questions I should be asking my doctors?