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Forum Name: Urology Topics

Question: Issues Urinating, constant dribbling, slow flow. What is it?


 lostboy - Fri Dec 18, 2009 12:24 am

Hello,

I have stumbled upon this forum and am hoping to help get this solved, but first I think a little bit of my medical history may help.

I am a 20 year old male, 6ft 2" 185 pounds

I am anaphylactic to Nuts, Peanuts, peach, bamboo shoots, as well as Cravit (medication)

I am also allergic to hirudoid cream for eczema as well as any fish or shellfish (anything from the ocean), egg, nitrates, wheat, rice, soy, fruits such as kiwi, banana, apple, and the list goes on.

I have asthma.

Starting in the summer of 2008 I started having urinary issues. This was soon after being diagnosed with herpes.

It was very minor and pee just felt "weird". So I ignored it until last week.

I had been diagnosed by dermatologists twice for herpes but found a third opinion stating I had HPV warts, which made much more sense as they never went away.

About a month ago urinating became HELL. I just couldn't stop dribbling afterwords, I had pain in right in the pelvic area. And pee would just not come out with any control.

I visited a Urologist on Monday and did a urine test for the 13th time since the issue started and nothing came up, no signs of infection.

The urologist is very well known in this country and has appeared on television etc

The doctor continued on with pressure tests but no pain, the pain comes randomly for me and the area has a inflated feeling.

The Urologist continued with an ultrasound and that showed no real trouble. The doctor was at a loss of what is wrong with me.

My prostate was slightly swollen and my bladder has white stuff inside the wall (in a picture from the ultrasound) and I believe he said I had a week bladder. Which he said could contribute but still had too rapid of a transition.

He gave up diagnosing and gave me medication for my prostate. I have been taking it and flow became better but dribbling is the same and pain is worse.

My main question here is "What is wrong with me? What could be wrong with me?" any insight would be great but I found it odd a urologist was unable to identify the issue.

I am pretty fluent in the language of where I am right now and understand most medical terms but I will be going to an English speaking country in the next week and am worried about the flight and will try and see a GP there.

Thank you VERY VERY MUCH!
 Dr.M.Aroon kamath - Fri Dec 25, 2009 7:06 am

User avatar Hi,
It is possible that your problem could be due to genito-urinary schistosomiasis.This is generally considered in the differential diagnosis of symptoms such as yours (especially in countries where this condition is endemic).

The cornerstone of diagnosis of this disease is the detection of schistosome eggs in feces or urine.

But atypical cases are known to occur wherein the diagnosis may not be obvious or may be misssed.

Shedding of schistosome eggs fluctuates,therfore,up to three specimens may be required for diagnosis. These eggs are usually observed in isotonic saline solution. In patients who are likely to have a smaller parasitic burden, such as returning travelers, formalin-based techniques have been shown to improve the yield.

In China, an an alternative technique for S. japonicum which involves the placement of concentrated fecal ova in distilled water has been used. Finding of hatching miracidia is said to be diagnostic.

Genital symptoms in residents of tropical countries and among returned travellers can arise from bacterial, protozoal, and helminthic infections which are not usually sexually transmitted.

The symptoms may mimic classic sexually transmitted infections(STIs) by producing wart-like lesions (schistosomiasis),lesions of the genital tract (epididymo-orchitis caused by tuberculosis, leprosy, and brucellosis; salpingitis as a result of tuberculosis or amoebiasis) & ulceration (for example, schistosomiasis, amoebiasis and leishmaniasis).

Schistosomiasis is known to involve the seminal vesicles and the prostate gland (as often as the bladder). Eggs are frequently found in semen in S. haematobium-infected men. However, seminal egg excretion also showes marked day-to-day variation(like in the urine). Seminal eosinophil cationic protein (ECP) level also is raised frequently.

Male genital schistosomiasis (MGS),in this context been hypothesized to be a be risk factor for transmission of human immunodeficiency virus (HIV) because of egg-induced inflammation in the seminal fluid–producing organs and an associated potentially increased viral shedding in ejaculate.

The HIV prevalence rate in areas highly endemic for this parasite is 1.2-1.7 times higher in women than in men.
STDs increase the probability for HIV transmission, presumably through lesions in the genital mucosa. Female genital schistosomiasis, a special form of urinary schistosomiasis, is being increasingly considered to be another risk factor for HIV transmission.

Your doctor must have tested your urine for the schistosomal eggs but, it is likely that the eggs were not found(due to the varying rates of egg passage or due to very low parasitic burden).
In case you are from a non-endemic area, then one has to consider possibility of this being a 'non-gonococcal' urethritis.

Best wishes!
 Dr.M.jagesh kamath - Fri Dec 25, 2009 10:16 am

User avatar Hello,Dr.A.Kamath has given a good interpretation to the findings and indeed NGU is one thing to think of, apart from Schistosomiasis which can be missed even by the well trained.The other I may add is tuberculous cystitis which has been mentioned in the above post needs to be highlighted too.Best wishes.

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