Enlarged prostates, UTIs, Testosterone and Orchiectomy

[Old Greebo (imported)]

Right.

I think this is my hundredth posting.

Time I came clean about why I came here in the first place.

It was in 1993 that I first noticed my pee stream would occasionally be, well, a bit constricted.

I gave it no thought at the time. Put it down to nerves (it would occur especially if I'd allowed my bladder to overfill). I didn't even think that it could be a sign of something seriously (terminally?) wrong down there.

It's gradually progressed. Oh, I can still pee OK. Usually. I reckon that, if the problem progresses at its present rate, I'll be 97 or thereabouts before the prostate completely strangles my urinary tract and I have to call in the emergency guys to empty my bladder.

I had a UTI about 6 years back, and my doctor persuaded me to get my nether regions scanned. The technician used one of those devices they use on pregnant girls to check the foetus's progress.

"Your liver and kidneys are OK" he said. "But the prostate's enlarged."

"I knew that!" I replied.

I've occasionally had other UTIs. Not more than once every couple of years though. Antibiotics have always (so far) cleared things up. My doctor always gets worried about this, and recently has insisted on having blood tests to check on liver/kidney/prostate function. But actually I know they're probably my own fault.

I asked her if it could be a problem resulting from poor hygiene. She said that's sometimes the cause for women who have UTIs, but it's very rare with men.

She didn't know I have an enema fetish (and OK I occasionally get careless about hygiene when I'm at it!). But I came clean with her about that earlier this year. She didn't bat an eyelid!

She keeps asking me to go and get more tests done. Presumably she's had the results from the bloke who scanned me and warned me about the enlarged prostate. She'd like me to have PSA tests, and others.

So far, I've refused.

My own feeling is that yes, I know there's something a bit wrong down there, but it's not a problem yet. I can live with it. I keep remembering the line that says most men die 'WITH' prostate cancer, but few die 'OF' it.

Most procedures for investigating, and dealing with, prostate cancer seem to be very invasive. At my age (73) I'm not convinced that the balance of risk would be in my favour. Things like MRSA and the other antibiotic-resistant hospital infections do present a significant risk.

I've heard that high testosterone levels hasten the development of prostate cancer. Is this right? If so, would it be sensible for me to look into the possibility of seeking an orchiectomy?

I don't seem to have any other health issues apart from occasional attacks of gout, for which I take Naproxen (which works super-fast if I recognise the symptoms in time!). Oh, and night cramps every now and then (which I HATE, but have learned to live with).

Balls seem to have shrunk quite a bit. Haven't been able to maintain a decent erection since about 6 years ago. So I reckon testosterone production is already low. Am I right in thinking there's a correlation between testosterone and prostate enlargement?

Would I possibly benefit from an orchiectomy?

Your considered views would be appreciated, guys!

[tugon (imported)]

My initial thought on your UTIs is are you taking more showers than baths. When you soak in a tub you are more at risk for UTIs than if you shower more frequently. If you have to wear any undergarments for incontinence you need to change them frequently. Urine trapped in underwear can be a breeding ground for micro organisms. Yes any fecal matter from an enema can enter the urethra and cause a UTI.

You mentioned an enlarged prostate and at 20 years your junior and a eunuch I have no problem with an enlarged prostate or any problems urinating. I piss like a 17 year old just more frequently. There are several medications that will shrink your prostate and of course T blockers that will also cause your prostate to shrink. Castration could also help.

Still my concern is the UTIs. As we age a UTI can effect many systems of the body. Some older folks can have dementia like behaviors when having a urinary tract infection. Recently a woman I knew was labeled as having alzheimer's disease and the hospital wanted to ship her to a nursing home. Two days after the start of antibiotics she was returning to the person she was before the UTI.

Hygiene is important for body and mind.

[Sweetpickle (imported)]

You might be helped by a drug like Flomax.

You might be helped by TURP.

Who knows, castration might even help you although it is the most

unlikely solution.

In any case, your doctor would be negligent if she treated you

without knowing whether you have BPH or cancer.

Find a doctor you're willing to trust.

[kristoff]

The source of the UTIs really should be tracked down. They can wreak havoc.

A couple of years ago, I was having repeat, often massive UTIs. Couldn't figure the source until I told the doc I was blowing bubbles when I pissed. Figured out it was a fistula - colon had attached to the bladder and a hole opened between them. I was crapping into my bladder. Five hours of surgery to examine and resect the colon, clean and repair the bladder, and stent the ureters, no more UTI's.

Mine was a fairly severe case. But do track down the source. You'll be glad you did.

[speedvogel (imported)]

A responsible doctor will insist that you have a PSA. That, combined with a digital rectal exam will allow the doctor to make a reasonable decision as to what other tests are necessary to determine why your prostate is enlarged.

