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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: vesicoureteral reflux at 20?!

 bubbletea - Fri Oct 23, 2009 4:05 am

Hello there, I'm a 20 year old healthy male with a bit of urinary problem.
About three weeks ago (while masturbating, I'm embarrassed to say) I think I held back urination for a little too long and got this pretty annoying back and scrotal pain. I didn't actually notice anything wrong with my urination except for it's weaker and I'm going more frequently.
A week later, I developed a bit of anterior abdominal/flank/back pain pain. I'd say it's a little "spasmic". Not excruciating. About a 3-4. The doctor did a deep palpation of the abdomen and found pain on the RHS.
All Urinalysis, CT, ultrasound returned completely normal. No stones or any sign of obstruction. No haemoturia or bacteria, epithelial, casts, leukocytosis whatever. Bladder size and prostate normal.
Now the pain has come and gone (and come, again) and I've developed a pretty annoying symptoms of waking up early in the morning (4 o'clock) with an uncomfortable bladder. if I ignore the bladder and try to sleep, I'll get the pain again, when I get up.
The doctor says it's because the urine some times flows backwards and causes spasm of the ureter and that's the cause of the pain. He says it's nothing to worry about.
Now I've learnt my lesson I'll do my best not to do anything stupid...but I've got a few questions I'd like you to enlighten me on.

1. I've learnt a bit about bladder anatomy. I know that as the bladder expands the ureteral sphincter becomes more constricted. Is it possible that the backflow only occurs with moderate or minimal amount of fluid and ONLY when I'm lying down?
2. If 1 was the case, then wouldn't the pyelogram miss it because it contrast is injected to fill the bladder to the full and the X ray is taken when I'm standing up?
3. If 2 was the case, should I mention my concern to the urologist?
4. What do you think of the diagnosis? Thanks very much!
 Dr.M.Aroon kamath - Fri Oct 23, 2009 12:21 pm

User avatar Hi,
You say that this started following masturbation(may be important for a doctor to know what kind of masturbation it was, any oils,gels,cremes etc were used,the duration,self or otherwise etc etc).I have had one patient who developed severe burning sensation in the urethra following masturbation - who later came out with the revelation that he masturbated with his hand immediatly following a meal of hot, spicy curry (without of course washing his hands thoroughly with soap!). Well, i am only trying to point out the importance of the history!

Although i am not personally convinced about vesico- ureteric reflux as the cause of your complaints, i will try to answer some of your doubts...
- reflux can occur whether the urinary bladder is completely full or not.
- internal sphincter normally remains tightly closed.Otherwise all of us will be incontinent.
- reflux can occur in any body position (vertical position may help in the urine coming back to the urinary bladder - akin to what happens in swallowing - you can swallow even while upside down!)
- pyelogram may or may not show it.
- radionuclide studies may better reveal a reflux as well as quantify it.
As for the diagnosis, it needs investigations.
Strong contenders are cystitis & prostatitis
 bubbletea - Fri Oct 23, 2009 4:23 pm

but for prostatitis, don't you have to have perineal pain before it gets referred to the back/abdomen? Can you get prostatitis and only have pain on one side? Btw, ultrasound showed that my prostate is only 15cc, my bladder is of normal size when full/empty. I have no pain on urination, non what so ever never had any.

I think I forgot to mention a particularly important bit of history. The pain has been improving. Just recently I developed nocturia. Sometimes I wake up and feel that I SHOULD go. The urge, isn't actually strong. Usually because the volume is only about 100ml-200mls, the bladder doesn't feel uncomfortable. Sometimes I try to go back to sleep by holding it in and ignoring my urge, and that, I find, worsens the RHS abdomen/flank pain.
Btw I've been on 500mg keflex for a week I'm not sure if that did anything.

The reason I'm concerned about the testing is because
1. non of this occurs at day. EVEN if I hold in urine at day it doesn't worsen the pain. That's why I think it may have to do with me lying supine.
2. I've had to go to the toilet before, but this is different. This actually wakes me up COMPLETELY as opposed to semi completely so I'm afraid it might have something to to with my neurologic state.
That's why I'm afraid the test may not be successful at picking things up.
 Dr.M.Aroon kamath - Fri Oct 23, 2009 7:44 pm

User avatar Hi, Thanks for giving me a bit more info...
That prostatitis causes pain referred to the perineum etc are text book descriptions of 'typical' cases of prostatitis.In clinical reality,any clinician will vouch for the fact that atypical presentations often occur! Also, prostatic size and risk of prostatitis are not linearly related.
Urgency in the supine position is a fairly well known in relation to other conditions such as BPH and at times urinary bladder calculi.It is believed that the 'trigone' of the urinary bladder is in the dependent position while supine and this very sensitive region gets irritated causing this symptom. Cheers!
 bubbletea - Sun Dec 06, 2009 5:45 pm

seen a urologist, formally diagnosed me with prostatitis. He says it's most likely the same bacteria that causes acnes giving me the symptoms.
Thank you.

After doing some research, I still have a few questions I hope you can answer. I did a urine flow test he said it was not perfect but normal. My bladder capacity was 600ml. I kept a urinary diary and he said he was seeing normal volumes. (anywhere between 200ml to 500 ml).

Not having done a cystoscopy, how do one distinguish between interstitial cystitis and prostatitis on these findings alone? Because my prostate still feels fine to me. How is it possible you get referred pain without primary pain?

From what I've researched, urologists seem a little "prostatitis happy" to me and classify all these symptoms as prostatitis without effective testing. What are the current efforts to reclassify and identify new diseases?

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