I am speaking from personal experience here. I started having problems peeing. It got so bad that two years ago at this time, I was admitted to the hospital with, presumably, a bad UTI. They kept pumping me full of IVs with antibiotics even though I could not get rid of the fluid. Every seven minutes, I popped out of bed, disconnected my IV device from the wall, dragged the pole over to the the bathroom, dribbled 16.8 drops, then went back and plugged the damned thing back into the wall, climbed in bed and waited for seven minutes.

Finally, on Christmas Eve, I was discharged and, when I got home, I started to pee decently. I was not a happy camper with this whole ritual.

I had my family doctor set me up to see the local urologists. Their testing was rather rudimentary and told me that I had an enlarged prostate and was retaining a lot of urine. Gee, I already knew that.

In the mean time, I had started researching benign prostatic hypertrophy on the web. I found that the best treatments, which offered the most relieve were the TURP and the newer laser reduction procedures. I found that there was a urologist about 50 miles from me who was one of the few in the whole state who were trained in the laser procedures. I transferred to his care for this problem.

Now my bother score was running 26, which is very high, indeed. The new urologist repeated the ultrasound of my bladder, did a PSA, and performed a digital rectal exam. He then explained the further tests we needed to do.

These involved a cystoscope and a trans-rectal ultrasound (TRUS) to determine more accurately what was going on. They also did a CT scan of my whole urinary tract. My prostate was about 40 grams and average is about 25 grams.

We fiddled and diddled for a few months with more testing and scheduling issues (his vacation, my vacation, etc.) and come early fall, we went in for another check and then, presumably, the laser surgery to reduce my prostate. Meanwhile, I had UTI after UTI every six weeks right on schedule.

He had another PSA done and it had risen from almost nothing to 11.7 in less than six months. I was scheduled for an ultrasound guided trans-rectal biopsy of my prostate. I'm sure the doctor shared my pessimism and was convinced I had a rapidly growing prostate cancer.

He did a fourteen needle biopsy using a local. It was not a pleasant experience, but was not horrid either. The lab was backed up as there is a serious shortage of pathologists in our area. After way too long, the word came back that I did not have cancer. I have a condition called granulatomis prostatitis. This mimics prostate cancer. It was the cause of my enlargement and my frequent UTIs.

We scheduled as soon as possible the Evolve laser procedure to reduce the size of my prostate. This is an in office procedure. I was given some sedatives and a local. The doctor inserted the cystoscope and the laser fiber and video camera and started to burn away the excess tissue. I actually watched much of the operation. It did not hurt at all. In less than an hour, I was ready to go home.

I did have a catheter in. Since I was bleeding quite a bit (I am a free bleeder even when I do not take aspirin) I left the cath in for three days. I removed it myself, which is no big deal at all. The first time I peed on my own, I knew we had a great success.

It took about six weeks to get completely over the surgery. I was only restricted in my activities for a week, though. My bother score went from 26 to less than 1. I was able to restart my testosterone injections. My prostatitis has not flared in over a year.

What this all is boiling down to is that you need to allow your doctor to do the testing that you need. You can then get the treatment you need. This is not going to get better unless you do this.

You probably do not have cancer. You sound like you may well have prostatitis. Now most prostatitis is treated by an extended course of Cipro or Levaquin. These are nasty drugs, but they do work If you simply have BPH or a condition like mine, either laser surgery or a TURP is the solution. Do it; don't dink around with pills or halfway measures. Get it fixed

Speed

[Old Greebo (imported)]

Thanks for your comments.

Tugon:

Thanks for your reply.

Normally I shower, but when I get caught up in my enema fetish I soak in a tub. In earlier days I would actually evacuate straight into the tub (yeah, I know, don't say it!) but I don't think I've done that for a good twenty years now. Nowadays I keep the nozzle inside me, disconnect the tube from the enema container and evacuate via the tube into a jug (which I empty into the handily-adjacent wc!). That way I can measure what goes in and what comes out, plus I keep my bathwater pretty clean!

Even so, I'm 95% certain that this is where most of my UTIs have originated.

When I've presented myself to my current doctor with a UTI (twice in the last 5 years), she's asked me if I had symptoms of dementia, but that's not how it has affected me. First indications are always rather as if I've eaten something bad, then the painful-to-pee symptoms come in. Never had any dementia symptoms.

However, I do know that my first wife (2 years younger than me, and with diabetes) contracted a UTI about 10 years ago and it did provoke a dementia that. sadly, didn't go away. She doesn't even recognise her daughters now. Lessons to be learned there, I know.

However, I'm pretty good about keeping my underwear clean!

My enlarged prostate (assuming that's what it is) seems only to constrict the flow. It doesn't make me go more frequently. If I feel that there's more pee left in my bladder, I only need to stimulate the glans a bit (by rubbing it) and the residue comes rushing out!

Sweetpickle:

I had to look up TURP. "Transurethral resection of the prostate". Sounds like one of the procedures that I'd rather avoid!

I don't think I need Flomax.

But thanks for your input. I *do* trust my doctor. It's just that she views things from a 35 y-o- point of view, and I'm more than twice that age!

Kristoff:

Ew, that must have been a ghastly experience for you! In my case, I feel about 95% certain I know where my UTIs have come from. Self-inflicted and stupid! Nowadays I do try to take precautions. Perhaps I'd be better advised to just try and drop my enema fetish! Sometimes I go years between doing it, but I'm sure you guys understand how these ideas take hold!

Speedvogel:

I respect my doctor, and yes, she's been doing her best to insist that I take a PSA test. She hasn't done a digital rectal exam though. (sigh! She's gorgeous!)

I'm intrigued by your talk of a 'bother score'. I'm sure I've seen something about that in EA a while back, and I think I tried it but decided I just wasn't bothered! I seem to remember it was based on a sensible Q&A test, and I'd be grateful if you could tell me where to find it again.

Summary (so far):

I'm not persuaded that I'm in imminent danger of a horrible death. And I can still pee well enough not to be leaving smelly residues in my underpants! At my age, I still feel I'll succumb to something else rather than to whatever's currently afflicting my nether regions! However, I'm still somewhat attracted to the idea that I can blame my testosterone level for the problems my prostate is having, and I'm wondering how I might persuade my lovely doctor that a bollockectomy could be the answer to all my prayers!

[speedvogel (imported)]

Regarding the bother score, here is a simple text version rather than the nice, pretty .pdf file I have.

American Urological Association Prostate symptom Score

1. Over the past month, how often have you had the sensation of not emptying your

bladder completely?

2. Over the past month, how often have you had to urinate again in less than 2 hours?

3. Over the past month, how often have you stopped and started when urinating?

4. Over the past month, how often have you found it difficult to postpone urinating?

5. Over the past month, how often have you had a weak urinary stream?

6. Over the past month, how often have you had to push or strain to begin urinating?

Not at all = 0

Less than 1 time in 5 = 1

Less than half the time = 2

About half the time = 3

More than half the time = 4

Almost always = 5

7. Over the past month, how many times did you most typically get up to urinate from the

time you went to bed until the time you got up in the morning?

None = 0

Once =1

Twice = 2

3 times = 3

4 times = 4

5 times or more = 5

Mild BPH = 1 to 7

Moderate = 8 to 19

Severe = 20 to 35

Speed

[sailorboy (imported)]

Old Green...

I just turned 65 and have been having annual PSA's since I was 50 and the physician will sometimes perform the digital (finger) exam. My prostate is small, but it causes me to urinate about every 2 hours each night I sleep. I asked my Urologist if Flomax might help and He prescribed it for me. I have tried 2 other medications to alleviate the frequency of urination, but none of them worked. I STRONGLY advise you to have regular PSA exams and digital exams, plus any other tests recommended for males over 50 years of age. I know a guy who had good PSA tests, but began to have problems concernign his prostate different from those of us who just have a benign (Enlarged) prostate. The doctors discovered that he had an aggressive form of prostate cancer that took his life within six months. His wife, a Lab Tech, said that if he had had PSA test done every six months that they might have caught this carcenogenic invasion. I'm not trying to scare you, but suggest that YOU take care of YOU!

When we age, our testosterone level gradually drops and for some of us, our sex drive also decreases. I don't think testosterone is your problem. Have some tests done to ensure that you have ONLY an enlarged prostate and nothing worse!

I will share something of a personal nature with you. When I had my last physical (12 hour blood fast) and brought my urine sample to the clinic, a physician contacted me around 5PM that day to tell me, among other results,

that I had blood in my urine, I was troubled. I scheduled an appointment with a Urologist who discussed the problem with me and then set up another appointment to run some tests to see what was causing it. The doctor mentioned four things that it could be (just guessing) and three of them were, in my opinion, worse case scenarios. I am anxious to find out what the problem is and how it can be corrected, but not worried. Males are less likely to see a doctor than females, according to a study performed by an educational institution. Personally, I want to stay on this earth as long as I am physically and mentally able to do so and that means trusting the medical profession to help me with my health!

Best wishes to you as you decide what to do. Make a rational decision because you have people who love you and are concerned about you.

Sailorboy

[A-1 (imported)]

Greebo,

If you are concerned you should go see a urologist and get the appropriate care. You say that your UTI's are self-inflicted and that tells me that it is possible that you could have some mechanical issues internally from non-specified activity and that this could be at the "root" of your troubles. Chances are that the UTI's are NOT from DIRTY bathwater.

The way medicine works is that the worst-case scenarios are ruled out first and so since you have a family doc I imagine that your life is not in danger. However, since you are asking in this forum you have concerns and I feel that those are best addressed by a urologist.

When you go, BE SURE TO TELL EVERYTHING ABOUT YOUR ACTIVITIES, no matter how embarrasing, because doing otherwise is forcing you doctor to do a diagnosis without pertinent information. This can cause very, very undesirable results.

Remember, take care of yourself, nobody else can... O.K.?